Acid Reflux (GERD)
Symptoms, Causes & Treatment
Acid reflux (GERD) is one of the most common GI conditions, affecting up to 20% of UK adults weekly. It is caused by gastric acid refluxing into the oesophagus. Most cases are managed effectively with lifestyle changes and acid-suppressing medication.
What is Acid Reflux (GERD)?
Gastro-oesophageal reflux disease (GORD) occurs when gastric acid repeatedly flows back into the oesophagus, causing heartburn, regurgitation, and in severe cases, oesophageal mucosal damage. Risk factors include obesity, hiatus hernia, H. pylori, pregnancy, smoking, alcohol, and high-fat diet. Chronic untreated GORD can cause Barrett’s oesophagus, a pre-malignant condition requiring endoscopic surveillance.
Symptoms of Acid Reflux (GERD)
GORD symptoms are characteristically worse after eating, on lying down, and at night. Alarm symptoms require urgent assessment.
Burning chest or upper abdominal pain after eating · Acid or bitter taste in mouth · Pain worse when lying down or bending forward · Regurgitation of food or liquid · Bloating and belching · Nocturnal symptoms waking from sleep · Sore throat or hoarse voice from reflux
Dysphagia (difficulty swallowing) · Haematemesis (vomiting blood) · Unexplained weight loss with reflux symptoms · Persistent vomiting · Iron deficiency anaemia with GI symptoms · Chest pain that may indicate cardiac cause — requires urgent assessment
Dysphagia · Vomiting blood · Black tarry stools · Unexplained weight loss · New heartburn over age 55 — see a GP urgently or go to A&E.
What Causes Acid Reflux?
GORD is caused by failure of the lower oesophageal sphincter mechanism, allowing gastric acid to reflux into the oesophagus.
GORD occurs when the lower oesophageal sphincter is weakened, allowing gastric acid to reflux into the oesophagus. It is caused by increased intra-abdominal pressure from obesity, pregnancy, hiatus hernia, smoking, and dietary triggers.
A hiatus hernia occurs when part of the stomach slides or rolls through the diaphragmatic hiatus into the chest, impairing the oesophageal sphincter mechanism. Sliding hiatus hernias (most common) strongly predispose to GORD.
H. pylori infection of the stomach lining causes peptic ulcer disease (gastric and duodenal ulcers) by disrupting the mucosal protective barrier. Eradication of H. pylori heals ulcers in over 90% of cases without the need for ongoing acid suppression.
Regular NSAID use (ibuprofen, naproxen, aspirin) inhibits prostaglandin synthesis, reducing gastric mucosa protection and causing erosions, ulcers, and GORD. Co-prescribing a PPI with NSAIDs is recommended in patients over 65 or those at high GI risk.
Obesity significantly increases intra-abdominal pressure, promoting acid reflux. A 10% reduction in body weight meaningfully reduces GORD symptoms and reduces the risk of Barrett’s oesophagus and oesophageal adenocarcinoma.
Barrett’s oesophagus occurs when chronic acid exposure causes columnar metaplasia of the oesophageal lining, conferring a 30–40 times increased risk of oesophageal adenocarcinoma. Regular endoscopic surveillance is required.
Key Risk Factors
Diagnosing Acid Reflux (GERD)
Most GORD is diagnosed clinically. H. pylori testing and endoscopy are reserved for alarm features or failure to respond to PPI therapy.
Treatment for Acid Reflux (GERD)
PPIs are first-line for GORD. Lifestyle modification is essential alongside medication. H. pylori eradication heals associated peptic ulcers.
Supportive Measures
Elevate the head of the bed 20cm. Avoid eating 2–3 hours before lying down. Wear loose clothing. Gaviscon provides immediate relief. Stay upright after eating. Small frequent meals reduce gastric volume and reflux episodes.
Managing Chronic GORD
Chronic GORD requires ongoing PPI therapy at the lowest effective dose, annual review, and Barrett’s oesophagus surveillance where applicable. Surgical fundoplication is considered for refractory GORD confirmed on pH study.
When to Seek Help
Vomiting blood, black tarry stools, or chest pain with sweating — call 999 immediately. These may indicate GI haemorrhage or cardiac pathology.
