Acid Reflux and GERD: The Complete Guide to Heartburn Relief and Treatment

Heartburn is one of the most common symptoms people experience. In many countries, around one in five adults has acid reflux symptoms at least once a week, and the numbers are rising as waistlines grow and populations age. For most people, occasional heartburn after a heavy meal is a nuisance and nothing more. But when reflux becomes frequent, it can damage the oesophagus, disturb sleep, cause a persistent cough or hoarse voice, and, rarely, lead to changes that increase the risk of cancer.

This complete guide explains what acid reflux and gastro-oesophageal reflux disease (GERD, also written GORD) are, why they happen, the symptoms that can be easily missed, the warning signs that need prompt tests, the lifestyle changes with real evidence behind them, how to use antacids, H2 blockers and proton pump inhibitors properly, how to stop acid-reducing medicines safely, and when surgery is an option. It also covers reflux in pregnancy, babies and children, and older adults.

What is acid reflux?

Your oesophagus (food pipe) carries food from your mouth to your stomach. At the bottom, where it joins the stomach, there is a ring of muscle called the lower oesophageal sphincter. It acts like a one-way valve: it opens to let food into the stomach and closes to stop stomach contents coming back up. The stomach produces strong acid and digestive enzymes to break down food. Its lining is protected against this acid, but the lining of the oesophagus is not.

Acid reflux happens when stomach contents flow back up into the oesophagus. Everyone has small amounts of reflux every day, especially after meals, usually without noticing. Symptoms develop when reflux is more frequent, lasts longer, or the oesophagus is more sensitive.

Gastro-oesophageal reflux disease (GERD) is the term used when reflux causes troublesome symptoms or damage. Many guidelines describe GERD as reflux symptoms that are bothersome on two or more days a week, or that cause complications such as inflammation of the oesophagus.

Why does reflux happen?

Several factors can make reflux more likely:

• Transient relaxation of the valve: the lower oesophageal sphincter briefly relaxes more often than it should, especially after large meals.
• A weak valve: the sphincter may not close firmly.
• Hiatus hernia: part of the stomach pushes up through the diaphragm into the chest, which weakens the barrier against reflux. Hiatus hernias are common, especially with age and obesity.
• Raised pressure in the abdomen: from excess weight around the middle, pregnancy, tight clothing or straining.
• Slow stomach emptying: food stays in the stomach longer, giving more opportunity for reflux.
• Increased sensitivity of the oesophagus: some people feel normal amounts of reflux as painful.

Common contributing factors include:

• Large, fatty or late-night meals.
• Overweight and obesity, especially fat around the abdomen.
• Smoking, which weakens the sphincter and reduces saliva that normally neutralises acid.
• Alcohol.
• Pregnancy.
• Certain medicines, including anti-inflammatory painkillers (NSAIDs), aspirin, some blood pressure medicines (calcium channel blockers), nitrates, some antidepressants, some asthma medicines, bisphosphonates for osteoporosis, iron and potassium tablets, and some hormone treatments.
• Stress and poor sleep, which can increase sensitivity to symptoms.

Symptoms of acid reflux and GERD

Typical symptoms

• Heartburn: a burning feeling rising from the upper abdomen or lower chest towards the throat, often after eating or when lying down or bending over.
• Regurgitation: sour or bitter-tasting fluid or food coming back into the throat or mouth.

Other symptoms

• Pain or discomfort in the upper abdomen (dyspepsia or indigestion).
• Feeling sick or bloated.
• Burping.
• Bad breath and dental erosion.
• Chest pain, which can feel very similar to heart pain.

Symptoms outside the oesophagus

Reflux can reach the throat, voice box and airways. This is sometimes called laryngopharyngeal reflux or “silent reflux”, because heartburn may be absent. Symptoms can include:

• A long-lasting cough, particularly at night or after meals.
• A hoarse voice, especially in the morning.
• Frequent throat clearing.
• A feeling of a lump in the throat.
• Sore throat.
• Worsening asthma.
• Recurrent sinus or ear problems in some people.

These symptoms have many other possible causes, so they need careful assessment rather than an automatic assumption that reflux is to blame.

Chest pain: heart or reflux?

This is one of the most important points in this guide. Reflux can cause chest pain that is almost impossible to tell apart from heart pain. You should never assume chest pain is reflux without proper assessment, especially if you have any risk factors for heart disease, such as high blood pressure, diabetes, smoking, high cholesterol, a family history of heart disease, or older age.

Call your local emergency number immediately if you have chest pain that:

• Feels heavy, tight, pressing or squeezing.
• Spreads to your arm, neck, jaw, back or stomach.
• Comes with shortness of breath, sweating, feeling sick, light-headedness or a feeling of doom.
• Lasts more than a few minutes or comes and goes.
• Comes on with exertion and eases with rest.

