Living with acid reflux

Overview

Acid reflux is a common condition where stomach acid flows back up into the tube that carries food from your mouth to your stomach (the esophagus). This can cause a burning feeling in your chest, often called heartburn, and an unpleasant sour taste in your mouth.

Yes, acid reflux is very common. Many people experience heartburn from time to time, and millions of people around the world have symptoms regularly.

Acid reflux can affect people of all ages, including children and older adults. It is more common during pregnancy, and people who are overweight or smoke are also more likely to have it.

Symptoms

Common symptoms

• A burning feeling in the chest, often after eating (heartburn)
• A sour or bitter taste in the mouth
• Feeling like food is coming back up into the throat or mouth (regurgitation)
• Difficulty swallowing or a feeling of a lump in the throat
• A chronic cough or frequent hiccups

Symptoms in children

• Frequent spitting up or vomiting
• Fussiness or irritability during or after feeding
• Poor weight gain or refusal to eat
• A persistent cough or wheezing

Symptoms in older adults

• Heartburn may be less severe or not felt at all
• Difficulty swallowing or pain when swallowing
• Chest pain that is not related to the heart
• A persistent sore throat, hoarseness, or a feeling of mucus in the throat

Causes

Main causes

• A weak lower esophageal sphincter: this is the ring of muscle at the bottom of the esophagus that normally closes after food enters the stomach
• Hiatal hernia: when part of the stomach pushes up through the diaphragm
• Increased pressure on the belly, for example from pregnancy, obesity, or lifting heavy objects

Risk factors

• Being overweight or obese
• Pregnancy
• Smoking or exposure to secondhand smoke
• Eating large meals or eating late at night
• Certain foods and drinks, such as spicy foods, fatty foods, citrus, tomatoes, chocolate, caffeine, and alcohol
• Certain medicines (ask your doctor or pharmacist if any of your medicines might be a factor)

When to see a doctor

See a doctor urgently if:

• Seek immediate emergency care if you have severe chest pain, trouble breathing, vomiting blood, or black stools.
• See a doctor the same day if you have trouble swallowing, are vomiting repeatedly, or are losing weight without trying.

Book a routine appointment if:

• See your healthcare provider if you have heartburn or other reflux symptoms at least twice a week.
• If you have had reflux symptoms for several weeks, or if over-the-counter remedies are not helping, make an appointment.
• If symptoms interfere with your daily life or sleep, talk to your doctor.

Diagnosis

To diagnose acid reflux, your doctor will ask about your symptoms and medical history, and may do a physical exam. They may also recommend tests to measure stomach acid or look at your esophagus.

Tests that may be done

• Upper endoscopy: a thin, flexible tube with a camera is passed down your throat to look at the esophagus and stomach
• pH monitoring: a test that measures how often stomach acid backflows into your esophagus
• Esophageal manometry: a test that measures the strength and coordination of the muscles in your esophagus
• Barium swallow: an X-ray after drinking a chalky liquid to see the shape of your upper digestive tract

What to expect at your appointment

Usually, the process starts with a thorough conversation about your symptoms. You may not need any tests at first. If tests are needed, they are typically done as outpatient procedures, meaning you go home the same day. Your doctor will explain each step and why it is being done.

Treatment

Treatment for acid reflux focuses on three things: relieving symptoms, healing any damage to the esophagus, and preventing complications. For most people, this starts with lifestyle changes and, if needed, medicines that reduce stomach acid.

Self-care at home

• Eat smaller meals more often instead of large meals
• Stop eating at least 3 hours before bedtime
• Raise the head of your bed by 15–20 cm (6–8 inches) using blocks or a wedge pillow
• Avoid known trigger foods and drinks
• Lose weight if you are overweight, and try not to gain extra weight
• Quit smoking, and avoid alcohol
• Wear loose clothing around your waist

Medical treatments

Your doctor may recommend medicines that reduce or neutralize stomach acid. These come as antacids, acid reducers (H2 blockers), and proton pump inhibitors (PPIs). Some are available over the counter, while stronger options require a prescription. Always talk to your healthcare provider or pharmacist about what is right for you, and never take more than the recommended dose or length of treatment without medical advice.

When is surgery considered?

In a small number of people, surgery may be an option when reflux is severe, does not respond to medicine, or causes serious complications. A common procedure is called fundoplication, where the top of the stomach is wrapped around the lower esophagus to strengthen the valve. Discuss this with your specialist to see if it is appropriate for you.

Living with this condition

Living with acid reflux means learning your personal triggers and making a few daily adjustments. Many people find a routine that works well with a little planning, such as eating earlier in the evening and keeping simple remedies on hand.

Lifestyle tips

• Keep a food diary to identify what bothers you
• Plan meals so you do not eat too much at once
• Take a short walk after meals, but avoid vigorous exercise right after eating
• Sleep with your head and upper back raised
• Avoid lying down for at least 2–3 hours after eating
• Manage stress with breathing exercises, meditation, or other relaxing activities

Diet and exercise

A balanced diet can help. It is often useful to reduce fatty, fried, and very spicy foods. Some people find that acidic foods like citrus and tomatoes make symptoms worse. Regular, moderate exercise can support a healthy weight and reduce pressure on your stomach, but wait a few hours after eating before working out.

Mental health and emotional wellbeing

Living with a chronic condition like acid reflux can feel stressful, especially if it interrupts your sleep or makes social eating anxious. It is normal to feel frustrated sometimes. If you feel low or worried, talk to your healthcare provider. You may also benefit from talking to a counselor or joining an online community.

Prevention

You cannot always prevent acid reflux, but you can lower your chances of frequent symptoms. Keeping a healthy weight, avoiding trigger foods, eating smaller meals, not smoking, and managing stress all help reduce reflux episodes.

Complications

If left untreated

• Esophagitis: inflammation and irritation of the esophagus lining
• Esophageal stricture: narrowing of the esophagus due to scar tissue, which can make swallowing difficult
• Barrett's esophagus: a change in the cells lining the esophagus, which is linked to a very small increase in the risk of esophageal cancer
• Respiratory problems, such as asthma, chronic cough, or voice changes, especially if acid is breathed into the lungs

Long-term outlook

With the right treatment and lifestyle changes, most people with acid reflux manage their symptoms well and lead comfortable lives. It is important to follow your healthcare provider's advice and keep regular follow-up appointments, especially if you have long-term reflux. Taking care of your health now can prevent most complications.

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