Feeling The Burn Of Acid Reflux

Overview

Acid reflux happens when acid from your stomach washes back up into your food pipe. Your food pipe (the oesophagus — the tube that carries food from your mouth down to your stomach) is not built to handle acid, so it feels sore and burning. That burning feeling in your chest is often called heartburn. It has nothing to do with your heart. Most people get it now and then, especially after a big or rich meal. When it keeps coming back, doctors may call it GORD (gastro-oesophageal reflux disease) — which simply means reflux that happens often and keeps bothering you.

Yes, very common. Most adults get heartburn at some point, and many people get it repeatedly. It is one of the most frequent reasons people ask a pharmacist or doctor for help.

Anyone can get acid reflux, including children and babies. It is more common in people who are overweight, in pregnant women, in people over 40, in smokers, and in people with a hiatus hernia (when part of the stomach pushes up through the muscle that separates the chest from the belly).

Symptoms

Common symptoms

• A burning feeling in the chest, usually after eating or when lying down or bending over
• A sour or bitter taste in the back of your mouth
• Acid or food coming back up into your throat (regurgitation)
• A feeling of a lump in your throat or a tight throat
• A hoarse voice or sore throat, especially first thing in the morning
• A dry cough, clearing your throat a lot, or hiccups that keep coming back
• Bad breath
• Bloating, burping or feeling full quickly

Symptoms in children

• Babies: bringing up milk after feeds, fussiness or crying during feeds, arching the back
• Poor feeding or slow weight gain
• Frequent cough, hoarse cry, or chestiness
• Older children: tummy or chest pain after eating, a sour taste, or avoiding meals

Symptoms in older adults

• Symptoms can be quieter and less obvious than in younger people
• A cough, hoarseness or choking feeling rather than clear heartburn
• Trouble swallowing or food feeling like it sticks
• Chest discomfort that is easy to mistake for something else — always worth checking

Causes

Main causes

• The ring of muscle at the bottom of the food pipe (the valve that keeps stomach contents down) relaxing when it should stay shut
• Pressure on the stomach from extra weight or from pregnancy
• A hiatus hernia, where part of the stomach sits higher than usual
• Large, fatty or spicy meals, and eating close to bedtime
• Lying down or bending over soon after eating
• Alcohol, coffee, chocolate, fizzy drinks and citrus — these affect people differently
• Smoking
• Some medicines, such as certain painkillers for long-term use — ask your pharmacist or doctor to review your medicines

Risk factors

• Being overweight or having a lot of weight around the middle
• Pregnancy
• Smoking
• Eating large meals or eating late at night
• Wearing tight belts or waistbands, especially after eating
• Stress and poor sleep, which can make symptoms feel worse
• A family history of reflux or a hiatus hernia
• Getting older

When to see a doctor

See a doctor urgently if:

• Chest pain with sweating, breathlessness or pain spreading to your arm or jaw — call emergency services first
• Vomiting blood or coffee-ground-like vomit, or black stools
• Trouble swallowing, or food sticking
• Losing weight without trying
• Severe tummy pain, or being unable to keep fluids down

Book a routine appointment if:

• Reflux symptoms more than twice a week
• You are using over-the-counter remedies most days, or for more than two weeks in a row
• Symptoms wake you at night or affect your work, sleep or mood
• A cough, hoarse voice or sore throat that will not go away
• A baby or child with reflux that affects feeding, growth or comfort

Diagnosis

Most people are diagnosed from their symptoms alone. Your doctor will ask what the burning feels like, when it happens, what makes it better or worse, and what medicines you take. Often the next step is a short trial of treatment to see whether symptoms settle. Tests are usually only needed if symptoms are unusual, keep coming back despite treatment, or come with warning signs.

Tests that may be done

• A trial of acid-reducing treatment for a few weeks, to see if symptoms improve
• Endoscopy — a thin flexible tube with a camera checks the food pipe and stomach; usually done with a sedative so you are comfortable
• A test for Helicobacter pylori, a common stomach germ, using a breath or stool sample
• A 24-hour acid test — a small sensor measures how much acid comes back up over a day
• Manometry — a test that checks how well the food pipe muscles squeeze
• Blood tests to check for anaemia or other causes

What to expect at your appointment

Your visit will mostly be a conversation. If tests are suggested, your doctor will explain why. An endoscopy is usually quick — often under 15 minutes — and you can usually go home the same day. Ask any questions you have beforehand; it is fine to bring someone with you.

