Acid reflux is a very common problem that most people suffer from time to time, and some people are prone to flare-ups on a regular basis. Most people can think of things in their recent lifestyle choices that cause it and this is all they need to do to allow it to settle whereas others need medication to improve their discomfort.
Acid reflux occurs when digestive acid rises up from the stomach, burning the sensitive lining of your oesophagus (foodpipe or gullet). It usually happens about half an hour after eating and can cause a bitter taste in the mouth, halitosis (bad breath), burping, bloating, nausea, a long-standing dry cough and pain on swallowing hot drinks. It can also sometimes cause a sore throat when you first wake up.
It can feel quite uncomfortable, typically as a burning feeling in your tummy or chest going up towards the neck – it’s known as ‘heartburn’ for good reason although it has nothing to do with the heart – but in most cases it's mild and gets better on its own. If you suffer reflux regularly, it helps to have a few medications at home that you know work for you, so let’s talk you through the treatment options.
It's also a good idea to consider any lifestyle factors you can modify, like obesity, alcohol excess, smoking, stress and certain foods, like those that are spicy or fatty. Bending forward a lot during the day can also make it more likely.
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. They also come in flavours such as peppermint that take away any unpleasant taste and any associated bad breath. 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 (PPIs) 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 versions which are now available to buy without a prescription such as Nexium Control (contains esomeprazole), and Pyrocalm tablets (contains 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, including headache, stomach ache, diarrhoea, constipation, wind and nausea.
H2 receptor blockers, a type of gut antihistamine, work differently from PPIs by reducing the amount of acid produced by the stomach in the first place. Ranitidine (found in Zantac), cimetidine (found in Tagamet), or famotidine are the most common active ingredients. However, as of January 2023 there is an ongoing shortage of ranitidine available, due to a recall prompted by safety concerns about levels of N-nitrosodimethylamine (NDMA), a nitrosamine impurity. It is not clear how long this shortage will continue.
##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, but 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. It's a good idea to consult with a doctor to confirm the diagnosis before using them, as normal ‘posseting’ of baby milk is often mistaken for reflux, and there may be other causes for symptoms that a doctor needs 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 means you’re overweight whereas one over 30 is obese), will help reduce 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 is very important – this 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 for example. Whatever you choose, make sure it 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 has 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 to 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.
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 Caidr think that nurturing the gut microbiome makes sense in building up a healthy balance of bacteria and protecting 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 adjusted certain 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 a plan together.
If you have any serious symptoms like unintentional weight loss, reduced appetite or nausea, difficulty swallowing, regurgitation of food and drink or yellowing of the skin or eyes you should contact your doctor urgently.
Read about: Acid reflux (heartburn) - triggers and treatments to ease
Read about: Heartburn
Read about: Heartburn in pregnancy
Read about: Dyspepsia
Read about: Gastro-oesophageal reflux disease
Read about: Indigestion
Read about: Gastritis
Read about: Lactose intolerance vs milk allergy in kids
Read about: H Pylori
Read about: Stomach ulcer
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