Acid Reflux (Heartburn) - Triggers and treatments to ease

Certain foods

Many foods can cause acid build-up in the stomach. Particular culprits include spicy food, fatty food, tomatoes and tomato-based food, chocolate and caffeine.

Pattern of eating

Reflux is more likely in those who skip meals, eat large meals, or have their meal shortly before bed.

Alcohol

Binge drinking or repeatedly drinking more than the maximum recommended limit may contribute to reflux.

Smoking

Both the chemicals and smoke itself can cause damage to the delicate lining of the oesophagus, so whether you smoke or you live or work in smoky environments, stopping smoking and avoiding smokers around you can help with reflux symptoms. If you need help to stop smoking, you can read through the Healthwords stop smoking guide.

Obesity

Anything that causes stomach contents to be squashed can push acid the wrong way past the oesophageal sphincter, causing acid reflux. Obesity puts pressure on stomach contents via this mechanism.

Pregnancy

In a similar way, a growing pregnancy takes up more of the abdominal cavity, causing the stomach to be squashed and increasing the chance of acid reflux.

Hiatus hernia

The sack of the stomach usually sits below the diaphragm, the wall of muscle under your lungs that helps you breathe. Hiatus hernia is an anatomical variant where your stomach sack moves up through a narrow opening in the diaphragm, into your chest. It’s quite common in those over 50, and if it’s not causing problems, it doesn’t need treatment. However, acid reflux or that burning feeling in the chest is a common symptom.

H Pylori bacteria

This is a bacteria that can set up home in your stomach and produce much more acid, and it’s ful name is Helicobacter pylori. Testing for it is fairly simple – a stool test, breath test or tissue biopsy if you are having a camera investigation – and treating it is fairly simple, with a combination of antibiotics and acid suppressants.

Stress and anxiety

Most people are familiar with the feeling of “having a knot in your stomach” when you’re feeling worried, but with ongoing anxiety or panic disorder, this adrenaline-fuelled can cause a repeated surge of stomach acid that can develop into reflux. It’s important to address matters of the mind alongside the body, and physical and mental symptoms are always connected.

Medications

A number of medications can cause or exacerbate acid reflux. It’s important to be aware of overuse of some of the most common medications bought from your pharmacy, like NSAIDs (non-steroidal anti-inflammatory drugs) which includes ibuprofen and aspirin, or those prescribed liked naproxen and diclofenac. Always take these at mealtimes to reduce acid build-up.

Others prescribed by your doctor include those for high blood pressure (hypertension), called beta-blockers, calcium channel blockers and alpha-blockers (also used to treat an enlarged prostate), steroid tablets to treat autoimmune or inflammatory disorders, anticholinergics to treat an overactive bladder, tricyclic antidepressants, an older type of medication, nitrates for angina, theophyllines for asthma or COPD, bisphosphonates for osteoporosis and benzodiazepines as short term pain relief or sedation in mental health disorders.

Cancer

Rarely but importantly, cancer in the upper gastro-intestinal tract (top of the digestive system) can cause reflux. This includes cancers of the oesophagus, stomach, pancreas, gallbladder and liver. While each gives slightly different symptoms, red flags to alert you to a serious problem include unintentional weight loss, poor appetite, progressive difficulty swallowing or regurgitating foods and liquids, and yellowing of the skin and eyes, called jaundice. Blood tests may show jaundice in a liver function test, and a cause for any iron deficiency anaemia should also be sought.

Acid reflux can be treated with medications that work in different ways and provide either immediate or long-term relief. They can also be combined to maximise their effectiveness.

Antacids, such as Rennie, neutralise excess acidity and provide immediate and short-term relief for a few hours. Antacids based on alginate, such as Gaviscon, can have a similar effect, but they also form a protective coating in the stomach, which can relieve symptoms for several hours.

Proton pump inhibitor (PPI) medications work by decreasing the amount of acid secreted into stomach juices. They are more effective than antacids in terms of duration of action, and the active ingredient is usually omeprazole, esomeprazole, or lansoprazole. There are now some versions which are now available to buy without a prescription such as Nexium Control (contains esomeprazole), and Pyrocalm tablets (containing omeprazole). Higher dose versions may still need to be prescribed for some people. Common side effects of PPIs are generally mild and tolerable for most people but may include: headaches, stomach aches, diarrhoea, constipation, wind and nausea.

H2 receptor blockers, a type of gut antihistamine, work differently to PPIs by reducing the amount of acid produced by the stomach in the first place. Ranitidine (found in Zantac), cimetidine, or famotidine are the most common active ingredients. As of August 2022, there is limited over-the-counter stock available due to a recall prompted by safety concerns about levels of N-nitrosodimethylamine (NDMA), a nitrosamine impurity. However, some manufacturers are looking to reintroduce it to the market.

Acute acid reflux (symptoms lasting less than 2 weeks):

We recommend an antacid such as Rennie tablets or an alginate such as Gaviscon suspension, to give immediate relief to neutralise acid reflux and heartburn from flare-ups or after a fatty or spicy meal.

