Acid reflux, also known as heartburn, can make eating a miserable experience. It feels like acid burning in your chest or throat which is exactly what it is – excess stomach acid travelling the wrong way up your oesophagus to places where it shouldn’t be. An occasional attack is easily managed at home but if you suffer regularly, it can damage your throat and lead to the chronic condition, gastro-oesophageal reflux disease. Thankfully, there are plenty of effective over-the-counter and prescription treatments to make you feel more comfortable when you eat.
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Acid reflux and heartburn are similar conditions that are caused by Gastroesophageal Reflux Disease (GORD). GORD is a very common condition where acid from the stomach leaks out into the oesophagus (gullet) and can travel all the way up to the throat.
There are various reasons why someone may suffer from acid reflux or heartburn, the most common being a failure of the lower oesophageal sphincter. This sphincter comprises a ring of muscles that act as a valve, allowing food to enter the stomach whilst keeping acid from exiting. If the lower oesophageal sphincter doesn’t close fully, it can let acid leak up out of the stomach.
There are known triggers that can contribute to experiencing acid reflux and heartburn, these include:
Acid reflux will involve stomach acid being regurgitated into your throat and mouth. This regurgitation will commonly lead to a sour-bitter, ‘acidy’ taste at the back of your mouth and throat.
Heartburn differs slightly as it will present as a discomforting burning pain just below your breastbone. This pain can move into the chest and even into the throat. This pain is usually found to be worse after eating, or when bending over or lying down.
If you are only experiencing symptoms a few times a month that can be attributed to food and/or drink then it may not be necessary to see a doctor; self-diagnosis and treatment is likely to be appropriate.
If the symptoms are new in onset or become more severe and frequent and the use of over-the-counter remedies has proven ineffective then it is then recommended to seek medical advice.
Less common symptoms that can be the result of regurgitated stomach acid include:
If you have any of the above symptoms, you should discuss them with your GP first.
For the majority of cases, a doctor will be able to diagnose gastroesophageal reflux disease from your symptoms and medical history – this is covered as part of your consultation. For mild and infrequent cases of acid reflux, indigestion or heartburn that are associated with food, alcohol or other known causes, self-diagnosis may be appropriate.
If you have any of the following symptoms, physical examination by your doctor will be required:
If required, your doctor can carry out further testing of your symptoms using various different methods. These include:
There are many treatment options available for this condition. Very mild cases can sometimes be treated using over-the-counter medications, such as:
Most over-the-counter antacid remedies work by neutralising the effects of stomach acid. Alginate preparations, such as Gaviscon work differently. Alginates provide a protective coating, designed to shield the lining of the stomach and oesophagus from the effects of stomach acid. These work best if taken just after eating a meal.
If over-the-counter treatments are proving ineffective then you may try a proton-pump inhibitor (PPI). Proton-pump inhibitors are widely used as they are well tolerated by most patients and rarely produce side effects. PPIs work by reducing the amount of acid produced by the stomach. Examples of PPIs include:
When prescribing PPIs, such as Omeprazole, you start with the lowest possible dose that will be effective in controlling your symptoms. If Omeprazole 10mg Capsules are ineffective, it is important to inform your prescriber so they can assess and potentially increase your dose.
Another type of treatment is H-2 antagonists, such as Famotidine. Famotidine blocks the production of stomach acid by a different mechanism to PPIs but with the same acid-reducing effects. Ranitidine is a long-established and effective treatment for acid reflux and heartburn that is well tolerated and normally causes few side effects.
If PPIs, such as Omeprazole, and H-2 antagonists, such as ranitidine, have proven ineffective or if the thought of taking medication on a long-term basis is unappealing, then surgery can be an alternative. You should discuss this with your GP.
There are steps you can take which will help reduce the risk of experiencing acid reflux and heartburn. These include:
There are many treatment options available for acid reflux and heartburn. Very mild cases can sometimes be treated using over-the-counter medications (available without a prescription from your pharmacy), such as:
Most over-the-counter antacid remedies work by neutralising the effects of stomach acid. Alginate preparations, such as Gaviscon work differently. Alginates provide a protective coating, designed to shield the lining of the stomach and oesophagus from the effects of stomach acid. These work best if taken just after eating a meal.
It is the movement of the stomach contents up the oesophagus or gullet. Often causing an uncomfortable or burning sensation behind the breastbone.
In more serious or left untreated, Stomach contents can be regurgitated into the mouth affecting the teeth, gums and causing bad breath.
Sometimes the regurgitated fluid can enter the airways and exacerbate or make asthma worse.
The stomach has a small circular piece of muscle at the top, called the cardiac or lower oesophageal sphincter.
This stops the stomach contents from travelling back up the oesophagus or gullet.
When this muscle becomes weakened, the stomach contents can travel up and cause symptoms like heartburn, bad breath and the feeling of being sick.
It is very common and 60% of people will have reflux or similar symptoms in a 12-month period.
In the same period, 20-30% of people will have symptoms on a weekly basis.
The movement of acid can give the following symptoms
The following can make acid reflux worse.
