Heartburn and acid reflux symptoms: causes, red flags and when to seek help

The NHS describes heartburn as a burning feeling in the chest caused by stomach acid travelling up towards the throat. Beyond burning, you may notice an unpleasant sour taste in the mouth, and sometimes a cough or hiccups that keep coming back, a hoarse voice, bad breath, bloating and feeling sick.

The NHS says symptoms are often worse after eating, when lying down and when bending over. That pattern, relating to meals and posture, is one of the most helpful ways of distinguishing reflux from other causes of chest discomfort.

A ring of muscle at the lower end of the food pipe normally keeps stomach contents down. Reflux occurs when it relaxes too often or the pressure in the abdomen rises. The NHS says lots of people get heartburn from time to time, often for no obvious reason, and lists things that can cause or worsen it: coffee, tomatoes, alcohol, chocolate and fatty or spicy foods, being overweight, smoking, pregnancy, stress and anxiety, hormonal changes such as progesterone and oestrogen, medicines such as anti-inflammatory painkillers like ibuprofen, a hiatus hernia, a stomach ulcer and a bacterial infection in the stomach.

• Large or late meals, which distend the stomach and overwhelm the valve.

• Lying flat or bending soon after eating.

• Extra abdominal weight and pregnancy, both of which raise pressure on the stomach.

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

• Medicines that irritate the stomach or relax the valve.

• Smoking and alcohol, which loosen the valve and irritate the lining.

The NHS suggests eating smaller, more frequent meals, trying to lose weight if you are overweight, and finding ways to relax. It advises avoiding trigger foods and drinks, avoiding eating within 3 or 4 hours before bed, not wearing clothes tight around the waist, not smoking, not drinking too much alcohol, and not stopping any prescribed medicine without speaking to a doctor.

It says a pharmacist may recommend antacids or alginates, best taken with food or soon after eating, which help in the short term but will not cure the problem and should not be taken regularly for long periods. If you are pregnant, a pharmacist can advise which medicines are suitable.

The NHS says to see a GP if heartburn is not helped by lifestyle changes and pharmacy medicines, if you have heartburn most days, or if you also have food getting stuck in your throat, frequently being sick or losing weight for no reason. The NHS oesophageal cancer page lists problems swallowing, feeling or being sick, heartburn or acid reflux, indigestion, a cough that is not getting better, a hoarse voice, loss of appetite or weight loss, tiredness, pain in the throat or middle of the chest especially when swallowing, and, less commonly, black poo or coughing up blood.

That page says to see a GP if you have problems swallowing, have lost a noticeable amount of weight, have heartburn most days that lasts for 3 weeks or more, or if symptoms change, get worse or no longer feel normal for you. It stresses these symptoms are very common and do not definitely mean cancer, but finding it early makes it more treatable.

The NHS oesophageal cancer page says to ask for an urgent GP appointment or get help from NHS 111 if you are being sick for more than 2 days, your poo is black or dark red, or you are worried and not sure where to get help.

Vomiting blood or coffee-ground material, black tarry stools with dizziness, food completely sticking so that you cannot swallow your saliva, or severe sudden pain in the upper abdomen that is rigid to the touch call for emergency care. The NHS stomach-ache guidance lists vomiting blood or vomit that looks like ground coffee, and black, sticky, extremely smelly poo, among reasons to call 999 or go to A&E.

Burning discomfort that is actually heart pain can be confused with reflux. Chest pain spreading to the arm, neck or jaw, or with sweating, breathlessness or nausea, particularly during exertion, should be treated as an emergency; call 999.

The doctor will ask how often symptoms occur, what brings them on, whether you wake at night with them, which tablets you take, your smoking and alcohol use, and whether you have difficulty swallowing, vomiting, weight loss or black stools. They will weigh you, feel your abdomen and may check for anaemia.

The NHS says a GP may prescribe a proton pump inhibitor (PPI) such as omeprazole or lansoprazole, usually for 4 or 8 weeks depending on severity, and that you should go back if symptoms return. If a PPI does not help, a different medicine such as an H2 receptor antagonist such as famotidine may be tried. If medicines do not help or symptoms are severe, you may be referred for tests, such as a gastroscopy, where a thin tube with a camera is passed down your throat into your stomach, tests for the bacteria that can cause heartburn, or surgery to stop acid reflux.

A pharmacist is the first stop for occasional symptoms. A GP reviews persistent or complicated symptoms. A gastroenterologist performs gastroscopy and manages Barrett oesophagus, ulcers and difficult reflux, while an upper gastrointestinal surgeon considers anti-reflux surgery when medicine fails. An ENT specialist may be involved if symptoms are mostly voice or throat related.