Acid reflux happens when acid from the stomach flows back up into the food pipe, causing a burning feeling in the chest and a sour taste in the mouth.
Go to hospital immediately if you notice
- Chest pain with sweating, breathlessness, nausea, or pain spreading to the arm, jaw or back — treat this as a possible heart attack and get emergency help, not an antacid
- Difficulty swallowing, or food feeling stuck
- Pain on swallowing
- Vomiting blood, or black tarry stools
- Losing weight without trying
- Symptoms starting for the first time after about age 45 to 50
- Anaemia found on a blood test
Overview
A ring of muscle sits where the food pipe meets the stomach and normally keeps stomach contents down. When it relaxes at the wrong time, acid flows back up. The food pipe has no protective lining against acid, so you feel it burn.
Occasional heartburn after a heavy or spicy meal is very common and not a disease. When it happens repeatedly, disturbs sleep or needs regular medicine, it is called gastro-oesophageal reflux disease, or GERD.
Most people manage well with changes to meals, weight and timing, plus medicine for a defined period.
The single most important thing to know is that chest pain is not always acidity — see the warning below.
Symptoms of Acid Reflux (GERD)
- A burning feeling in the chest, often after meals or when lying down
- A sour or bitter taste at the back of the throat
- Food or liquid coming back up into the mouth
- Burping and bloating
- A dry cough or throat clearing, especially at night
- Hoarse voice in the morning
- Disturbed sleep because of burning or coughing
What causes it
- Weakness or untimely relaxation of the muscle between the food pipe and stomach
- A hiatus hernia, where part of the stomach slides upward through the diaphragm
- Extra weight around the abdomen, which increases pressure on the stomach
- Pregnancy
- Smoking
- Large or late meals, and lying down soon after eating
- Some medicines, including certain painkillers
Who is at higher risk
- Being overweight, particularly around the middle
- Eating late at night and sleeping soon afterwards
- Smoking and regular alcohol use
- Frequent large, oily or heavily spiced meals
- Pregnancy
- Long-term use of anti-inflammatory painkillers such as ibuprofen or diclofenac
Tests and diagnosis
These are the tests doctors commonly use. Which ones you need depends on your symptoms.
- Usually diagnosed from your symptoms alone, without any test
- A trial of treatment that relieves symptoms supports the diagnosis
- Endoscopy — a camera test — if there are warning signs, if symptoms start later in life, or if treatment is not working
- Tests for Helicobacter pylori, a stomach bacterium, in some people
Treatment
- Eat smaller meals and avoid lying down for two to three hours after eating.
- Raise the head end of the bed by about 15 centimetres if night symptoms are a problem. Extra pillows under the head alone do not work as well.
- Losing even a modest amount of weight often helps considerably.
- Antacids neutralise acid already present and give quick, short relief.
- Acid-reducing medicines such as omeprazole or pantoprazole reduce how much acid the stomach makes. They are meant for a defined course, taken before food.
- If you have been taking acidity medicine daily for months, ask your doctor to review whether you still need it and whether anything has been missed.
Prevention
- Eat your last meal two to three hours before bed
- Keep portions moderate rather than eating one very large meal
- Identify your own trigger foods — they differ from person to person
- Cut down on smoking and alcohol
- Lose weight around the abdomen if you are carrying extra
- Avoid tight clothing around the waist
- Ask your doctor before regular use of anti-inflammatory painkillers
When should you see a doctor?
See a doctor if acidity happens more than twice a week, disturbs your sleep, or needs medicine regularly. Get emergency help for chest pain with sweating, breathlessness or pain spreading to the arm or jaw. See a doctor promptly for difficulty swallowing, vomiting blood, black stools or unexplained weight loss.
Frequently Asked Questions
How do I know if it is acidity or a heart problem?
You often cannot tell reliably, and that is exactly why this matters. Heart pain more often comes with sweating, breathlessness, nausea, or pain spreading to the arm, jaw or back, and is more likely brought on by exertion. If there is any doubt — particularly if you have diabetes, high blood pressure or a family history of heart disease — treat it as a possible heart problem and get emergency help. An unnecessary hospital visit is a far better outcome than a missed heart attack.
Is it safe to take acidity tablets every day?
Only with a doctor's advice and periodic review. They are intended for defined courses. Long-term use is linked to lower vitamin B12 and magnesium levels and to bone thinning, and it can also mask a problem that should be investigated.
Does drinking milk help acidity?
It may soothe the burning for a few minutes, but milk also stimulates acid production, so symptoms often return shortly afterwards. It is not a reliable treatment.
Do I have to give up spicy food?
Not necessarily. Triggers vary a lot between people. Meal size, timing and lying down afterwards usually matter more than spice. Keeping a short note of what preceded your symptoms is more useful than removing whole food groups.
Questions to ask your doctor about Acid Reflux (GERD)
Pick the three that matter most to you and write them down before your appointment. Consultations are short, and almost everyone forgets at least one.
- How long should I stay on this medicine?
- When will we review whether I still need it?
- Do I need an endoscopy, and why or why not?
- Should I be tested for H. pylori?
- Which of my other medicines could be making this worse?
- What symptoms would mean this is something more serious?