See a GP if heartburn is occurring more than twice a week, not responding to OTC antacids, or if you have alarm features. New heartburn over age 55 requires urgent GP assessment.
Preventing Acid Reflux
GORD is largely preventable through weight management, dietary modification, and lifestyle changes.
Lose weight if overweight. Maintain BMI below 25. Obesity significantly increases intra-abdominal pressure, promoting acid reflux and worsening GORD symptoms. A 10% weight reduction measurably reduces reflux episodes.
Avoid eating large meals, especially 2–3 hours before bedtime. Elevate the head of the bed by 20cm using a bed wedge. Eating in an upright position and staying upright for 2 hours after meals reduces reflux significantly.
Avoid personal dietary triggers for reflux: fatty and fried foods, chocolate, coffee, alcohol, citrus, spicy foods, and carbonated drinks all reduce lower oesophageal sphincter pressure and promote reflux.
Stopping smoking significantly reduces GORD symptoms. Nicotine relaxes the lower oesophageal sphincter and reduces saliva production, which normally helps neutralise acid in the oesophagus.
If you take NSAIDs, aspirin, or bisphosphonates regularly, discuss gastroprotection with your GP. A PPI co-prescribed with NSAIDs prevents gastric ulceration and reduces GORD symptoms.
All adults with Barrett's oesophagus should undergo endoscopic surveillance every 2–5 years (depending on grade). Dysplasia is treated with radiofrequency ablation to prevent progression to cancer.
Getting Treatment
A GP can diagnose and manage most GORD with lifestyle advice, PPI therapy, and H. pylori testing. Gastroenterology referral is needed for alarm features or Barrett's oesophagus surveillance.
Expert clinical advice, when you need it.
Acid Reflux (GERD) — Frequently Asked Questions
The most common cause of acid reflux is a weakened or inappropriately relaxing lower oesophageal sphincter (LOS), which allows gastric acid to reflux into the oesophagus. Contributing factors include obesity, hiatus hernia, H. pylori, pregnancy, smoking, alcohol, high-fat diet, and certain medications (NSAIDs, calcium channel blockers).
See a GP urgently if you have difficulty swallowing, vomiting blood, black tarry stools, unexplained weight loss with reflux symptoms, or if you are over 55 with new onset heartburn. These are alarm features requiring urgent endoscopy to exclude oesophageal or gastric cancer.
Yes. A hiatus hernia occurs when part of the stomach slides through the diaphragm into the chest. It impairs the LOS mechanism, allowing reflux to occur more easily. A sliding hiatus hernia is present in the majority of people with GORD. It does not always require surgery — most cases are managed medically.
Barrett's oesophagus is a pre-cancerous condition where the normal oesophageal lining is replaced by specialised columnar cells following chronic acid exposure. It is diagnosed at endoscopy. It requires regular surveillance and, if dysplasia develops, treatment with radiofrequency ablation to prevent progression to oesophageal adenocarcinoma.
Long-term PPI use is generally safe and appropriate for confirmed GORD or Barrett's oesophagus. Risks of long-term use are modest and include small increases in C. difficile diarrhoea, hypomagnesaemia, and fracture risk. Always take PPIs at the lowest effective dose for the shortest time needed.
Most people control GORD effectively with medication, lifestyle changes, and weight loss. Laparoscopic fundoplication surgery is an option for people with confirmed GORD on pH study who wish to stop medication, those with a large hiatus hernia, or those with refractory symptoms. Surgical success rates are excellent in selected patients.
The most effective lifestyle changes are: losing weight if overweight, stopping smoking, elevating the head of the bed by 20cm, not lying down within 2–3 hours of eating, eating smaller meals, avoiding fatty foods, alcohol, caffeine, and chocolate, and stopping NSAIDs if used regularly.
A GP can diagnose and manage most cases of acid reflux. Lifestyle advice, PPI prescriptions, and H. pylori testing can all be arranged online or in person. Gastroenterology referral is needed for alarm symptoms, failed treatment, or Barrett's oesophagus requiring surveillance endoscopy.