Heartburn and acid reflux are extremely common, and most people can get good control with a few changes and the right medicine, used the right way. This guide explains what’s happening, what UK guidance recommends step by step, how to use acid-reducing tablets properly, and when reflux needs a camera test.
Key points
- Reflux happens when stomach contents flow back up into the food pipe (oesophagus), causing heartburn, an acid taste or a cough.
- Weight loss if you’re overweight, stopping smoking, smaller evening meals and raising the head of your bed all help.
- Over-the-counter antacids and alginates are fine for occasional symptoms. Frequent symptoms usually need a 4 to 8 week course of a proton pump inhibitor (PPI).
- After that, aim for the lowest dose that works, or using it only when needed. Long-term PPIs should be reviewed at least once a year.
- Difficulty swallowing, weight loss, vomiting or signs of bleeding need checking promptly.
What is acid reflux?
At the bottom of your food pipe is a ring of muscle that acts like a valve, letting food into the stomach and stopping acid coming back up. If it relaxes at the wrong time, or there’s extra pressure from below, stomach contents can flow back up. That’s reflux.[3]
When reflux happens often enough to cause troublesome symptoms or damage, it’s called gastro-oesophageal reflux disease (GORD). If the lining of the food pipe becomes inflamed, it’s called oesophagitis.[1,5]
Symptoms
- heartburn: a burning feeling rising up behind the breastbone, often after meals or when lying down
- an acid or bitter taste at the back of your mouth
- bringing food or liquid back up (regurgitation)
- a cough, hoarse voice or sore throat, especially in the morning
- bloating, burping or feeling sick
- bad breath
See your GP promptly if you have:
- difficulty swallowing, or food sticking
- weight loss you can’t explain, especially if you are 55 or over
- vomiting that keeps happening
- vomit with blood in it, or that looks like coffee grounds, or black, tarry poo
- a lump in your upper tummy
- indigestion or heartburn that isn’t getting better with treatment, if you are 55 or over
Chest pain can be a sign of a heart problem rather than reflux. If you have chest pain that spreads to your arm, neck or jaw, or comes with breathlessness or sweating, call 999.[2]
What makes reflux worse?
- being overweight, especially around the middle
- smoking
- large meals, and eating late in the evening
- lying down soon after eating
- alcohol, coffee, chocolate, fatty or spicy food, and tomatoes (triggers vary from person to person)
- pregnancy
- a hiatus hernia, where part of the stomach pushes up into the chest
- some medicines, including anti-inflammatory painkillers, some blood pressure tablets and some medicines for anxiety or sleep. Don’t stop a prescribed medicine without speaking to your doctor or pharmacist.
Keeping a simple food and symptom diary for a week can show you your own pattern. You can download a free diary here.
Step 1: changes that help
NICE recommends these lifestyle steps first, and they help many people on their own:[1,5]
- If you’re overweight, losing even a few kilograms can reduce reflux.
- Stop smoking: it relaxes the valve at the bottom of the food pipe.
- Have smaller meals, and your main meal earlier in the evening.
- Leave at least 3 hours between eating and lying down.
- Raise the head end of your bed by 10 to 20cm, using blocks under the bed legs or a wedge under the mattress. Extra pillows don’t work as well, because they bend you at the waist.
- Notice your own trigger foods and drinks, and cut back on those.
- Wear loose clothing around your waist.
Step 2: over-the-counter treatments
For occasional heartburn, a pharmacist can recommend:
- Antacids, which neutralise acid and work within minutes.
- Alginates such as Gaviscon, which form a protective “raft” on top of the stomach contents. These are good taken after meals and at bedtime.
Some low-dose PPIs and H2 blockers are also available from pharmacies for short-term use. If you need them for more than 2 weeks, see your GP.[3]
Step 3: proton pump inhibitors (PPIs)
PPIs such as omeprazole, lansoprazole and esomeprazole reduce the amount of acid your stomach makes. They’re very effective. NICE recommends a full-dose course for 4 or 8 weeks for reflux.[1]
How to take a PPI properly
- Take it 30 to 60 minutes before breakfast. PPIs work best when the stomach is about to start making acid for a meal.
- Take it every day for the full course, not just when you have symptoms. It can take a few days to reach its full effect.
- If you’re on a twice-daily dose, take the second 30 to 60 minutes before your evening meal.
