Acid reflux: Causes, symptoms and treatment

If you’ve ever had too much coffee, or a lain down after a large meal, you might be familiar with the uncomfortable burn of acid reflux.

1 in 4 adults in the UK experience acid reflux from time to time, and these occasional bouts are typically harmless.

However, frequent episodes of acid reflux over a short period of time are not only uncomfortable, but can be an indicator of an underlying problem, and may give rise to complications over time.

In this article, we’ll explore what acid reflux is, what causes acid reflux, and ways to treat it. We’ll also share expert insight on the causes and complications of gastroesophageal reflux disease, which occurs when acid reflux becomes more severe and long lasting.

What is acid reflux?

Acid reflux is the movement of stomach acid up your oesophagus, causing a burning sensation that feels like indigestion or heartburn.

Usually, stomach acid sits in your stomach, sealed in by a circular layer of muscle known as the lower oesophageal sphincter (LOS). This muscle acts as a barrier between the contents of your stomach and oesophagus – the muscular tube that carries food from your mouth to your stomach – and relaxes only when you swallow or belch to allow food or air to pass.

Acid reflux happens when your LOS doesn’t close properly, allowing stomach acid to rise back up into your oesophagus.

What causes acid reflux?

While acid reflux can affect anyone at any time, there are certain factors that can trigger acid reflux more frequently, such as:

• Anxiety
• Asthma
• Being pregnant
• Being overweight
• Connective tissue disorders, such as scleroderma
• Delayed stomach emptying – when the muscles in your stomach don't move food as they should for it to be digested
• Drinking alcohol
• Having a hiatal hernia, where part of your stomach slides up into your chest
• Irritable bowel syndrome (IBS)
• Lying down after a large meal
• Older age
• Smoking or secondhand smoking
• Stomach ulcers
• Using nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen

What food causes acid reflux?

Not only can lying down after a large meal cause acid reflux, but certain food and drinks can trigger or exacerbate acid reflux, too.

Food and drinks linked to acid reflux include:

• Alcohol
• Caffeine
• Citrus fruit juices
• Chocolate
• Fatty foods
• Fizzy drinks
• Onions and garlic
• Peppermint
• Processed foods
• Spicy foods
• Tomatoes

Symptoms of acid reflux

While the terms ‘acid reflux’ and ‘heartburn’ are used interchangeably, heartburn is only a symptom of acid reflux.

Alongside heartburn, other symptoms of acid reflux include:

• A sour taste in your mouth
• Bad breath
• Backwash of food or sour liquid
• Bloating
• Difficulty swallowing
• Hiccups that keep coming back
• Nausea
• Persistent cough
• The feeling of a lump in your throat

How to get rid of acid reflux

If acid reflux bothers you from time to time but is not impacting your overall quality of life, there are simple lifestyle changes you can make to reduce the frequency and severity of acid reflux, such as:

• Eating smaller, more frequent meals
• Losing weight if you’re overweight
• Managing your stress
• Avoiding food and drink that causes acid reflux
• Avoiding large meals before bed
• Stopping smoking
• Abstaining from alcohol
• Elevating the head of your bed using wood, bricks or books, so your head is above your chest and you’re more upright when you sleep

How to get rid of acid reflux fast

To get rid of acid reflux in the short term, you can get medication from your local pharmacist for fast-acting relief.

Antacids relieve the symptoms of acid reflux by neutralising the acid in your stomach. These medicines come as liquid or chewable tablets, and can be bought over the counter without a prescription.

To neutralise the acidity of your stomach, antacids can contain the following ingredients:

• Aluminium hydroxide
• Magnesium carbonate
• Magnesium trisilicate
• Magnesium hydroxide
• Calcium carbonate
• Sodium bicarbonate

Some brands also contain alginate, an ingredient that coats your gullet with a protective layer, reducing the burning sensation in your oesophagus.

If you experience acid reflux on a regular basis, you may be prescribed a proton pump inhibitor (PPI), a medicine that reduces the amount of acid your stomach makes. Depending on the severity of your acid reflux, you’ll need to take these tablets for four to eight weeks.

What is GERD?

If you experience acid reflux more than twice a week on a regular basis, or if your acid reflux causes serious injury, you may have a case of gastroesophageal reflux disease, or GERD.

GERD is when stomach acid repeatedly flows back up into the oesophagus, damaging the lining of the oesophagus over time. Not only is GERD uncomfortable, but can cause further complications in your body.

Complications of GERD

Over time, GERD can give rise to a range of complications, such as:

• Oesophagitis, the inflammation of the oesophageal tissue. Over time, excess stomach acid can break down tissue in the oesophagus, causing bleeding and ulcers.
• Oesophageal stricture, the narrowing of your oesophagus. As the tissue in your oesophagus breaks down, scar tissue forms in its place, narrowing the food pathway and causing problems with swallowing.
• Barrett oesophagus, or changes to your oesophagus that are associated with an increased risk of oesophageal cancer.

How to treat GERD

If antacids or PPIs aren’t enough to treat your GERD, your consultant may consider the following treatment options.

Gastroscopy

Your consultant may order a gastroscopy, or upper endoscopy (EGD) to first determine the cause of your symptoms.

In this procedure, a thin tube with a camera attached to the end is passed down your mouth and into your stomach, allowing your consultant to take a closer look at the severity of your symptoms before deciding next steps.

During this procedure, you may be administered local anesthetic to relax, which may cause drowsiness for the remainder of the day. You may also find you develop a sore throat within three days after the procedure.

Bacteria tests

In this very simple test, you’ll be asked to drink a sugary solution before blowing into a series of test tubes to determine if you have Small Intestinal Bacterial Overgrowth, or SIBO, where bacteria grows in your small intestine instead of your large intestine.

As well as bloating and nausea, SIBO can cause reflux symptoms, and may be the underlying cause of your GERD. If your test results come back positive for SIBO, your consultant may prescribe a course of antibiotics and work with you to implement dietary and lifestyle changes.

Surgery

If your GERD is severe, you may need surgery on your stomach or oesophagus to stop acid reflux altogether.

The procedure, known as Nissen fundoplication, is a last resort for chronic acid reflux in cases where medicine and lifestyle changes have made no impact.

In this surgery, the upper part of your stomach is wrapped around your oesophagus, making a new valve that stops the acid in your stomach flowing back up into your oesophagus. If a hiatal hernia is the cause of your GERD, the hernia will be corrected during the surgery, too.

This keyhole surgery is conducted under general anaesthetic, and you’ll need to spend up to three days in hospital to recover.

Acid reflux in summary

While the occasional bout of acid reflux is unpleasant, it’s rarely a cause for concern. However, if your acid reflux happens frequently and is causing you distress, don’t hesitate to book an appointment with one of our expert consultants today.

Clinical resources

1. Heartburn and acid reflux, NHS
2. Gastroesophageal reflux disease (GERD), Mayo Clinic
3. What is acid reflux? Medical News Today
4. GERD (Acid Reflux), Healthline