What is acid reflux and GERD?
After you swallow, food passes down your oesophagus (food pipe) into your stomach, and a ring of muscle at the bottom normally closes to keep stomach contents down. Acid reflux occurs when this muscle relaxes or weakens, allowing acidic stomach contents to flow back up. This causes the burning sensation known as heartburn.
Occasional reflux is normal and common. When it happens frequently — generally more than twice a week — or causes troublesome symptoms or complications, it is called gastro-oesophageal reflux disease, or GERD. Persistent acid exposure can irritate and inflame the lining of the oesophagus.
Symptoms
The classic symptom is heartburn — a burning feeling in the chest, often after eating or when lying down. Other common symptoms include:
- •A sour or bitter taste in the mouth from acid
- •Regurgitation of food or liquid
- •A sensation of a lump in the throat
- •Difficulty or discomfort swallowing
- •A persistent cough or hoarseness, especially at night
- •Worsening of symptoms when lying down or bending over
What causes and triggers reflux?
Reflux happens when the valve between the stomach and oesophagus does not close properly. Several things can trigger or worsen it:
- •Large or fatty meals
- •Eating late at night or lying down soon after eating
- •Being overweight, which increases pressure on the stomach
- •Certain foods and drinks — such as coffee, alcohol, chocolate, spicy or fatty foods, and tomatoes
- •Smoking
- •Pregnancy
- •Some medications
- •A hiatus hernia, where part of the stomach moves up through the diaphragm
Relief, treatment and prevention
Many people manage reflux with lifestyle changes: eating smaller meals, not lying down for a few hours after eating, raising the head of the bed, losing excess weight, avoiding known trigger foods, stopping smoking and cutting down on alcohol. These simple steps are often very effective.
When more help is needed, antacids neutralise acid for quick relief, while medicines that reduce acid production — such as proton pump inhibitors — are used for more persistent symptoms. Most reflux is well controlled this way. Frequent, severe or long-standing reflux should be assessed by a doctor, both to control symptoms and to check for complications.
Foods and habits that affect reflux
Diet and eating habits have a strong influence on acid reflux, and adjusting them is often the most effective way to reduce symptoms. While triggers vary between individuals, some foods and drinks commonly worsen reflux, including fatty and fried foods, spicy dishes, citrus fruits, tomatoes and tomato-based sauces, chocolate, coffee, alcohol and carbonated drinks. Keeping a food diary can help you identify which ones affect you personally.
How and when you eat matters as much as what you eat. Large meals increase pressure on the valve between the stomach and oesophagus, so eating smaller, more frequent meals helps. Eating slowly, not lying down for two to three hours after eating, and avoiding late-night meals all reduce reflux. Many people also benefit from raising the head of the bed slightly, so gravity helps keep stomach contents down overnight.
Other habits play a role too. Being overweight increases abdominal pressure and reflux, so weight loss often improves symptoms significantly. Smoking weakens the valve that keeps acid down, and stopping helps. Wearing loose clothing rather than tight waistbands can also reduce pressure on the stomach. These adjustments, combined where needed with medication, control reflux for most people.
When reflux becomes long-term (GERD)
Occasional reflux is normal, but when it happens frequently — generally more than twice a week — or causes troublesome symptoms, it is classed as gastro-oesophageal reflux disease (GERD). Persistent exposure of the oesophagus to stomach acid can inflame and irritate its lining, a condition called oesophagitis, which is why long-standing reflux should be properly assessed and managed rather than simply endured.
In a minority of people, long-term acid exposure can cause changes to the cells lining the lower oesophagus, a condition known as Barrett's oesophagus. This is usually managed with monitoring and is not something to be alarmed about, but it is one reason doctors take persistent reflux seriously and may recommend investigation, sometimes with a camera test (endoscopy), particularly if there are warning symptoms.
The reassuring message is that GERD is very treatable. Acid-reducing medicines such as proton pump inhibitors are highly effective, and combined with lifestyle changes, the great majority of people achieve good control. Seeking proper assessment for frequent reflux allows both symptom relief and appropriate monitoring where needed.