Treatment

Treatment usually starts with changes to daily habits, plus short courses of medicine from a pharmacy or prescribed by your doctor. The aim is to reduce how often acid comes up and to protect the food pipe from irritation. Most people find a combination that works well.

Self-care at home

• Eat smaller meals, and eat more slowly
• Try to finish eating at least 3 hours before lying down or going to bed
• Raise the head end of your bed by 10–15 cm (a brick under the legs or a wedge pillow), rather than just adding extra pillows
• If you are carrying extra weight, gentle steady weight loss often helps a lot
• Stop smoking — ask for support, as it works better than going it alone
• Cut back on alcohol, coffee, chocolate and fizzy drinks if they seem to trigger symptoms
• Loosen tight belts and waistbands, especially after meals
• Keep a simple food and symptom diary for a couple of weeks to spot your own triggers
• Chew sugar-free gum after meals — it can help clear acid from the food pipe

Medical treatments

There are two main groups of treatment. The first are remedies that neutralise acid or form a protective layer on top of the stomach contents — these are sold in pharmacies and are good for short-term relief. The second are medicines that reduce how much acid the stomach makes; these are usually prescribed for a set number of weeks and then reviewed. Your pharmacist or doctor can advise on which is suitable for you, taking into account your other medicines and health conditions. It is best not to stay on acid-reducing medicines long-term without a review, because your doctor will want to check whether something else is going on.

When is surgery considered?

Surgery is only considered in a small number of people — for example, when symptoms stay troublesome despite treatment, or when there is a large hiatus hernia. The operation tightens the valve at the bottom of the food pipe. It is decided together with a specialist after a full discussion of the benefits and risks.

Living with this condition

Reflux is usually something you manage rather than cure. A short symptom diary helps you learn your own pattern — many people find evenings, big meals and stress are the triggers. Keep a plan that works for you: smaller meals, an earlier dinner, and the head of the bed raised. If you use pharmacy remedies, keep a note of how often, so you can tell your doctor if it is becoming frequent.

Lifestyle tips

• Keep regular meal times and avoid eating late
• Leave 2–3 hours between your last meal and lying down
• Wear comfortable clothes around your middle
• Avoid bending or heavy lifting straight after eating
• Keep active — walking after a meal can help digestion
• Get regular sleep, and try to manage stress where you can
• Reduce or stop smoking, and cut back on alcohol if it triggers symptoms

Diet and exercise

There is no single reflux diet — triggers vary from person to person. Common ones are fatty and fried foods, very spicy dishes, chocolate, mint, coffee, alcohol, citrus and fizzy drinks. Try cutting one thing at a time for a week rather than removing lots at once. Gentle, regular activity such as walking, swimming or cycling helps with weight and digestion. Try to avoid vigorous exercise or lying flat straight after eating.

Mental health and emotional wellbeing

Ongoing reflux can wear you down. It can disturb sleep, make meals feel stressful, and cause worry about eating out or traveling. Stress does not cause reflux, but it can make symptoms feel worse. If symptoms are affecting your mood, sleep or daily life, tell your doctor — this is a normal part of the picture and worth addressing. If you ever feel overwhelmed or hopeless, please reach out to a trusted person, your doctor, or a crisis support line in your country.

Prevention

You cannot always prevent reflux, but you can lower how often it happens. Eating smaller meals, not eating late, keeping to a healthy weight, not smoking, and raising the head of your bed all make a real difference for many people. If a particular food reliably sets it off, avoiding it is sensible.

Screening programmes

There is no routine screening test for reflux. If you have had reflux for many years, or you have warning signs such as trouble swallowing or weight loss, your doctor may suggest an endoscopy to check the food pipe. Ask your doctor whether this applies to you.

Complications

If left untreated

• Oesophagitis — soreness and inflammation of the food pipe
• Narrowing of the food pipe, which can make swallowing difficult
• Barrett's oesophagus — changes in the lining of the food pipe that need monitoring, though most people with it never develop anything more serious
• Bleeding from an irritated food pipe, which can cause anaemia (low iron in the blood)
• A long-running cough, hoarse voice or throat problems
• Wear on tooth enamel from repeated acid in the mouth
• Poor sleep and lower quality of life

Long-term outlook

The outlook is good for most people. Reflux is common, well understood, and usually managed well with everyday changes and short courses of treatment. Most people find a routine that keeps symptoms to a minimum. If symptoms change or become harder to manage, that is a reason to check in with your doctor, not a reason to panic.

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