Living with and managing acid reflux

Acid reflux is a common condition that everyone experiences at some point. It refers to the contents of your stomach, which are highly acidic, coming back up your gullet (oesophagus). The result is a burning sensation in your chest called heartburn, which is sometimes accompanied by liquid from your stomach entering your mouth. Frequent heartburn can also cause a cough and irritate your voice box (larynx), leading to a hoarse voice. 

Who is at risk of acid reflux?

Everyone experiences a certain amount of acid reflux every day. This is because at the bottom of your oesophagus is a valve called the lower oesophageal sphincter, which tightens to prevent stomach acid from leaking upwards. However, whenever you eat or drink, this valve relaxes to allow food and drink to pass into your stomach. At these times, acid can come back up into your oesophagus. 

You are at greater risk of more frequent and/or severe acid reflux if you are overweight or obese as this can put increased pressure on your abdomen. However many people with unpleasant reflux are a healthy weight and suffer from a sphincter that is either too weak or relaxes too often. 

Drinking too much alcohol or caffeine, and smoking can relax the valve at the bottom of your oesophagus too much, which also increases your risk of acid reflux. 

You are also at greater risk of acid reflux if you have a hiatus hernia, where part of your stomach pushes up into your chest via an opening in your diaphragm. 

If you have acid reflux often enough, you may experience persistent symptoms and consequently develop gastro-oesophageal disease (GORD). 

Getting a diagnosis of acid reflux

If you are concerned that you have acid reflux and it is affecting your quality of life, see your GP. 

They will ask you questions about your symptoms, such as: when do your symptoms occur? And do your symptoms occur more often after a meal or when lying down at night?

Based on your symptoms, your GP may refer you to a specialist, who may request a gastroscopy. This involves passing a thin, telescope-like tube, with a light and camera on the end, down into your oesophagus via your mouth. This will allow your doctor to examine the inside of your oesophagus and stomach for any abnormalities or changes. 

During your gastroscopy, a pH test (Bravo test) may be performed to check the level of acidity at the bottom of your oesophagus. Other tests may also be needed to rule out other conditions and make an accurate diagnosis. 

Managing acid reflux at home

Reducing lifestyle factors that increase the risk of acid reflux can help ease your symptoms. You should, therefore, try to quit smoking and reduce how much alcohol and caffeine you drink. 

Eating smaller meals more frequently, rather than larger meals, and avoiding eating at least two hours before bedtime will reduce your risk of acid reflux. Sleeping with your head and upper body slightly raised will also help prevent stomach acid from leaking up into your oesophagus. 

If you are overweight or obese, losing excess weight will reduce your symptoms too.

When to see a doctor

If you have a diagnosis of acid reflux and your symptoms are affecting your quality of life despite making changes to your lifestyle, you should see your GP.

If necessary and depending on the severity of your symptoms, your GP may refer you to a specialist, namely a consultant gastroenterologist.

Acid reflux medication

The most common treatment for acid reflux is acid-suppressing medication, which reduces the production of stomach acid. These drugs are effective in around 70% of people who need medical treatment for acid reflux and include proton pump inhibitors (PPIs) and H2 antagonists.

How often you need to take these drugs will depend on your symptoms. You should always follow the advice of your doctor and the guidance of taking the lowest dose to control your symptoms. For example, you may find you only need to take your medication before a large meal.

When is surgery needed to treat acid reflux?

Surgery is only recommended if other treatments ie lifestyle changes and medication, have proven unsuccessful and your quality of life is significantly affected by acid reflux. 

Surgery usually involves tightening the sphincter at the bottom of your oesophagus. This can involve using part of your stomach (fundoplication) or a prosthesis such as magnetic augmentations (the Linx procedure). This is performed as a keyhole procedure, which means only small cuts are needed and recovery is faster than with traditional open surgery. 

In more recent times, endoscopic surgery — transoral incisionless fundoplication (TIF) or radiofrequency ablation (the Stretta procedure) — where no cuts are needed, has become available in certain cases. Your consultant will discuss the most suitable options in your case.