Symptoms and conditions
What is acid reflux? A beginner’s guide to heartburn
Acid reflux is the backward flow of stomach contents into the food pipe. It causes heartburn, a burning feeling behind the breastbone, and a sour taste in the mouth. Occasional reflux is normal. When it happens twice a week or more, disturbs sleep or needs regular medicine, it is called GERD and deserves proper treatment.
In short
- Reflux happens when the valve between the food pipe and the stomach does not close firmly.
- Large meals, late dinners, weight around the waist, alcohol and smoking make it worse.
- Changes in meal timing and sleep position help most people. Medicines help when these are not enough.
- Difficulty swallowing, weight loss, vomiting blood or black stools need prompt medical attention.
What does acid reflux feel like?
- A burning feeling rising from the upper abdomen into the chest
- Sour or bitter fluid in the throat or mouth
- Symptoms that are worse after meals, on bending or on lying down
- Burping, and a feeling of a lump in the throat
- A night-time cough or a hoarse voice in the morning
People often call this “acidity” or “gas”. The words overlap, but the cause is the same: stomach contents moving in the wrong direction.
Is heartburn related to the heart?
No. The name describes where the burning is felt. But pain from the heart can be mistaken for heartburn.
Treat chest pain as a heart emergency if
- It comes with sweating, breathlessness or nausea
- It spreads to the arm, neck or jaw
- It comes on with exertion and eases with rest
Go to the nearest emergency department. Do not take an antacid and wait.
See chest pain: acidity, gas or the heart?
Why does reflux happen?
A ring of muscle at the lower end of the food pipe acts as a valve. Reflux occurs when it relaxes at the wrong time or is weakened. The common reasons are:
- Large or fatty meals, which stretch the stomach and slow its emptying
- Lying down soon after eating
- Weight around the waist, which presses on the stomach
- A hiatus hernia, in which part of the stomach slides into the chest
- Alcohol and smoking, which relax the valve
- Pregnancy
- Some medicines, including certain painkillers and blood-pressure tablets
What should I try first?
Change the timing
Finish dinner three hours before bed. Avoid lying down or bending after meals.
Change the size
Smaller meals, eaten slowly. A very full stomach refluxes more.
Raise the head end of the bed
By 15 to 20 centimetres, using blocks under the bed’s legs or a wedge. Extra pillows do not work as well.
Find your triggers
Common ones are fried and fatty food, very spicy food, coffee, chocolate, mint and alcohol. Test them one at a time; you may tolerate more than you expect.
Look at weight
Losing even a few kilograms from around the waist reduces reflux.
Give these two to four weeks. See also acidity home remedies.
Which medicines are used?
- Antacids and alginates neutralise acid or form a barrier on top of the stomach contents. They act within minutes and suit occasional symptoms.
- Acid-blockers reduce the amount of acid the stomach makes. They are taken before a meal, usually for four to eight weeks, and then reviewed.
Taking an acid-blocker for months without a review is common and avoidable. See what to do after years on acid-blockers.
When should I see a doctor?
- Symptoms twice a week or more, despite the steps above
- Symptoms that return as soon as medicine is stopped
- Food sticking, or pain on swallowing
- Weight loss, vomiting, black stools or a low blood count
- Reflux that begins for the first time later in life
A doctor may advise an endoscopy or other tests. The full approach is described on the acid reflux and GERD page.
Questions patients ask me
Does cold milk help acidity?
It can give relief for a short while by coating the food pipe. It does not treat reflux, and a large glass at bedtime can make night-time symptoms worse.
Is reflux in pregnancy harmful?
It is very common and usually settles after delivery. Smaller meals and raising the head of the bed help. Ask your doctor before taking any medicine.
Will I have reflux for life?
Not necessarily. Many people control it fully with changes in eating and weight. Others need medicine from time to time, and a few need long-term treatment or an operation.
Does stress cause acid reflux?
Stress does not increase acid very much, but it makes the food pipe more sensitive, so the same reflux is felt more strongly. It also leads to habits, such as late meals and poor sleep, that worsen reflux.
Sources
This page is written for patients and is based on the guidelines and studies below. It is for education and does not replace a consultation.
- American College of Gastroenterology guideline on gastro-oesophageal reflux disease. Katz PO et al. Am J Gastroenterol. 2022. doi:10.14309/ajg.0000000000001538
- Indian consensus on gastro-oesophageal reflux disease in adults. Bhatia SJ et al. Indian J Gastroenterol. 2019. doi:10.1007/s12664-019-00979-y
- Review of lifestyle measures in reflux disease. Ness-Jensen E et al. Clin Gastroenterol Hepatol. 2016. PubMed 25956834