For prevention or protection throughout the day:

We would suggest a PPI such as Nexium (esomeprazole 20mg), taken once every morning, to give all-day protection to the lining of the stomach. You should take it with water, but you don’t need to take it with food.

Acid reflux during pregnancy and breastfeeding:

Antacids such as Rennie or Gaviscon are safe to take for short-term relief. The manufacturers of PPIs such as Nexium Control do not recommend use, so it may be worth a discussion with your doctor about the risks versus benefits of any particular medication.

Acid reflux in babies:

Gaviscon infant sachets can be purchased at the pharmacy, however it is advisable to consult with a doctor before use, to confirm the diagnosis, as normal posseting of baby milk is often mistaken for reflux, and there may be other causes to symptoms for a doctor to consider.

Meal adjustments can make all the difference. Eat smaller meals, even if this means eating four times a day, rather than the usual three. Make sure you stick to regular mealtimes and don’t skip. Bring your evening meal earlier, so you have at least three to four hours after eating before you go to bed (lying down on the sofa is also a bad idea).

Adapting your diet can help – start by cutting out any potential triggers in your usual intake. Once symptoms are under control, you can keep a diary and gradually re-introduce them one by one, but keep them in moderation and cut them out again if reflux returns.

Elevating the head of your bed by 10 to 20cm may help, as it keeps your chest higher than your stomach, to allow gravity to work by keeping stomach contents where they should be.

Losing weight if you are overweight or obese (a BMI or Body Mass Index over 25), will help acid reflux, and may even resolve it. This is best done with sensible low-calorie food options and a sustainable exercise programme. If you also have a hiatus hernia, weight loss may also ease pressure pushing this up into the chest.

Stopping smoking can help in the long term for the oesophagus to recover and regenerate newer, healthier cells. This is alongside all of the other health benefits a smoke-free existence gives you.

Alcohol consumption similarly, should be addressed by avoiding binge drinking and sticking to the recommended limit of 14 units per week. It’s a good idea to have at least two alcohol-free days in the week, to rest your system.

Stress and anxiety may play a role in your life, and it’s worth addressing these with whatever measures you feel appropriate – for severe cases, this may need a discussion with your doctor or professional guidance from a psychologist. For everyone, introducing relaxation techniques, either formal such as mindfulness or body scanning, or whatever helps you unwind – yoga, music, a hearty walk, a good book. Whatever can be easily incorporated into your daily routine.

Drinking peppermint tea is thought to aid digestion, and chamomile tea is thought to have soothing properties on the digestive tract, as well as helping to soothe an anxious mind. But you should avoid chamomile if have a ragweed allergy. Ginger tea has long been celebrated as an aid to digestion and in alleviating stomach pain.

Liquorice supplements are said to increase the production of mucus to coat the oesophageal lining, thereby making it more resistant to the abrasion of stomach acid. Make sure any supplements contain deglycyrrhinzinated liquorice, as too much glycyrrhizin is thought to be harmful.

Loosen your belt and stand up straight after eating, to help take the pressure off the oesophageal sphincter while you digest your food, giving gravity a chance to keep stomach acid in the right place.

Chewing gum for about half an hour after eating has been shown in studies to reduce the stomach acid surge associated with mealtimes, as it increases saliva production, which helps to dilute the acid and coat the oesophagus in a protective shield. Pick sugar-free gum to keep your teeth happy.

Can prebiotics and probiotics help acid reflux?

The doctors at Healthwords think that nurturing the gut microbiome makes sense in building up a healthy balance of bacteria and protecting it from harmful bacteria like H Pylori. This should all reduce the risk of acid build-up and reflux. Currently there isn’t enough scientific data to support this, but neither is it known to be harmful. Try four weeks of daily prebiotic or probiotic drinks or supplements, or fermented mild drinks or kefir and see if it helps symptoms.

If you’ve taken the suggested lifestyle measures, and you’ve tried over-the-counter medication for more than 1 to 2 weeks without sufficient improvement, or if your symptoms are having a serious impact on your daily life, it’s worth seeing your doctor.

If you think one of your prescribed medications could be contributing to acid reflux, before reducing or stopping this, discuss it with your doctor to agree on a plan together.

If you have any serious symptoms like unintentional weight loss, reduced appetite, difficulty swallowing or regurgitation of food and drink, you should book an urgent appointment with your doctor.

The doctor will examine your abdomen, look for signs of anaemia or jaundice, and they may weigh you. They may suggest a blood test and stool test. Depending on their findings, they may send you for further tests, such as a camera tube down the throat, called an endoscope, or they may suggest a scan. If they think cancer is a high probability, they will refer you urgently to a specialist gastrointestinal team.

Acid reflux is a very common problem that most people suffer with from time to time, and some people are prone to flare-ups. Most people can think of things in their recent lifestyle choices that have slipped, and they rein these in. But it can help to have a few medications at home that they know work for them.