Women, older adults and people with diabetes are more likely to have less typical heart attack symptoms, such as breathlessness, tiredness, nausea or upper abdominal discomfort. If in doubt, get checked urgently.

Red flags: when you need prompt tests

See a healthcare provider promptly if you have reflux or indigestion along with any of the following:

• Difficulty swallowing (dysphagia), or food sticking on the way down.
• Pain on swallowing.
• Unintentional weight loss.
• Persistent vomiting.
• Vomiting blood, or material that looks like coffee grounds.
• Black, tarry stools.
• Anaemia or iron deficiency.
• A lump in your upper abdomen.
• New indigestion or reflux symptoms that start after the age of about 55 to 60, depending on your country’s guidelines.
• Symptoms that do not respond to treatment.
• A family history of oesophageal or stomach cancer.

Vomiting blood or passing large amounts of black stool is an emergency.

How reflux and GERD are diagnosed

Most people with typical heartburn and regurgitation and no warning signs can be diagnosed from their symptoms. A healthcare provider or pharmacist may suggest a trial of lifestyle changes and acid-reducing medicine. If symptoms improve, this supports the diagnosis.

Further tests are used when there are red flags, symptoms are not typical, symptoms do not respond to treatment, or surgery is being considered:

• Upper endoscopy (gastroscopy): a thin, flexible camera is passed through the mouth to look at the oesophagus, stomach and duodenum. It can show inflammation (oesophagitis), ulcers, narrowing, Barrett’s oesophagus, hiatus hernia and cancer. Biopsies can be taken. Many people with GERD have a normal-looking oesophagus, which is called non-erosive reflux disease.
• pH or pH-impedance monitoring: a thin tube through the nose or a small capsule clipped to the oesophagus measures acid and non-acid reflux over 24 to 96 hours. It is used when the diagnosis is unclear or before surgery.
• Oesophageal manometry: measures how well the oesophagus muscle and sphincter work. It is usually done before surgery and when swallowing is difficult.
• Testing for Helicobacter pylori: a breath, stool or blood test for this common stomach bacterium may be done in people with indigestion, because it can cause ulcers and is treatable.

Lifestyle changes that actually help

Many lifestyle tips are given for reflux. Some have good evidence; others are based mostly on experience. These are the most useful:

Lose excess weight

Weight loss has some of the strongest evidence of any lifestyle change for reflux. Even a modest loss of 5 to 10 percent of body weight can reduce symptoms significantly, especially if weight is carried around the abdomen.

Raise the head of your bed

If you have night-time symptoms, raising the head of your bed by about 15 to 20 centimetres, using blocks under the bed legs or a wedge under the mattress, uses gravity to keep acid in the stomach. Piling up extra pillows is less effective because it bends you at the waist and can increase pressure on the stomach.

Leave a gap between eating and lying down

Try to finish your last meal at least three hours before going to bed. This gives the stomach time to empty.

Sleep on your left side

Studies suggest that lying on the left side reduces night-time reflux compared with the right side, because of the position of the stomach relative to the oesophagus.

Eat smaller meals

Large meals stretch the stomach and increase relaxations of the sphincter. Smaller, more frequent meals can help.

Identify your own trigger foods

Commonly reported triggers include fatty and fried foods, chocolate, coffee, alcohol, peppermint, spicy foods, citrus fruits, tomatoes, onions and fizzy drinks. However, not everyone reacts to all of these. Rather than cutting them all out, keep a diary and remove only the foods that consistently trigger your symptoms.

Stop smoking

Stopping smoking improves reflux and has huge benefits for overall health. Our guide to quitting smoking explains the methods that work best.

Limit alcohol

Alcohol relaxes the sphincter and irritates the oesophagus. Reducing or stopping alcohol often helps.

Wear looser clothing

Tight belts and waistbands increase pressure on the stomach.

Manage stress and protect sleep

Stress does not create acid, but it increases sensitivity to symptoms. Relaxation techniques, regular exercise and good sleep habits can reduce how much reflux bothers you.

Chew gum after meals

Chewing sugar-free gum after meals increases saliva, which helps neutralise and clear acid from the oesophagus. Avoid peppermint flavours if they trigger symptoms.

Medicines for reflux

Medicines for reflux work in different ways and are suited to different situations. Many are available from pharmacies without a prescription.

Antacids and alginates

Antacids, such as calcium carbonate, magnesium hydroxide and aluminium hydroxide, neutralise stomach acid quickly. Alginates, such as sodium alginate, form a protective “raft” that floats on top of the stomach contents and blocks reflux. Many products combine both. They work within minutes and are good for occasional symptoms or as top-up relief. They do not heal inflammation.

