Heartburn And Acid Reflux

Overview

Heartburn is a burning feeling behind your breastbone that often rises up towards your throat. It happens when acid from your stomach leaks back up into your food pipe (the oesophagus — the tube that carries food from your mouth to your stomach). Doctors call this leaking 'acid reflux'. Heartburn is the name for the burning symptom, not a problem with your heart. Many people get it now and then, especially after a big or spicy meal. If it keeps happening, it is often called gastro-oesophageal reflux disease, or GORD for short.

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

It can affect anyone, including children. It is more common in adults, in people who are overweight, in pregnant women, and in people who smoke or often eat large or late meals.

Symptoms

Common symptoms

• A burning feeling in the chest, often behind the breastbone, that may rise towards your throat
• A sour or bitter taste in your mouth
• A hot, acid-like feeling in the back of your throat
• Feeling bloated or full, or burping more than usual
• A hoarse voice or a dry cough, especially at night
• Symptoms that get worse after eating, bending over, or lying down

Symptoms in children

• Frequent spitting up or vomiting in babies
• Crying or being unsettled during or after feeds
• Coughing, hiccups, or a hoarse voice in older children
• Complaining of a tummy ache or a 'burning' feeling in the chest
• Being fussy about food or finding eating uncomfortable

Symptoms in older adults

• Symptoms may be milder or less typical than in younger people
• A dry cough, hoarse voice, or throat clearing rather than clear burning
• Feeling full quickly or having a poor appetite
• Symptoms that are easy to mistake for other chest or stomach problems, so check with a doctor if anything changes or worries you

Causes

Main causes

• The valve-like ring of muscle at the top of the stomach relaxing when it should stay closed, letting acid rise
• A full stomach pressing upwards, especially after large meals
• Lying down or bending over soon after eating
• Certain foods and drinks that relax the valve or irritate the food pipe, such as very fatty or spicy foods, chocolate, coffee, alcohol, and fizzy drinks
• Pressure on the stomach from being overweight or pregnant
• Some medicines can make reflux more likely — ask your doctor or pharmacist about your own medicines

Risk factors

• Being overweight or having extra weight around the middle
• Smoking or vaping
• Pregnancy
• A hiatal hernia (when part of the stomach pushes up through the muscle in the diaphragm — the sheet of muscle under the lungs)
• Eating large meals late at night
• Wearing tight clothing around the waist
• Stress, which can make symptoms feel worse for some people
• A family history of reflux problems

When to see a doctor

See a doctor urgently if:

• Chest pain, especially with sweating, breathlessness, or pain spreading to your arm or jaw — call your local emergency number
• Vomiting blood or material that looks like coffee grounds
• Black or bloody stools
• New trouble swallowing, or food feeling stuck
• Losing weight without trying
• Heartburn that is severe, sudden, and different from what you usually get

Book a routine appointment if:

• Heartburn on most days for more than three weeks
• Symptoms that come back as soon as pharmacy treatment stops
• Symptoms that wake you at night or affect your sleep
• A hoarse voice, cough, or sore throat that will not settle
• You are pregnant and symptoms are troublesome
• You are worried about your symptoms, whatever they are

Diagnosis

Usually a doctor can tell what is going on by talking with you about your symptoms and examining you. If your symptoms are typical and nothing else seems wrong, you often will not need any tests at all. If symptoms are unusual, do not improve with treatment, or you have warning signs, your doctor may suggest some checks.

Tests that may be done

• A trial of treatment to see whether symptoms settle — this is often the first step
• A test for Helicobacter pylori (a common stomach bacterium — a germ that can live in the stomach) using a breath or stool test
• An endoscopy, where a thin flexible tube with a tiny camera looks inside your food pipe and stomach, usually with some sedation
• A blood test to check for anaemia or other causes
• Monitoring of acid levels in the food pipe, used only in specific cases
• A barium swallow, an X-ray test where you drink a liquid that shows up on the scan

What to expect at your appointment

Your appointment will be a conversation, not a quiz. Your doctor will ask when symptoms happen, what makes them better or worse, and what medicines you take. You can bring a short note of your symptoms and questions. If tests are suggested, ask why they are needed, what they involve, and when you will get results. You are always free to ask questions or take time to decide.

