Understanding Acid Reflux and When to See a Specialist

Acid reflux — also known as gastro-oesophageal reflux disease (GERD) — is one of the most common digestive conditions, affecting approximately 20% of adults in the Western world. While occasional heartburn is normal, frequent or persistent reflux can indicate a more significant problem that may benefit from specialist assessment and treatment.

What Is Acid Reflux?

Acid reflux occurs when stomach acid flows back up into the oesophagus (the tube connecting your mouth to your stomach). This happens when the lower oesophageal sphincter (LOS) — a ring of muscle at the bottom of the oesophagus — relaxes inappropriately or becomes weakened.

The acid causes irritation and inflammation of the oesophageal lining, leading to the characteristic burning sensation known as heartburn. When this happens frequently (more than twice a week) or causes complications, it is classified as GERD.

Common Symptoms

GERD presents with a range of symptoms that extend beyond simple heartburn:

• Heartburn: A burning sensation rising from the stomach to the chest and throat, often worse after meals or when lying down.
• Acid regurgitation: An unpleasant sour or bitter taste in the mouth from stomach acid reaching the throat.
• Difficulty swallowing (dysphagia): A sensation of food getting stuck, which may indicate narrowing of the oesophagus.
• Chest pain: Can mimic cardiac chest pain — always have chest pain assessed urgently to rule out heart problems first.
• Chronic cough: Acid irritating the airways can cause a persistent dry cough, particularly at night.
• Hoarse voice: Acid reaching the voice box (larynx) causes laryngopharyngeal reflux (LPR).
• Feeling of a lump in the throat (globus): A common but distressing symptom often associated with reflux.

What Causes GERD?

Several factors contribute to the development of acid reflux:

• Hiatus hernia: The stomach pushes up through the diaphragm, weakening the LOS. Present in about 60% of people with GERD.
• Obesity: Increased abdominal pressure pushes stomach contents upward. Even modest weight gain increases reflux risk.
• Diet: Fatty foods, chocolate, coffee, alcohol, spicy foods, citrus, and tomatoes can trigger symptoms.
• Smoking: Weakens the LOS and increases acid production.
• Medications: Some medications (NSAIDs, calcium channel blockers, nitrates) can worsen reflux.
• Pregnancy: Hormonal changes and increased abdominal pressure make reflux very common in pregnancy.

Lifestyle Modifications

For many patients, lifestyle changes are the first and most important step in managing reflux:

• Weight management: Losing 5–10% of body weight can significantly reduce symptoms.
• Elevate the head of the bed: Raise the head end by 15–20cm using blocks under the bed legs (extra pillows alone don't work well).
• Avoid eating late: Have your last meal at least 3 hours before lying down.
• Reduce trigger foods: Identify and limit foods that worsen your symptoms.
• Stop smoking: This has multiple health benefits beyond reflux control.
• Avoid tight clothing: Tight belts and waistbands increase abdominal pressure.

Medication Options

When lifestyle changes alone are insufficient, medications can effectively control symptoms:

• Antacids (Gaviscon, Rennie): Provide quick, short-term relief by neutralising stomach acid. Useful for occasional symptoms.
• H2 blockers (ranitidine, famotidine): Reduce acid production. Moderate effectiveness, fewer side effects than PPIs.
• PPIs (Proton Pump Inhibitors) (omeprazole, lansoprazole, esomeprazole): The most effective acid-suppressing medications. Reduce acid production by up to 95%. Usually taken for 4–8 weeks initially.

Long-term PPI use should be reviewed regularly. While generally safe, prolonged use has been associated with small risks including vitamin B12 deficiency, magnesium deficiency, and slightly increased fracture risk. I help patients find the lowest effective dose.

Barrett's Oesophagus: Understanding the Risk

Long-standing acid reflux (typically more than 5–10 years) can cause the cells lining the lower oesophagus to change — a condition called Barrett's oesophagus. This affects approximately 1 in 10 people with chronic reflux.

Barrett's oesophagus is important because it is a pre-cancerous condition with a small but real annual cancer risk of 0.5–1%. However, with regular surveillance gastroscopies and appropriate treatment, the risk can be managed effectively. Most people with Barrett's never develop cancer.

Red Flag Symptoms — When to See a Specialist

You should seek specialist assessment from a gastroenterologist if you experience any of the following:

• Difficulty swallowing (dysphagia) — food getting stuck
• Painful swallowing (odynophagia)
• Unintentional weight loss
• Persistent vomiting
• Vomiting blood or dark, coffee-ground material
• Black, tarry stools (melaena)
• Symptoms persisting despite 8 weeks of PPI treatment
• Reflux symptoms starting after age 55
• Anaemia (iron deficiency)

These symptoms may indicate complications such as oesophageal stricture, Barrett's oesophagus, or rarely, oesophageal cancer. Early investigation with a gastroscopy can provide answers and peace of mind.

When to Get an Endoscopy

A gastroscopy is recommended if you have red flag symptoms, long-standing reflux (more than 5 years), reflux not responding to PPIs, or are over 55 with new reflux symptoms. The procedure takes just 5–10 minutes and provides a definitive view of your oesophagus and stomach.

I offer comprehensive acid reflux assessments at The Beaumont Hospital in Bolton and Spire Fylde Coast Hospital in Blackpool. Book an appointment — no GP referral is needed.