What is reflux?
What people usually refer to as reflux or heartburn is what doctors call gastro-oesophageal reflux.
This is when stomach acid flows back up into your food pipe (oesophagus).
This actually happens to everyone from time to time – it’s normal. But it becomes a problem when it happens too often, starts to affect your daily life or causes irritation or damage to your oesophagus.
When reflux moves from being just an occasional, harmless thing to something frequent and troublesome, that’s when it’s called GORD (also called GERD), short for gastro-oesophageal reflux disease.
What causes it?
Reflux happens because the muscle valve at the bottom of your food pipe (the lower oesophageal sphincter) isn’t working properly. Normally, the valve opens to let food into the stomach and then closes tightly to keep acid down. But sometimes it becomes a bit loose or relaxes at the wrong time, letting stomach acid slip back up.
This is more likely after a big or fatty meal or if you lie down too soon after eating. It can also be triggered by eating too quickly or consuming gassy or irritating foods, such as soft drinks, spicy foods or caffeine.
Sometimes the problem isn’t just the valve itself, but the stomach taking too long to empty. When food stays in the stomach for longer, pressure can build up and push the valve open.
Certain conditions, like a hiatal hernia, can also make reflux more likely by affecting how well the valve works.
Reflux is also common when there’s extra pressure on the stomach from the outside, such as being overweight or during pregnancy.
Why certain foods cause reflux?
Some foods and drinks can make reflux more likely because they either relax the valve at the bottom of your food pipe or slow down how quickly your stomach empties.
Fatty or fried foods are a common trigger. They slow down digestion, so food and acid stay in the stomach longer, which can push acid back up.
Large meals can have the same effect simply because there’s more in your stomach at once.
Spicy foods, caffeine, alcohol and chocolate can relax the valve between your stomach and oesophagus – making it easier for acid to leak up.
Carbonated drinks (like soft drinks or sparkling water) create gas in the stomach, which increases pressure and can also force the valve open. Foods that naturally produce gas in the digestive system, like beans, onions and vegetables as broccoli, cabbage or cauliflower can do the same.
Even eating too quickly, swallowing air while chewing gum or food or drinking alcohol can increase pressure in the stomach and make reflux more likely.
Everyone is a bit different, so it’s helpful to notice which foods bother you most.
How your meds and habits affect reflux?
Reflux isn’t just about what you eat – your medications and daily habits can play a big role too. Some medications, like certain blood pressure pills, asthma inhalers and sedatives, can relax the muscle (sphincter) at the bottom of your food pipe, making it easier for acid to flow back up.
Opioid painkillers can slow digestion, causing food to build up and putting more pressure on the valve, which makes reflux more likely.
Lifestyle habits also matter.
Smoking makes reflux more likely because nicotine relaxes the valve that controls the acid, increase stomach acid and slow the natural clearing of acid from your oesophagus.
Stress, eating quickly, lying down after meals, being overweight and even everyday habits like chewing gum or drinking fizzy drinks can also raise stomach pressure and trigger reflux. Paying attention to these triggers, along with your diet, can make a real difference in keeping reflux under control.
What are the symptoms?
Reflux usually causes heartburn, a burning feeling in your chest or throat. You may notice a sour or bitter taste in your mouth or that food or liquid comes back up, especially at night or when lying flat.
Sometimes the stomach acid can even reach your mouth or airway, which can erode tooth enamel or cause chronic cough, hoarseness, a sore throat or a feeling of a lump in the throat.
Other common symptoms include burping, bloating and discomfort after meals, and some people may experience trouble swallowing.
It can affect your food pipe, throat, mouth, teeth and even your airway.
How do you know it’s reflux disease?
Most of the time, doctors can tell if you have reflux disease just by talking about your symptoms, like frequent heartburn. If it happens often, your doctor may start you on medication, usually an antacid, to see if it helps.
If there are other concerns, such as trouble swallowing, persistent pain or signs that the oesophagus might be damaged, your doctor might recommend an endoscopy.
