Health condition · Clinically reviewed
Acid reflux & GORD, the guide that answers what to do next.
When heartburn stops being occasional, treatment is straightforward - and knowing the red flags matters. Here is how to tell what is going on, what actually works, and when to push for an endoscopy.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Every claim is checked against NICE, BSG or peer-reviewed sources you can see at the end.
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Current for 2026
Reflects current UK guidance on PPIs, red-flag symptoms, and when to consider endoscopy.
Key facts
Acid reflux and GORD at a glance.
The essentials, in plain English - what reflux is, how common it is, what treatment usually looks like, and when to escalate.
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What it is
Stomach acid rising into the oesophagus (reflux). When it happens often enough to cause symptoms or damage, it becomes GORD (gastro-oesophageal reflux disease).
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How common
Around 1 in 4 UK adults experience reflux at least weekly.
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Typical symptoms
Heartburn, acid regurgitation, chest discomfort after meals or at night.
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First-line treatment
Lifestyle changes plus a 4-8 week course of a proton pump inhibitor (PPI).
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When to escalate
Difficulty swallowing, weight loss, vomiting blood, black stool, or new symptoms after 55 - urgent endoscopy.
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Long-term risk
Untreated persistent reflux can cause Barrett’s oesophagus - a small but real risk of cancer.
Why this guide matters
Common, treatable, and worth taking seriously.
Reflux is easy to underestimate and easy to treat - but a small group of people need faster investigation. The three points below shape everything else on this page.
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Lifestyle change is not filler
Weight loss and meal timing outperform many pills for reflux control.
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PPIs are effective and safe
Well tolerated when used properly - review annually and step down where possible.
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The red flags decide who scopes
Difficulty swallowing, weight loss or bleeding - endoscopy without delay.
How the diagnosis is made
From first symptoms to a clear plan.
The steps a UK GP will normally follow, in order - so you know what to expect and why.
Phase 1 · Recognising
Pattern, red flags and a treatment trial
Phase 2 · Confirming
H. pylori and endoscopy when needed
Phase 3 · Managing
Lifestyle and long-term plan
- 01
Recognising
Pattern recognition
Heartburn, acid regurgitation, chest discomfort worse lying down or after large meals.
- 02
Recognising
Red-flag screening
Difficulty swallowing, weight loss, vomiting blood or black stool - urgent 2-week-wait referral.
- 03
Recognising
A trial of treatment
For typical symptoms with no red flags, a 4-8 week PPI trial confirms diagnosis and treats it.
- 04
Confirming
H. pylori test
Stool antigen or breath test - if positive, eradication therapy relieves reflux and reduces ulcer risk.
- 05
Confirming
Endoscopy when indicated
Red flags, persistent symptoms despite PPIs, or symptoms starting after 55 all trigger endoscopy.
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Managing
Lifestyle plan
Weight, meal timing, alcohol, smoking, sleeping position - each has measurable effect.
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Managing
Long-term plan
Step-down to lowest effective dose. Reflux surgery considered for selected patients.
Typical timeline: 4-8 weeks from first PPI trial to a settled plan.
Symptoms
What reflux actually feels like.
Classic heartburn is only part of it. Reflux can be silent - through the throat and voice - and the red flags matter most of all.
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Heartburn
A burning sensation behind the breastbone, often after meals or lying down.
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Acid regurgitation
A sour or bitter taste at the back of the throat.
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Chest discomfort
Pressure or pain that can mimic cardiac pain - always investigate a new chest pain.
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Symptoms at night
Waking with cough or heartburn - often relieved by raising the head of the bed.
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Sore throat or hoarse voice
Silent reflux can present through the throat and voice, without classic heartburn.
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Chronic cough
Reflux is one of the top three causes of a persistent unexplained cough.
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Difficulty swallowing
Food sticking or catching - a red flag, needs prompt endoscopy.
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Red-flag symptoms
Weight loss, vomiting blood, black stool, persistent vomiting or new symptoms after 55 - urgent GP.
Treatment
How reflux is treated in the UK.
Lifestyle first, medication where needed, surgery for a small group - what each option does and where it fits.
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Lifestyle first
Smaller meals, finish eating 3 hours before bed, lose 5-10% weight if overweight, reduce alcohol and smoking.
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Sleep position
Raise the head of the bed 15-20 cm; sleep on your left side - both reduce nocturnal reflux.
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Antacids
Gaviscon or similar for occasional symptoms - taken after meals and at bedtime.
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H2 blockers
Famotidine for mild symptoms - useful when PPIs are not appropriate or as top-up therapy.
