Acid reflux is a very common condition. Up to 60% of the population is estimated to suffer from acid reflux at some time during the year, while 20-30% experience it on a weekly basis. But although acid reflux isn’t rare, the symptoms it causes – uncomfortable burning in your chest and throat (heartburn), a bitter taste in the back of your throat, food regurgitating from your stomach into your mouth – can still be unsettling and even painful.
Thankfully, acid reflux is easily managed with treatment. With the right combination of lifestyle changes, dietary alterations and prescription medications, you’ll be able to control acid reflux and get back to doing the things you love most.
What is acid reflux?
Acid reflux occurs when excess stomach acid rises up into the oesophagus – the tube that connects your throat and mouth. This backwashed stomach acid can then irritate the lining of the oesophagus.
While the majority of people experience acid reflux from time to time, people who experience it at least twice a week – or once a week if the symptoms are moderate to severe – are classed as having gastroesophageal reflux disease (GERD).
What causes acid reflux?
The lower oesophageal sphincter is a bundle of muscles at the end of the oesophagus that closes to prevent acid leaving the stomach. Acid reflux occurs when these muscles fail to close completely, allowing stomach acid and contents to seep back up the oesophagus.
In most cases, acid reflux is set off by triggers – dietary or lifestyle factors that cause the symptoms. Acid reflux triggers usually come from food, but they can also include:
- Being overweight
- Stress and anxiety
- Certain medications
- A hiatus hernia – where part of your stomach moves up into your chest
If your acid reflux is caused by lifestyle factors, it’s useful to address them first before considering medications. Quitting smoking, for example, could have a huge impact on your acid reflux. Losing weight, as well, can help the body digest food more easily, which in turn reduces reflux symptoms.
What foods should I avoid if I have acid reflux?
It’s important to remember that no one trigger for acid reflux will affect everybody in the same way. However, certain foods are more likely to set off symptoms. These include:
- Alcohol – especially red wine
- Black pepper
- Raw onions
- Spicy foods
- Citrus fruits and products, including fruit juices
- Fatty foods
In addition to specific foods, acid reflux can also be triggered by the way you eat. Overeating, for example, or eating too quickly can set off symptoms. If you’re struggling with acid reflux when you go to bed, you should also make sure you eat dinner at least two hours before. Lying down makes digestion difficult, increasing the likelihood of reflux.
What are the symptoms of acid reflux?
Most people will be familiar with the classic symptom of acid reflux: the burning feeling in your chest and throat more commonly known as heartburn. Heartburn, however, isn’t the only symptom of acid reflux. Other symptoms include:
- Chest pain
- Difficulty swallowing
- Food or sour liquid travelling back up into your throat (regurgitation)
- Feeling like there’s a lump in your throat
- Increased salivation
In addition to these symptoms, more serious ones can occur if you regularly experience reflux at night. These include:
- Chronic cough
- New or worsening asthma
- Disrupted sleep
If untreated, chronic instances of GERD can lead to potentially serious complications, including:
- Oesophagitis – where the oesophagus becomes inflamed which can cause GERD symptoms alongside vomiting and abdominal pain
- Oesophageal stricture – where tightening of the oesophagus can cause GERD symptoms, choking, shortness of breath, frequent burping or hiccups, pain or trouble swallowing, throwing up blood and weight loss
- Barret’s oesophagus – where an abnormal change in cells lining the lower portion of the oesophagus can cause frequent, longstanding heartburn, difficulty swallowing, vomiting blood pain under the sternum, and unintentional weight loss
What treatments are there for acid reflux?
Although acid reflux can be a troublesome condition, there are a host of over-the-counter and prescription medications that can effectively alleviate the symptoms.
Over-the-counter treatments such as Gaviscon typically work by keeping stomach acid where it belongs using a protective barrier known as a raft. The raft usually forms within a few minutes of taking the treatment, and forms on the surface of the stomach contents. This blocks the contents travelling up into the oesophagus, preventing the classic symptoms of acid reflux.
Although over-the-counter medications for heartburn usually work quite quickly, they tend to need reapplying throughout the day. Gaviscon, for example, lasts for up to four hours, meaning you’d have to use more as your symptoms return.
What are the side effects of Gaviscon?
Gaviscon is usually well-tolerated by people who use it. However, mild side effects can occur, and these include:
- Stomach cramps
- Taste impairment
If you experience any side effects while taking Gavison that trouble you, you should contact your GP.
What prescription medications are available for acid reflux?
Prescription medications for acid reflux are usually taken orally once a day to alleviate reflux symptoms. These medications, known as proton-pump inhibitors (PPIs), are the most effective treatments for blocking the secretion of stomach acid. They work by targeting the final step in the production of stomach acid, which is caused by the hydrogen/potassium adenosine triphosphatase enzyme system (or, more commonly, the gastric proton pump).
By targeting this final stage, PPIs become a highly effective means of blocking the secretion of stomach acid. In addition, the mechanism of PPIs is irreversible, which means they can alleviate symptoms for prolonged periods of time.
Examples of PPIs include:
PPIs come in a variety of dosages depending on how severe your reflux symptoms are. They’re taken once a day, and should be taken in the morning before food. While highly effective over the short-term, there’s little evidence to suggest that it is necessary to take PPIs over longer periods of time in most cases.
Before you take a PPI, it’s important to let your doctor know if:
- You have a vitamin B12 deficiency
- You have ever had liver disease
- You are allergic to PPIs or any other medication
- You are due for an endoscopy
What are the side effects of medications like omeprazole?
In most instances, PPIs such as omeprazole are tolerated very well by those who take it. However, common side effects include:
- Stomach pain
If you experience any side effects while taking PPIs that trouble you, you should contact your GP.
In addition to common side effects, in some cases rare but serious side effects can emerge. These include:
- Signs of liver problems, including yellow skin, dark urine and tiredness
- Subacute cutaneous lupus erythematosus (joint pains with skin rash)
Contact your GP immediately if you develop these side effects.
How long will I take heartburn treatment for?
Generally speaking, over-the-counter medications can safely be taken over long periods of time without much risk. However, PPIs should only be taken for a maximum of two weeks. If you’re still experiencing reflux after two weeks of taking a PPI, you should contact your doctor for further assessment.
What if I take medications like omeprazole for a long period of time?
Taking a PPI for longer than three months can cause a serious reduction in your body’s magnesium levels, leading to tiredness, confusion, muscle twitches and an irregular heartbeat. After a year, you may be at more risk of developing bone fractures, a vitamin B12 deficiency or gut infections. There is also evidence to suggest that long-term use of PPIs increases your risk of developing stomach cancer.
Talk to your doctor immediately if you experience any of these symptoms while taking PPIs.
I’ve heard Losec and Pyrocalm also treat acid reflux. What are they?
Losec and Pyrocalm are branded versions of omeprazole. They’re medically equivalent, meaning neither will work more effectively than generic forms of the treatment. However, unlike generic omeprazole, Losec can be dissolved in water for people who have difficulty swallowing tablets. Pyrocalm, on the other hand, is available over-the-counter, unlike generic omeprazole.