This procedure uses a small camera to look at the inside of your oesophagus and stomach. It can check for acid-related damage or complications, and also make sure you don’t have a hiatal hernia, a condition where part of the stomach moves up into the chest and can disrupt the body’s normal acid-protection mechanisms, making reflux more likely.
In some cases, you may be referred to a specialist who could suggest special tests like a pH or impedance study. These tests measure how often acid or bile comes up into the oesophagus, even when it isn’t very acidic. This helps identify reflux that isn’t obvious from symptoms alone and ensures the right treatment is chosen.
What is the treatment?
usually involves a combination of lifestyle changes and medication. In fact, lifestyle modifications are just as important as taking medicine.
Some helpful strategies include:
- Avoiding foods that trigger reflux.
- Talking to your doctor about any medications that might contribute.
- Losing excess weight.
- Waiting 2–3 hours before lying down after a meal.
- Eating slowly.
- Choosing small, healthy meals.
- Quit smoking.
- Limit or avoid alcohol.
- Elevate the head of your bed 15–20 cm – it can reduce night-time reflux.
- Reduce stress.
While you start making the right lifestyle changes, and/or if your symptoms are significant, your doctor might also prescribe medication, usually an antacid, to lower acid production and give your oesophagus a chance to heal.
In some cases, they might also use medication to help food move more quickly through the stomach, or a protective agent to coat and protect the oesophagus if it has become inflamed, giving it a better chance to heal.
For some people, surgery – usually fundoplication— is an option. The surgery reinforces the valve at the bottom of the oesophagus, preventing acid from flowing back up.
Who might need surgery?
For most people, lifestyle changes and medications are enough, but surgery – usually a fundoplication – is sometimes required.
Guidelines suggest surgery for people who have a hiatal hernia and those who continue to have troublesome reflux symptoms despite lifestyle changes and maximum medical therapy when reflux has been confirmed as the cause.
When a hiatal hernia is present, part of the stomach has moved up into the chest, which can disrupt the normal mechanisms that keep acid in the stomach. Surgery can put the stomach back in place and reinforce the valve at the end of your oesophagus – this might be needed even if your reflux is well controlled with medication, to prevent problems caused by the hernia itself.
Other indications might include severe complications from reflux, intolerance to medications or a strong preference to avoid long-term medicine.
Ultimately, the decision is always personalized. Your specialist surgeon will help determine if surgery is right for you based on your symptoms, tests and overall health.
When reflux leads to problems
Most of the time, reflux only causes discomfort, like heartburn or regurgitation; but if it happens often or isn’t well managed, it can lead to a range of complications affecting the oesophagus, mouth and even airways.
Understanding these possible issues shows why managing reflux early is so important.
Oesophagitis (inflammation in the oesophagus)
Frequent exposure to stomach acid can irritate and inflame the lining of the oesophagus, causing pain, burning or discomfort when swallowing.
In some cases, it can also cause ulcers in the lining, which may lead to bleeding or pain. They generally heal with proper acid control medications and lifestyle changes.
Strictures (narrowing of the oesophagus)
Over time, repeated irritation can lead to scar tissue forming in the oesophagus, making it narrower. This can make swallowing difficult or feel like food is ‘stuck’. Strictures can often be treated with procedures to gently widen the oesophagus.
Barrett’s oesophagus
Long-term irritation from reflux can cause changes in the cells lining the oesophagus, a condition known as Barrett’s oesophagus. Having Barrett’s increases the risk of oesophageal cancer, so once it is diagnosed, it should be monitored with regular endoscopies and sometimes treated.
Respiratory problems
Acid can reach the airways and lungs, leading to chronic cough, hoarseness, asthma-like symptoms or repeated chest infections. These issues often improve when reflux is controlled.
Dental erosion
Frequent acid reaching the mouth can wear away tooth enamel, causing sensitivity or damage over time. Good oral hygiene and managing reflux can prevent this.
Impact on daily life
Persistent reflux can affect sleep, comfort and overall quality of life, but following lifestyle strategies and treatment usually keeps these effects under control.
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