Treatment

Treatment aims to reduce how often acid rises up, soothe the food pipe, and stop symptoms coming back. Most people start with lifestyle changes and, if needed, medicines from a pharmacist. If symptoms continue, your doctor can review your treatment and check for other causes.

Self-care at home

• Eat smaller meals and try not to overfill your stomach
• Leave about three hours between your last meal and lying down
• Raise the head of your bed slightly, or use an extra pillow to keep your upper body a little higher
• Notice which foods trigger your symptoms and cut back on those — common ones include fatty foods, spicy food, chocolate, coffee, alcohol, and fizzy drinks
• Lose weight gradually if you are carrying extra weight — this often helps a lot
• Stop smoking if you smoke; ask your doctor or pharmacist for support
• Loosen tight belts and waistbands
• Chew sugar-free gum after meals — it can help clear acid from the food pipe
• Keep a simple symptom diary for a week or two so you can spot patterns

Medical treatments

Pharmacists can suggest medicines that neutralise stomach acid for quick relief, and medicines that reduce how much acid your stomach makes for longer-lasting control. Your doctor can review whether these are right for you, how long to take them, and whether another approach is needed. Some people need a course of treatment to clear a stomach bacterium called Helicobacter pylori, if tests show it is present. Always check with a pharmacist or doctor before starting or stopping any medicine, especially if you take other medicines or are pregnant. Never start, stop, or change a medicine without advice.

When is surgery considered?

Surgery is only considered for a small number of people — for example, when symptoms stay severe despite treatment, or when there are ongoing problems such as strict narrowing of the food pipe. It is not a first step, and your doctor would discuss the benefits and risks with you in detail if it were an option.

Living with this condition

For most people, heartburn is something you manage rather than something that controls your life. Small, steady changes — eating earlier, eating a little less, and adjusting your bed — often make a big difference. Keep your medicines where you will remember them, and note what helps so you can repeat it.

Lifestyle tips

• Plan your evening meal for earlier in the evening
• Keep a note of triggers so you are not guessing
• Choose water or herbal drinks instead of fizzy or caffeinated ones in the evening
• Avoid lying down or doing vigorous bending soon after eating
• Wear comfortable clothing around your middle
• Build gentle movement into your day, such as a short walk after meals
• Get support to stop smoking if you smoke

Diet and exercise

There is no single 'reflux diet' that suits everyone. Aim for regular, balanced meals with plenty of vegetables, fruit, and whole grains, and go easy on very fatty, fried, or spicy foods if they set off your symptoms. Eating slowly and stopping when comfortably full helps. Gentle regular activity — walking, swimming, cycling — supports a healthy weight and can reduce symptoms. If exercise brings on heartburn, try waiting longer after eating, or choose a less bending or jarring activity and see how you feel.

Mental health and emotional wellbeing

Ongoing symptoms can be tiring and can affect sleep, work, and mood. Stress does not cause reflux, but it can make symptoms feel worse, and worrying about symptoms can add to the strain. If heartburn is making you anxious or low, tell your doctor — this is a normal part of the picture and help is available. If you ever feel you cannot cope, please reach out to a trusted person, your doctor, or a local crisis support service without delay.

Prevention

You cannot always prevent heartburn, but you can lower your chances of getting it and reduce how often it comes back. Staying at a healthy weight, not smoking, eating smaller meals, and leaving time before lying down are the changes that help most.

Screening programmes

There is no routine screening test for heartburn. The important thing is to see your doctor if symptoms are frequent, changing, or come with warning signs such as trouble swallowing or weight loss. Your doctor will decide whether any checks are needed.

Complications

If left untreated

• Ongoing soreness or inflammation of the food pipe (called oesophagitis — irritation of the tube that carries food to the stomach)
• Narrowing of the food pipe, which can make swallowing harder
• A dry cough, hoarse voice, or disturbed sleep from acid at night
• Bleeding or anaemia in some cases, if the food pipe is badly irritated
• Rarely, changes in the lining of the food pipe over many years — your doctor can advise if you need checks

Long-term outlook

The outlook is good for most people. Simple changes and, where needed, treatment from a pharmacist or doctor usually keep symptoms under control. Many people find symptoms settle once they adjust meals, weight, and bedtime habits. If symptoms return, that is common and manageable — just speak to your pharmacist or doctor again rather than putting up with it.

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