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PPIs
Omeprazole, lansoprazole or esomeprazole - first-line for moderate-severe reflux and GORD.
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H. pylori eradication
7-14 days of triple therapy if H. pylori is positive - improves symptoms and heals ulcers.
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Step-down and pause
Aim for lowest effective PPI dose; try annual "PPI holidays" where possible.
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Reflux surgery
Laparoscopic fundoplication or LINX - considered for selected patients with confirmed severe reflux.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP knows your history and can tell you which parts apply to you. If in doubt, see them.
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NICE. Gastro-oesophageal reflux disease and dyspepsia in adults (CG184).
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British Society of Gastroenterology. Guidelines on Barrett’s and reflux disease.
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Guts UK. Patient information on GORD.
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NHS. Heartburn and acid reflux: overview.
Red flags
When reflux stops being routine.
Most of the time, reflux is a nuisance. These are the situations where it is not - and you should act today.
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Difficulty swallowing
Food sticking or catching - urgent 2-week-wait endoscopy referral.
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Unexplained weight loss
Especially with reflux - urgent GP.
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Vomiting blood
Bright red or coffee-ground appearance - call 999.
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Black tarry stool (melaena)
A sign of upper GI bleeding - call 999 or attend A&E.
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Persistent vomiting
Ongoing vomiting or inability to keep fluids down - urgent review.
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New symptoms after 55
New dyspepsia after 55 warrants prompt investigation.
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Iron-deficiency anaemia
With reflux symptoms - possible chronic bleeding, investigate.
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Chest pain like a heart attack
Any severe or new chest pain - call 999. Do not assume it is reflux.
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Persistent hoarseness or cough
For weeks without another explanation - assess.
Living with it
A long-term issue, but a very manageable one.
Four things that make the biggest difference day to day - meals, sleep, long-term medication and Barrett’s follow-up.
A quiet reminder
Consistency beats intensity, every time.
Small, steady changes - kept up for months - do more than a heroic week that does not last.
- 01 Meals
Timing matters more than diet
Finishing meals 3+ hours before bed helps more than eliminating any single food.
- 02 Sleep
Raise the head of the bed
Under the bed legs, not with pillows - it is one of the highest-yield changes.
- 03 Long-term
PPIs are safe but not neutral
Long-term PPIs are effective but not without downsides - review annually and try to step down.
- 04 Barrett’s
A specific follow-up plan
If Barrett’s oesophagus is diagnosed, surveillance endoscopy at intervals is standard.
Frequently asked
Everything we get asked about acid reflux.
Quick answers on PPIs, H. pylori, lifestyle change, Barrett’s and when to worry.
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What is the difference between reflux and GORD?
Reflux is stomach acid rising into the oesophagus. GORD (gastro-oesophageal reflux disease) is reflux happening often enough or severely enough to cause symptoms or damage.
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How is it diagnosed?
For most people, on symptoms - and confirmed by a PPI trial. Endoscopy is arranged when red flags are present, when PPIs do not work, or for anyone with new symptoms after 55.
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Do I need an endoscopy?
Not always. Red flags (difficulty swallowing, weight loss, bleeding), persistent symptoms despite treatment, or new symptoms over 55 all trigger endoscopy - see our colonoscopy page for what a scope is like (an OGD is the upper equivalent).
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Are PPIs safe long-term?
Widely used and effective, with a good long-term safety profile - but not entirely neutral. Long-term PPIs are associated with modest increases in some risks, so annual review and stepping down where possible is sensible.
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What is H. pylori?
A stomach bacterium that causes ulcers and can drive reflux symptoms. Diagnosed by stool antigen or breath test; treated with 7-14 days of triple therapy.
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What lifestyle changes actually help?
Weight loss (5-10%), finishing meals 3 hours before bed, raising the head of the bed, reducing alcohol and stopping smoking - each has measurable evidence.
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Which foods should I avoid?
Common triggers include large fatty meals, alcohol, coffee, spicy food, chocolate and citrus - but triggers are individual. A short food diary helps identify yours.
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What is Barrett’s oesophagus?
A change in the oesophageal lining after chronic reflux. It carries a small but real risk of oesophageal cancer, and is managed with surveillance endoscopy.
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When would surgery help?
For confirmed severe reflux not controlled by medication or when someone cannot take long-term PPIs. Laparoscopic fundoplication and LINX are established options.
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When should I call 999?
Vomiting blood, passing black tarry stool, or any severe chest pain - do not assume it is reflux.