Most symptoms of acid reflux can be treated either with over the counter remedies or by visiting your pharmacy.
It’s important to get your symptoms checked by a Doctor if you’re
There are different categories of treatment and their uses and explanations are listed below.
Generally, patients should start with antacids and then make their way down the list if treatment does not control their symptoms.
1. Antacids – the first line treatment. These help neutralise stomach acid to relieve symptoms. The effects usually last for 2-3 hours. Examples of antacids include Rennie, Enos, Andrews Salts, and Tums. They contain ingredients like calcium carbonate, which neutralizes stomach acid, but too much calcium taken regularly can make acid reflux worse. Only be for occasional or infrequent use.
2. Alginates – neutralize and form a layer on the top of stomach acid, which prevents upward movement. Are available in tablet and liquid forms. Liquids act quicker but are more inconvenient to carry around. Usually, these last no more than 3-4 hours.
Alginates are made up of calcium carbonate, magnesium carbonate or aluminum salts. Too much calcium taken frequently can cause stomach acid to worsen, so should only be used infrequently. Excessive magnesium salts can cause diarrhoea and too much aluminum salts can cause constipation.
Always check with pharmacist, as alginates can interact with other medication. Examples include Gaviscon, Gaviscon Advance, and Peptac.
3. H2 Receptor Antagonists – available as tablets. They reduce the production of stomach acid and were initially introduced on prescription, before being available to buy from pharmacies. They start to work in as little as 30 minutes and their effects can last for up to 12 hours. They are well tolerated and side effects are rare. They can include diarrhoea, tiredness, rashes, and constipation. Examples include Ranitidine, Zantac, Gavilast, Cimetidine, and Pepcid AC.
4. Proton Pump Inhibitors – or PPIs for short, are the latest medicine for controlling acid reflux and other stomach symptoms. They work by reducing the stomach acid, but are more effective and last longer. Effects can be seen up to 17 hours after the dose is taken. They come in tablet or capsule forms, be should be swallowed whole (Losec Tablets can be crushed if needed). PPIs are very well tolerated, with low incidence of side effects. Usually, unwanted effects include diarrhoea, constipation, drowsiness. Examples include Omeprazole, Pantoprazole, Losec, Nexium, and Pantoloc.
Short-term treatment with medication will help to control and alleviate the symptoms. Treatment time varies with different medication and can be very quick with antacids working within minutes and H2 receptor Antagonists and PPI’s up to 60mins.
Non-medicinal treatments to help alleviate acid reflux include:-
Yes, acid reflux can affect the sinuses for those that are struggling with the condition over a long period of time. Acid reflux can actually cause hoarseness, sore or burning throat, post-nasal drip, sinusitis, cough and lots more.
Given the close proximity of acid reflux symptoms and your nose throat and ears, it’s common to have other symptoms that affect that specific area.
Acid reflux and heartburn affect the body in a number of different ways. The severity of symptoms vary from person to person, however,there are some similar signs that tend to be consistent. Things like burning in the chest behind the breastbone, pain after eating or lying down and a sore throat.
Acid reflux can cause stomach acid to be brought up into the mouth causing bad breath, tooth decay and discolouration of the tongue in some cases.
If this condition is still not easing after taking medication or you have been suffering with it for more than a couple of times a month, then this can be caused by other medical conditions such as stomach ulcers, issues with the oesophagus or GORD.
There are different stages of GORD which is why it is so important to speak to a healthcare professional if symptoms persist.
Acid reflux is usually diagnosed from your symptoms. Our doctors will ask about your symptoms, when they occur and the severity. From this, they will be able to make a diagnosis of acid reflux or heartburn. Simply fill in our consultation form so we can ascertain your medical history.
Depending on the severity of the condition, doctors may prescribe medication to help get symptoms under control. If they are unable to determine the cause of your symptoms, or they are very severe, you may be sent for more in depth-testing. This will help to determine the cause and the right form of treatment for your specific condition.
Treatment for GORD may differ depending on the stage of the disease you are in. If you are experiencing symptoms of acid reflux or heartburn on a regular basis then it’s important to consult a doctor to avoid complications.
Some believe that milk and other natural remedies will help to ease the symptoms of acid reflux and heartburn. However, their effectiveness is unknown. Milk is known to reduce symptoms straight after drinking it, but could actually cause symptoms to become worse after a while. This is mainly because of the high quantity of fat in milk products.
If you would like to reduce the symptoms of acid reflux or heartburn then the best option is using specifically designed medication to treat the underlying causes of the condition.
It is best to treat a baby or young child suffering from heartburn or acid reflux using natural means. The best way to do this effectively is to change your child's eating pattern, holding them upright for 30 minutes after feeds and raising the head of the baby's crib.
Authored by
Andy is a co-founder and the Superintendent Pharmacist and Director at The Independent Pharmacy.
Reviewed by
Dan is an experienced pharmacist having spent time working in both primary and secondary care. He currently supports our clinical team by providing robust clinical governance review of our internal processes and information.
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