Medically reviewed by Dr Usman Naeem, 24 Oct 2026.
Key points
- Occasional heartburn is normal. Gastro-oesophageal reflux disease (GERD) means reflux that causes troublesome symptoms or complications.
- Lifestyle changes help many people: smaller meals, not eating close to bedtime, weight loss if overweight, and avoiding your own triggers.
- Acid-lowering medicines work well but should be used at the lowest dose that controls symptoms and reviewed regularly.
- Difficulty swallowing, weight loss, vomiting blood, black stools or anaemia are “alarm” features and call for early endoscopy.
Overview
A ring of muscle at the lower end of the food pipe (the lower oesophageal sphincter) normally keeps stomach contents in the stomach. In reflux it relaxes too often or is weak, so acid and food flow back up and irritate the lining.
Most people with GERD have normal-looking or mildly inflamed lining on endoscopy. In some, acid causes erosive oesophagitis, a narrowing (stricture), or a change in the lining called Barrett’s oesophagus. These are uncommon but are why long-standing or severe symptoms are checked.
Chest pain can come from the heart. Do not assume that chest pain is reflux. New chest pain, especially with breathlessness, sweating or spreading to the arm or jaw, needs emergency assessment.
Causes and risk factors
- Excess weight and a large waistline
- Large, late or very fatty meals; lying down soon after eating
- Smoking and alcohol; some medicines (for example certain painkillers, calcium-channel blockers)
- Hiatus hernia
- Pregnancy
Symptoms
- Burning behind the breastbone, especially after meals or when lying down
- Sour or bitter fluid coming up (regurgitation)
- Belching, a feeling of food “sticking”
- In some people: long-standing cough, hoarse voice, frequent throat clearing
When to seek urgent medical care
- Difficulty or pain when swallowing
- Unintended weight loss, repeated vomiting, or tiredness and pallor (possible anaemia)
- Vomiting blood or passing black stools
- Chest pain with breathlessness, sweating or spreading to the arm or jaw: get emergency help
In an emergency go to the nearest emergency department or call Rescue 1122.
How it is assessed
- A conversation and examination, confirming that reflux is the likely cause
- Upper GI endoscopy when there are alarm features, symptoms are long-standing or treatment is not working, and in some people with risk factors for Barrett’s oesophagus
- Further tests such as pH monitoring or oesophageal manometry in a few people whose symptoms are unclear
Treatment
Medicines
- Proton pump inhibitors (PPIs) are the most effective acid-lowering medicines and are usually taken for a defined course, then reviewed. Other options include H2 blockers and antacids for occasional symptoms
- Aim for the lowest dose that controls symptoms. Do not stay on a medicine for years without a review. Do not stop long-term treatment suddenly without advice because symptoms can rebound
- Surgery or endoscopic procedures are for a small group with proven, troublesome reflux despite good medical treatment
What you can do
- Smaller meals, and finish eating 2 to 3 hours before lying down
- Raise the head end of the bed with blocks under the bedposts; extra pillows only bend the neck
- Lose weight if overweight; this often reduces symptoms
- Note your own triggers (for example very spicy or fatty food, tea, coffee, fizzy drinks) and cut down on those
- Stop smoking and limit alcohol
- Avoid anti-inflammatory painkillers where possible
Common questions
Do I need to take acid tablets for life?
Not always. Many people can use them for a course, then reduce to the lowest dose or use them only when needed. Some people with severe oesophagitis or Barrett’s oesophagus need longer treatment. Review with your doctor.
Is reflux the same as an ulcer or H. pylori?
No. Reflux is acid flowing upwards. Ulcers and H. pylori affect the stomach lining and cause upper abdominal pain. They can occur together, and your doctor can tell them apart.
Can reflux cause cancer?
Long-standing reflux slightly raises the risk of Barrett’s oesophagus, and rarely of oesophageal cancer. This is why alarm symptoms and long-standing, severe symptoms are investigated with endoscopy.
اردو خلاصہ
معدے کا تیزاب یا کھانا واپس خوراک کی نالی میں آ جائے تو سینے میں جلن، منہ میں کھٹا پانی اور ڈکار جیسی علامات ہوتی ہیں۔ تھوڑا تھوڑا کھانا، رات کے کھانے اور سونے کے درمیان 2 سے 3 گھنٹے کا فاصلہ، وزن میں کمی اور سگریٹ سے پرہیز مددگار ہیں۔
نگلنے میں دشواری، بلاوجہ وزن کم ہونا، بار بار قے، خون کی قے، کالا پاخانہ یا خون کی کمی ہو تو جلد ڈاکٹر کو دکھائیں۔ سینے کا درد ہمیشہ تیزابیت نہیں ہوتا؛ سانس پھولنے، پسینے یا بازو میں درد کے ساتھ ہو تو فوراً ایمرجنسی جائیں۔
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This page gives general information prepared for Dr Usman Naeem and is not personal medical advice. See the medical disclaimer.