Acid reflux occurs when acid travels from your stomach up towards your throat. This creates a burning feeling in your chest (known as heartburn) and a sour taste in your mouth. You may also have a hoarse voice or bad breath, hiccups or a cough that keeps coming back, or feel bloated or sick.

The chronic severe form of acid reflux is known as gastroesophageal reflux disease (GERD or GORD).

What is the difference between heartburn, acid reflux and indigestion?

Acid reflux and heartburn are different words to describe the same thing: acid from your stomach travelling up towards your throat. They are symptoms of indigestion, which is the general term for when the stomach acid irritates your stomach lining or throat.

The common symptoms of acid reflux are:

• a burning sensation in the middle of your chest, which is known as heartburn
• an unpleasant taste in your mouth
• a burning feeling in your throat

Other symptoms can include:

• bad breath
• hoarse voice
• bloating
• feeling sick
• persistent hiccups
• persistent cough

How long does heartburn last?

Heartburn can last from a few minutes to several hours, depending on what has caused it. It can also return after an initial episode when you lie down or bend over.

Heartburn can have various causes, and for some people, the source is clear. Common triggers include:

• Certain foods: Tomatoes, chocolate, high-fat foods, and spicy dishes can take longer to digest and may increase acidity, leading to excess stomach acid.
• Specific drinks: Coffee and alcohol can relax the muscles connecting the stomach and oesophagus, allowing acid to travel upwards.
• Smoking: Nicotine relaxes the muscle between the stomach and oesophagus, facilitating acid reflux.
• Pregnancy: Hormonal changes and the pressure from the growing baby on the stomach can cause acid to move up the throat.
• Stress & anxiety: These can slow digestion, leading to a buildup of stomach acid.
• Being overweight: Extra weight increases pressure on the stomach, which can trigger more acid production.
• Medications: Painkillers, especially anti-inflammatory drugs like ibuprofen, can contribute to acid reflux.
• Hiatus hernia: This condition, where part of the stomach moves up into the chest, can increase the likelihood of acid buildup.

Does pregnancy cause acid reflux? Yes, acid reflux is common during pregnancy, especially after 27 weeks. Hormonal changes and pressure from the baby on the stomach are key contributors.

If you're pregnant and experiencing heartburn regularly, lifestyle adjustments and certain medications may provide relief.

You can manage acid reflux through lifestyle changes, dietary adjustments, medications, and home remedies. Here's a breakdown of options:

Prescription Treatment:

• Proton Pump Inhibitors (PPIs): These reduce stomach acid production. PPIs should be taken 30 minutes before meals, once or twice a day. They typically take 2-4 days to work and are prescribed for 4-12 weeks. Long-term use may increase the risk of side effects, though risks are generally small. Different PPIs may be prescribed based on your condition. For example, Omeprazole is safe during pregnancy, while Lansoprazole is not. Some common PPIs include:
  • Lansoprazole
  • Omeprazole
  • Pantoprazole
  • Esomeprazole

Antacids:

• Antacids, available over the counter, neutralize stomach acid to relieve heartburn. Popular brands include Gaviscon and Pepto-Bismol. They provide temporary relief but don’t address the underlying cause, so they are not recommended for long-term use.

Lifestyle Changes: Making certain adjustments can help reduce the frequency and severity of acid reflux:

• Quit smoking
• Limit alcohol consumption
• Avoid trigger foods and drinks
• Eat smaller meals and avoid eating 3 hours before bed
• Lose weight if necessary
• Manage stress and anxiety
• Elevate your head and chest while sleeping
• Avoid tight clothing around your waist
• Consult your doctor before starting or stopping any medication

Home Remedies: Some people turn to home remedies, though their effectiveness varies:

• Milk: Can buffer stomach acid, but high-fat milk may worsen reflux.
• Ginger: Its alkaline and anti-inflammatory properties may help neutralize stomach acid.
• Apple cider vinegar and lemon juice: Though acidic, when diluted in warm water, they may provide relief for some people, though research on their effectiveness is limited and they may worsen symptoms for others.

Each treatment option can vary in effectiveness, so it’s important to discuss your condition and treatment plan with a healthcare professional.