Points to know:

• Antacids can interfere with the absorption of other medicines, including some antibiotics, iron and thyroid tablets. Leave a gap of a couple of hours.
• Some contain a lot of sodium, which matters for people with heart failure, high blood pressure or kidney disease.
• Magnesium-based products can cause diarrhoea; aluminium-based products can cause constipation.

H2 receptor antagonists (H2 blockers)

These medicines, such as famotidine, cimetidine and nizatidine, reduce acid production. They take effect within about an hour and last several hours. They can be used for occasional symptoms, before a meal that is likely to cause heartburn, or at night alongside other treatment. Their effect can wear off with continuous daily use.

Proton pump inhibitors (PPIs)

PPIs, such as omeprazole, lansoprazole, esomeprazole, pantoprazole and rabeprazole, are the most powerful acid-reducing medicines. They block the “pumps” in the stomach lining that produce acid. They heal oesophagitis and control symptoms in most people with GERD.

How to take them for best effect:

• Take a PPI 30 to 60 minutes before a meal, usually breakfast. PPIs work best when the acid pumps are activated by food. Taking them at bedtime or after eating is a common reason they seem not to work.
• They take a few days to reach full effect, so they are not ideal for instant relief.
• A typical initial course is four to eight weeks at a standard dose. If symptoms are controlled, the dose can often be reduced or stopped, or taken only when needed.
• If a once-daily dose does not work, a healthcare provider may suggest a different timing, a twice-daily dose, or a different PPI, and will review whether the diagnosis is correct.

Newer acid blockers

Potassium-competitive acid blockers, such as vonoprazan, are available in some countries. They block acid quickly and strongly and can be used for erosive oesophagitis. Availability and approved uses vary.

Other medicines

Prokinetic medicines that speed up stomach emptying are sometimes used in specific situations, but side effects limit their use. For people with oesophageal hypersensitivity, low-dose neuromodulators may help.

Are long-term PPIs safe?

PPIs are among the most widely used medicines in the world, and for many people they are both effective and necessary. However, they are also often taken for longer than needed. Long-term use has been linked in observational studies with several possible risks, including:

• Lower absorption of vitamin B12, magnesium, calcium and iron.
• A slightly higher risk of certain gut infections, including Clostridioides difficile.
• A possible small increase in fracture risk.
• Interactions with some other medicines.

Many of these links come from studies that cannot prove cause and effect, because people who take PPIs long term are often older and less healthy. The overall message from experts is balanced: if you need a PPI, for example for severe oesophagitis, Barrett’s oesophagus, or to protect your stomach while taking aspirin or anti-inflammatory medicines, the benefits usually outweigh the risks. But if you are taking a PPI out of habit, it is worth reviewing whether you still need it, and at what dose.

How to reduce or stop a PPI safely

When people stop PPIs suddenly after several weeks or more, many experience “rebound acid hypersecretion”: the stomach temporarily produces extra acid, causing heartburn that can be worse than before. This can make people think they cannot stop, when in fact the symptoms would settle within a few weeks.

A step-down approach agreed with your healthcare provider or pharmacist may involve:

1. Reducing to the lowest effective dose, for example halving the dose for two to four weeks.
2. Then taking the low dose every other day, or switching to taking it only when needed.
3. Using an alginate or antacid to manage any temporary rebound symptoms.
4. Keeping up lifestyle changes, especially weight management, meal timing and bed raising.

Do not stop a PPI without advice if you were prescribed it for Barrett’s oesophagus, severe oesophagitis, a bleeding ulcer, or to protect your stomach while taking blood thinners, aspirin or anti-inflammatory medicines.

Complications of long-term reflux

Oesophagitis

Repeated exposure to acid can inflame and erode the lining of the oesophagus. This can cause pain, bleeding and, over time, scarring. Most oesophagitis heals well with PPIs.

Strictures

Scarring can narrow the oesophagus, causing food to stick. Strictures can be stretched during an endoscopy.

Barrett’s oesophagus

In some people with long-term reflux, the normal lining of the lower oesophagus is replaced by a different type of cell, similar to the lining of the intestine. This is called Barrett’s oesophagus. It does not cause symptoms by itself, but it slightly increases the risk of a type of oesophageal cancer called adenocarcinoma. Most people with Barrett’s oesophagus never develop cancer. Those who have it are usually offered regular endoscopy surveillance, so that any precancerous changes can be found early and treated, often without major surgery.

Risk factors for Barrett’s oesophagus include long-standing reflux (more than five years), being male, being over 50, white ethnicity, obesity (especially around the abdomen), smoking and a family history of Barrett’s or oesophageal cancer. People with several of these risk factors may be offered screening in some countries.