After the course
If symptoms come back, your doctor will usually suggest the lowest dose that controls them, or taking a PPI only when you need it. Many people can step down or stop. If you’ve been on a PPI for a long time, ask for a review: NICE recommends an annual check for anyone on long-term treatment.[1,5]
Stopping suddenly after a long course can cause a short-lived “rebound” in acid and symptoms. Reducing gradually, and using an alginate in the meantime, usually helps. Speak to your GP or pharmacist first.[5]
The timing of your tablet matters
I perform gastroscopies as a regular part of my work, and I also prescribe, so I see reflux from both sides: what it does to the lining of the food pipe, and how people actually take their medicines at home.
One of the most common things I come across is a PPI taken at the wrong time: at night, with food, or only when symptoms are bad. Moving the dose to 30 to 60 minutes before breakfast and taking it every day for the full course often makes a bigger difference than switching to a stronger tablet.
The other is people staying on a PPI for years without anyone checking whether they still need it. If that sounds like you, ask for a review. Many people can step down safely.
Ben JohnsonAdvanced Clinical Practitioner, Gastroenterology
Reflux or indigestion?
Reflux and indigestion (dyspepsia) overlap, and many people have both. Heartburn and an acid taste point towards reflux. Pain or discomfort in the upper tummy, feeling full quickly and nausea point more towards indigestion, which can be caused by gastritis, an ulcer or the stomach infection H. pylori.[1,5]
If indigestion is your main symptom, your GP will usually offer an H. pylori test. If heartburn is the main symptom, H. pylori treatment doesn’t usually help, and the steps in this guide come first.[1]
What if nothing works?
If symptoms continue despite a full course of a PPI taken properly, your GP may try a different PPI, a higher dose, or add another medicine at night. If symptoms still don’t settle, you may be referred to a specialist.[1,5]
Specialist tests can include a gastroscopy, and tests that measure acid in the food pipe over 24 hours (pH monitoring) and how well it squeezes (manometry). For a small number of people whose symptoms are clearly caused by reflux, an operation to tighten the valve (laparoscopic fundoplication) may be an option, particularly if they don’t want to take medicine long term.[1]
Will I need a camera test?
Most people with reflux don’t. Your GP may refer you for a gastroscopy (or a thinner transnasal endoscopy) if you have any of the warning signs above, if your symptoms don’t improve with treatment, or if you’ve had reflux for many years and have other risk factors for a condition called Barrett’s oesophagus.[1,2,4]
What is Barrett’s oesophagus?
Long-term reflux can change the lining at the bottom of the food pipe. This is called Barrett’s oesophagus. It doesn’t cause extra symptoms, and most people with it never develop cancer, but the risk is higher than average, so some people are offered regular check-ups with a gastroscopy. It’s more common in men, people over 50, white people, people who are overweight, and people who’ve had reflux for a long time.[4]
Frequently asked questions
Are PPIs safe long term?
For most people who need them, the benefits outweigh the risks. Long-term use has been linked with some side effects, such as low magnesium, certain infections and a small increase in fracture risk, which is why the aim is the lowest effective dose and a regular review. Don’t stop a PPI prescribed to protect your stomach, for example alongside anti-inflammatory painkillers, without advice.
Is milk good for heartburn?
It may soothe briefly, but milk can stimulate more acid afterwards. An alginate or antacid is a better quick fix.
Can reflux cause a cough?
Yes. Reflux can irritate the throat and airways, causing a cough, hoarseness or throat clearing, sometimes without obvious heartburn. A persistent cough should always be checked by your GP.
Is reflux in pregnancy normal?
Very common, because of hormones and pressure from the growing baby. Small meals and alginates are usually first choice. Ask your midwife, GP or pharmacist before taking other medicines.
References
- NICE. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management (CG184). 2014, updated 2019. https://www.nice.org.uk/guidance/cg184
- NICE. Suspected cancer: recognition and referral (NG12), section 1.2. Amended 2025. https://www.nice.org.uk/guidance/ng12
- NHS. Heartburn and acid reflux. https://www.nhs.uk/conditions/heartburn-and-acid-reflux/
- Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut 2014;63:7–42.
- NICE Clinical Knowledge Summaries. Dyspepsia: proven GORD. https://cks.nice.org.uk/topics/dyspepsia-proven-gord/
