Heartburn and Acid Reflux

You should see a doctor for acid reflux if symptoms are frequent, persistent, or worsening, typically occurring more than twice a week or not improving with over-the-counter treatments. It is very common in the UK, and whilst for some the symptoms are mild, but annoying, for others it can affect their ability to carry out normal daily activities.

You shoudl seek medical advice if you experience difficulty swallowing, unexplained weight loss, persistent nausea or vomiting, or ongoing chest pain, as these may indicate a more serious condition. Chronic cough, hoarseness, or symptoms that disrupt sleep should also be investigated.

By seeking an accurate diagnosis early on, complications such as oesophagitis or Barrett’s oesophagus can be prevented.

Symptoms of heartburn and acid reflux typically include a burning sensation in the chest (heartburn), often after eating or when lying down. Many people experience acid regurgitation, where sour or bitter fluid rises into the throat or mouth. Other symptoms include difficulty swallowing (dysphagia), a chronic cough, hoarseness, sore throat, and a sensation of a lump in the throat (globus). Some individuals report bloating, nausea, or excessive belching. Symptoms may worsen after large meals, with certain foods, or at night. Acid reflux can be very uncomfortable and tiring to live with, if symptoms persist. Successful treatment options exist, but understanding the cause of the symptoms is the first step to finding a solution.

Heartburn and acid reflux are caused by stomach acid flowing back into the oesophagus, often due to a weakened lower oesophageal sphincter. Common triggers include large or fatty meals, caffeine, alcohol, obesity, smoking, pregnancy, and certain medications, which increase acid exposure and irritate the oesophageal lining, leading to burning and discomfort.

GERD – Gastro-oesophageal reflux disease is also known as GORD and is a chronic condition in which stomach acid frequently flows back into the oesophagus. This occurs due to a weakened or malfunctioning lower oesophageal sphincter, allowing acid to irritate the oesophageal lining. Common symptoms include heartburn, acid regurgitation, chest discomfort, difficulty swallowing, chronic cough, and hoarseness. Untreated GERD/GORD can lead to complications such as oesophagitis, Barrett’s oesophagus, or strictures. Diagnosis is based on symptoms, response to acid-suppressing medication, and diagositic tests such as an endoscopy.

A hiatal hernia occurs when part of the stomach pushes up through the diaphragm into the chest cavity. This can allow stomach acid to glow back into the oesophagus, causing acid reflux and heartburn. Symptoms of hiatus hernias include chest pain, difficulty swallowing, regurgitation and belching. Hiatal hernias can be treated using medications, lifestyle changes and in some cases, surgery to repiar the hernia.

Oesophagitis is inflammation of the lining of the oesophagus, the tube that carries food from the mouth to the stomach. It is most commonly caused by acid reflux from gastro-oesophageal reflux disease (GORD), but can also result from infections, medications, or allergies. Symptoms typically include heartburn, chest pain, difficulty swallowing (dysphagia), and sometimes regurgitation or nausea. If left untreated, oesophagitis can lead to complications such as ulcers, bleeding, scarring, or strictures that narrow the oesophagus. Diagnosis is usually made with endoscopy and biopsy, and treatment focuses on reducing acid exposure, managing underlying causes, and protecting the oesophageal lining.

Barrett’s oesophagus is a condition in which the normal lining of the oesophagus is replaced by tissue similar to the lining of the intestine, usually due to long-term acid exposure from chronic gastro-oesophageal reflux disease (GORD). Barrett’s oesophagus itself does not usually cause symptoms, but it is often associated with persistent heartburn or acid reflux. It is clinically significant because it increases the risk of developing a type of cancer called oesophageal adenocarcinoma. A diagnosis of Barrett’s Oesophagus is confirmed with an endoscopy and a biopsy.

Heartburn and acid reflux are usually diagnosed based on symptoms and medical history, particularly if symptoms are typical and respond to treatment. Doctors may recommend a trial of proton pump inhibitors (PPIs) to assess improvement. For some people, PPIs can be very successful, but it is no uncommon for symptoms to persist and this can be hugely frustrating for sufferers. If symptoms persist or are atypical, further investigations may be required. This may include a gastroscopy (Haven Medical offer a transnasal gastroscopy, in which a very thin fibre optic camera is inserted via the nose and is often more comfortable than a traditional gastroscopy).

Heartburn and acid reflux are treated through lifestyle changes, medications, and sometimes surgery. Lifestyle modifications include avoiding trigger foods, eating smaller meals, losing weight, and elevating the head of the bed, which can reduce symptoms in many patients. Medications, such as proton pump inhibitors (PPIs) and H2 blockers, are highly effective, with studies showing 70–80% of patients experience symptom relief within weeks. Antacids provide rapid short-term relief. In severe cases, surgical options can offer longer term relief.