Any prescription medicine can have side effects. These can vary from person to person and in how severely they impact your life. In most cases, the side effects will clear up over a few days. Talk to your doctor if they do not or they are impacting your life. 

You should seek immediate medical attention if you notice any of the following rare but severe side effects of taking PPIs:

• sudden wheezing, swelling of your throat, lips and tongue, rash, fainting or difficulty in swallowing (signs of a severe allergic reaction)
• dark pee, yellow skin and tiredness (signs of liver problems)
• reddening of the skin with blisters or peeling, especially in the lips, eyes, mouth, nose and genitals (signs of erythema multiforme or Stevens-Johnson syndrome)
• increase in the number of infections (sign of low white blood cell count)
• diarrhoea (sign of infectious diarrhoea)

Common side effects of PPIs affect 1 in 100 people and include:

• headaches
• feeling or being sick
• constipation
• diarrhoea
• stomach pain
• farting (flatulence)

Rare side effects affect 1 in 1000 people, and very rare side effects impact 1 in 10,000 people. The patient information leaflet for each medicine details these.

If you take PPIs for more than three months, it is possible that the levels of magnesium in your blood may fall. This can impact you through tiredness, muscle contractions, dizziness and disorientation and increased heart rate. Talk to your doctor if you experience any of these symptoms.

PPIs are safe to take, but certain health conditions mean your doctor will carefully consider your situation before prescribing you a PPI for acid reflux.

Do not take Lansoprazole, Omeprazole, Pantoprazole, or Esomeprazol if you are allergic to any of the ingredients.

Your doctor may need to adjust your dose if you have any of the following conditions:

• liver problems
• have ever had a skin reaction after treatment with a similar medicine
• low Vitamin B12 levels
• due for a specific blood test  (Chromogranin A)

You should tell your doctor if you are taking any other medication as they may interact with the PPI they are prescribing you.

If you are pregnant, breastfeeding or trying to conceive, talk to your doctor before taking PPIs.

The primary way you can prevent acid reflux is by learning what triggers it and making changes to your lifestyle accordingly. These changes can include:

• losing weight if you are overweight
• stopping smoking
• reducing your anxiety and stress levels
• changing what you eat and when you eat it

For some people, avoiding specific foods and drinks makes a big difference to their acid reflux. Try eliminating the following foods from your diet one by one and seeing what impact that has:

• fast food including chips and pizza
• fried food
• meats with a higher fat content like bacon
• cheese
• chilli powder
• pepper
• tomatoes
• citrus fruits
• chocolate 
• peppermint
• fizzy drinks
• coffee

It can help if you increase your intake of:

• high fibre foods, which make you feel fuller so you are less likely to overeat
• alkaline foods such as bananas, nuts and melon, as these counteract the acid in your stomach
• watery foods such as lettuce, cucumber, broth-based soups and herbal teas as these dilute the acid

It can also be helpful to eat smaller meals more frequently and leave plenty of time (three hours) between eating and sleeping, avoid clothing that is tight around your waist and sleep with your head and chest higher than your stomach. You can do this by putting something under your mattress so that it is raised slightly under your head.

Here are some references regarding antacids, heartburn, acid reflux, and related treatments:

• Antacids - NHS, November 2019 [accessed 22nd October 2021]
• Heartburn and Acid Reflux - NHS, September 2020 [accessed 22nd October 2021]
• Indigestion - NHS, May 2020 [accessed 22nd October 2021]
• Indigestion and Heartburn in Pregnancy - NHS [accessed 22nd October 2021]
• Esomeprazole 20 mg Gastro-resistant Tablets - EMC [accessed 22nd October 2021]
• Lansoprazole - NHS, November 2018 [accessed 22nd October 2021]
• Lansoprazole 15mg Gastro-resistant Capsules - EMC [accessed 22nd October 2021]
• Omeprazole - NHS, November 2018 [accessed 22nd October 2021]
• Omeprazole 20mg Gastro-resistant Capsules - EMC [accessed 22nd October 2021]
• Pantoprazole 20 mg Gastro-resistant Tablets - EMC [accessed 22nd October 2021]
• Silent Reflux Update - NHS [accessed 22nd October 2021]