Acid reflux: symptoms, causes, treatment and what helps at home

The NHS says the main symptoms of acid reflux are heartburn, a burning sensation in the middle of your chest, and an unpleasant sour taste in your mouth caused by stomach acid. Symptoms are often worse after eating, when lying down and when bending over.

You may also have a cough or hiccups that keep coming back, a hoarse voice, bad breath, and bloating and feeling sick.

NICE CKS describes GORD as usually a chronic condition where stomach contents flow back into the oesophagus, with predominant symptoms of heartburn and acid regurgitation.

Treatment starts with lifestyle changes and pharmacy medicines, then moves to prescription medicines if needed. The NHS says antacids and alginates help symptoms in the short term but will not cure the problem and should not be taken regularly for long periods.

The NHS says simple lifestyle changes can help stop or reduce heartburn. It advises:

• Eat smaller, more frequent meals.

• Try to lose weight if you are overweight.

• Find ways to relax.

• Avoid food and drink that trigger your symptoms.

• Do not eat within 3 or 4 hours before bed.

• Do not wear clothes that are tight around your waist, do not smoke and do not drink too much alcohol.

• Raise the head of your bed by around 10 to 20cm using wood, bricks or books. The NHS says not to use extra pillows, as this can increase pressure on your belly and make symptoms worse.

• Do not stop taking any prescribed medicine without speaking to a doctor first.

Acid reflux is when stomach acid travels up towards the throat. The NHS says lots of people get heartburn from time to time, and that if it keeps happening it may be called gastro-oesophageal reflux disease (GORD).

NICE CKS uses the term dyspepsia for a group of upper gut symptoms typically present for four or more weeks, including upper abdominal pain or discomfort, heartburn, acid reflux, nausea and vomiting. It lists the most common causes as GORD, peptic ulcer disease and functional dyspepsia.

The NHS says there is often no obvious reason why you get heartburn. Sometimes it is caused or made worse by:

• Certain food and drink, such as coffee, tomatoes, alcohol, chocolate, and fatty or spicy foods.

• Being overweight.

• Smoking.

• Pregnancy.

• Stress and anxiety.

• An increase in some types of hormones, such as progesterone and oestrogen.

• Some medicines, such as anti-inflammatory painkillers like ibuprofen.

• A hiatus hernia, where part of the stomach moves up into the chest.

• A stomach ulcer or a bacterial infection in the stomach.

• NICE CKS adds that drugs that decrease the pressure of the lower oesophageal sphincter, including calcium-channel blockers, anticholinergics, theophylline, benzodiazepines and nitrates, can be involved.

Occasional heartburn after a trigger meal usually settles. For recurring symptoms, the NHS says a PPI is usually needed for 4 or 8 weeks, depending on how serious your acid reflux is, and that you should go back to your GP if symptoms return after stopping, as you may need a long-term prescription.

NICE CKS says GORD is usually a chronic condition, and that the annual risk of recurrence of untreated GORD symptoms is 50%. It recommends that people on long-term treatment have an annual review and are encouraged to step down or stop treatment if possible and appropriate.

The NHS says indigestion and heartburn are common in pregnancy and can be caused by hormonal changes and the growing baby pressing against your stomach. Symptoms can occur at any point, but are more common from 12 weeks onwards.

The NHS suggests eating small meals often rather than three larger meals, not eating within 3 hours of going to bed, sitting up straight when you eat and just after, cutting down on caffeine and rich, spicy or fatty foods, propping up your head and shoulders at night and sleeping on your left side. Antacids and alginates can be used, but tell the pharmacist you are pregnant as some antacids are not suitable. See your midwife or GP if lifestyle changes do not work.

The NHS says reflux in babies is when a baby brings up milk or is sick during or shortly after feeding. It is very common and usually gets better on its own. It usually starts before a baby is 8 weeks old and gets better by the time they are 1.

A baby does not usually need to see a doctor if they are happy, healthy and gaining weight. The NHS advises holding your baby upright during feeding and for as long as possible after, and burping regularly. See a GP if your baby is not improving, is not gaining weight, first gets reflux after 6 months or still has reflux after age 1. Ask for an urgent GP appointment or call NHS 111 for green or yellow vomit, blood in vomit or poo, projectile vomiting or a swollen or tender tummy.

The NHS says to see a GP if lifestyle changes and pharmacy medicines are not helping, you have heartburn most days, or you also have other symptoms, such as food getting stuck in your throat, frequently being sick or losing weight for no reason. A GP can provide alternative or stronger treatments and help rule out any more serious causes.

If you get sudden pain or discomfort in your chest that does not go away, which can feel like squeezing, pressure, burning or indigestion, or pain that spreads to your arm, neck, jaw, stomach or back, or chest pain with sweating, feeling sick, light headed or short of breath, the NHS says to call 999 straight away as it could be a heart attack. Do not assume chest pain is reflux.

NICE CKS says 10 to 15% of people with GORD will develop Barrett's oesophagus, and 1 to 10% of these will develop oesophageal adenocarcinoma over the next 10 to 20 years. It says referral to a gastroenterologist or upper gastrointestinal surgeon should be considered for GORD symptoms that are refractory to treatment, persistent or unexplained, or associated with risk factors for Barrett's oesophagus.

It also notes that a GP should consider whether another diagnosis, such as a heart or liver and gallbladder problem, may be contributing when symptoms do not respond to treatment.

Most people manage acid reflux with advice from a pharmacist and their GP. A GP can prescribe PPIs, test for H. pylori and refer for a gastroscopy if medicines do not help or symptoms are severe.

Some people choose a private gastroenterology consultation or gastroscopy to be seen sooner. Symptoms that suggest something more serious, such as food sticking, repeated vomiting or weight loss, should be assessed promptly through your GP rather than waiting for a private slot.