Acid Reflux - Causes, Symptoms and Treatment
Heartburn and acid reflux is when you have a burning feeling in the chest caused by stomach acid travelling up to the throat. Many people experience acid reflux from time to time, especially after eating certain foods. However, when your acid reflux is a long-term problem, it’s known as gastro-oesophageal reflux disease (GORD/GERD).
There are things you can do yourself to ease your acid reflux symptoms, like eating smaller, more frequent meals. Antacids can also help by neutralising the acid in your stomach. Additionally, your GP may wish to prescribe a medicine known as a proton pump inhibitor (PPI) such as omeprazole that reduces the amount of acid your stomach makes.
The symptoms of acid reflux include heartburn, which feels like a burning sensation in the centre of your chest. You may also have an unpleasant taste in your mouth, a cough, hiccups, a hoarse voice, bad breath, bloating and nausea. Usually, these symptoms worsen after eating, lying down and bending over.
The symptoms of gastro-oesophageal reflux disease (GERD/GORD) differ slightly from regular acid reflux. With GORD, you will experience acid reflux symptoms chronically, and the backflow of this stomach acid will gradually cause damage to the lining of your oesophagus, possibly leading to complications further down the line.
This can cause your oesophagus to become narrower and inflamed, making it difficult to swallow, in addition to causing pain and ulcers. GERD can also lead to symptoms of asthma, a long-term cough, dental problems, and rarely, cancer of the oesophagus.
The cause of acid reflux will be different for everyone. While some people are able to identify trigger foods, for others, it may be an underlying medical issue like a hormone imbalance or a hiatus hernia. Acid reflux can be uncomfortable, that’s why it’s important to find the cause so you can treat or manage it effectively.
Other factors include:
- Being overweight
- Stress and anxiety
- An increase in some types of hormones like progesterone and oestrogen
- Certain medicines like ibuprofen
- If you have a hiatus hernia, which occurs when part of your stomach moves up into your chest
Acid reflux can also be caused by an underlying issue like a weak lower esophageal sphincter (LES). The LES is a muscle located at the end of the oesophagus where it’s joined to the stomach.
The LES will be closed except when you swallow to allow food to pass from the oesophagus into the stomach. However, when you have a weak or loose LES, it does not close properly which allows stomach acid to backflow into the oesophagus, causing heartburn.
Additionally, stomach ulcers can sometimes cause symptoms of acid reflux, in addition to indigestion and nausea.
For many people, certain food and drink triggers their acid reflux, or makes existing symptoms worse. This is thought to be because some ingredients can cause the esophageal sphincter (LES) to relax, ultimately delaying the digestive process. Food and drink will then sit in the stomach for longer, triggering acid reflux symptoms. Common triggers include:
- Citrus fruits
- Fizzy drinks
- Fatty, spicy or salty foods
In most cases, your GP will be able to diagnose GORD by looking at your symptoms, but they may also wish to send you for other tests, such as an endoscopy, a barium swallow or meal test, manometry, 24-hour PH monitoring, and blood tests.
Usually, these tests will only be needed if your GP is unsure if you have GORD, your symptoms are unusual, you have signs of a potentially more serious condition, or they think you might benefit from surgery.
When to speak to your doctor
You should always speak to your GP if the changes you’ve adopted yourself and pharmacy medicines, like antacids, aren’t working, you have acid reflux most days for over three weeks, or you have other symptoms like food getting stuck in your throat, frequently being sick, or weight loss.
If you feel that your symptoms are getting worse, you should either contact your GP or NHS 111 for further advice.
Acid reflux treatment ranges from medicines you can get without a prescription like antacids (Gaviscon), to medicines your GP or a prescribing pharmacist can offer you like omeprazole.
Alternatively, you may wish to try some home remedies you can adopt yourself, like swapping large meals for smaller ones.
The majority of people use antacids or alginates like Gaviscon and Rennie that you can buy on the shelf at your local drug store or supermarket to treat symptoms of acid reflux. These work by neutralising the acid in your stomach, but they can only ease your symptoms in the short term. They won’t be able to cure chronic acid reflux, and neither should they be taken regularly for a long period of time.
If you’re taking an antacid, it works best when you take them with food or immediately after eating; they may also work for longer if taken with food.
Next we have a type of medicine known as a proton pump inhibitor (PPI) like omeprazole which you can buy over-the-counter in smaller doses (20mg) or larger doses on prescription from your GP or prescribing pharmacist. It’s widely used by those suffering from chronic acid reflux as it can be taken for an extended period of time.
However, you should be aware of the potential side effects of taking omeprazole. If you take it for more than 3 months, the levels of magnesium in your blood may fall, causing symptoms like fatigue, confusion, dizziness, muscle twitches, shakiness and an irregular heartbeat.
Taking omeprazole for over a year can increase your chances of bone fractures, gut infections and vitamin B12 deficiency. Your GP will frequently check your health if you’re taking omeprazole for over a year to see if you should continue taking it.
If none of the above medical treatments are effective in treating your acid reflux, your GP may refer you to have a gastroscopy (where a thin, flexible tube with a camera is passed down your throat) to determine what’s causing your symptoms. Additionally, there’s an operation on your stomach that can stop acid reflux, known as a laparoscopic fundoplication.
There’s little evidence to suggest that home remedies for acid reflux work. For example, drinking milk can actually make heartburn worse. Instead, there’s some simple things you can do that may improve your symptoms, especially when taken with acid reflux medicines.
Keeping a food diary on what food and drink triggers your heartburn can be helpful in identifying the products that aggrevate and agree with your body, in addition to losing weight if you’re overweight. Studies show that having excess weight, especially around the abdominal area, can add pressure to your stomach, increasing the risk of the backflow of acid in the oesophagus.
Eating smaller meals and sitting up for longer after them can help, too, as well as quitting smoking. When you’re eating, it’s best to avoid wearing tight clothing around your stomach, like tight bottoms and belts. Again, this puts unnecessary pressure on your stomach.