Oesophageal cancer

Oesophageal adenocarcinoma is uncommon, but its incidence has risen in many high-income countries over recent decades, linked to obesity and reflux. Difficulty swallowing, weight loss, and persistent reflux in older adults must be investigated promptly.

Surgery and procedures for reflux

Most people with GERD do not need surgery. Surgery may be considered when:

• Symptoms are proven to be caused by reflux on testing, and medicines work but the person does not want to take them long term.
• Medicines cause side effects.
• Regurgitation remains troublesome despite medicines (PPIs reduce acid but not the volume of reflux).
• There is a large hiatus hernia causing problems.

The most common operation is laparoscopic fundoplication, in which the top of the stomach is wrapped around the lower oesophagus to strengthen the valve. It is effective for well-selected patients. Side effects can include difficulty swallowing, bloating and being unable to burp or vomit. Newer options include a magnetic bead ring placed around the lower oesophagus and various endoscopic procedures. For people with obesity, certain types of weight-loss surgery (particularly gastric bypass) can also reduce reflux, while others (such as sleeve gastrectomy) can make it worse.

Careful testing beforehand is essential, because surgery is less likely to help symptoms that are not caused by reflux.

Reflux in pregnancy

Heartburn affects many pregnant women, especially in the third trimester. Hormones relax the sphincter, and the growing baby pushes up on the stomach. Helpful measures include small frequent meals, avoiding eating late, sitting upright after meals and raising the head of the bed. Antacids and alginates are commonly used in pregnancy, and some H2 blockers and PPIs may be used if needed. Always check with a midwife, pharmacist or healthcare provider before taking any medicine in pregnancy. Severe upper abdominal pain, particularly under the ribs on the right, with headache, visual disturbance or swelling, may be a sign of pre-eclampsia and needs urgent assessment.

Reflux in babies

Bringing up small amounts of milk after feeds (possetting or spitting up) is very common and normal in babies, because the valve at the top of the stomach is still developing. Most babies with reflux are happy, feed well and grow normally, and the reflux settles by around 12 months of age.

Helpful tips include:

• Holding the baby upright during and after feeds.
• Feeding smaller amounts more often if bottle-feeding, without reducing the total daily amount.
• Getting a feeding assessment from a midwife, health visitor or infant feeding specialist.
• Always placing the baby on their back to sleep, on a flat, firm surface. Raising the head of the cot or using sleep positioners is not recommended because of the risk of sudden infant death.

Seek medical advice if your baby is not gaining weight, refuses feeds, vomits forcefully or very often, has blood in their vomit or stools, vomits green or yellow fluid (which is an emergency), seems in pain or distress during feeds, has breathing problems, or has a fever. Projectile vomiting in a baby aged around two to eight weeks can be a sign of pyloric stenosis, which needs urgent assessment.

Reflux in children and teenagers

Older children and teenagers can develop GERD, especially those living with obesity. Symptoms are similar to adults, though younger children may describe tummy pain rather than heartburn. Treatment starts with lifestyle changes, and medicines are used under medical guidance. Children with difficulty swallowing or food sticking should be assessed for eosinophilic oesophagitis, an allergic inflammatory condition of the oesophagus that is increasingly recognised.

Reflux in older adults

Older adults may have fewer typical symptoms but more complications. They are also more likely to take medicines that cause or worsen reflux, and more likely to have heart disease, which makes chest pain assessment especially important. New indigestion or swallowing problems in later life always need investigation.

A note for nurses and healthcare workers

Shift work, irregular meals, eating quickly on breaks, high caffeine intake and night shifts all make reflux more likely. Nurses with reflux can help themselves by eating smaller meals, avoiding a large meal immediately before sleeping after a night shift, keeping caffeine moderate and avoiding a stockpile of antacids as a substitute for a proper assessment. When supporting patients, nurses play a key role in teaching correct PPI timing, reviewing medicines that may be worsening reflux, and recognising cardiac chest pain that has been wrongly labelled as indigestion.

Common myths about reflux

• “Heartburn is caused by too much acid.” Most people with GERD produce a normal amount of acid. The problem is that it ends up in the wrong place.
• “Milk soothes heartburn.” Milk may feel soothing at first, but its fat and protein can stimulate more acid production afterwards.
• “PPIs work best at bedtime.” They work best taken 30 to 60 minutes before a meal.
• “If I have no heartburn, I can’t have reflux.” Reflux can cause cough, hoarseness and throat symptoms without heartburn.
• “Chest pain after eating is always indigestion.” Heart pain can also come on after meals. If in doubt, get checked.

Functional heartburn and reflux hypersensitivity

Not all heartburn is caused by too much acid reflux. When people with persistent heartburn have tests, a surprising number turn out to have a normal amount of reflux. Two conditions explain many of these cases:

• Reflux hypersensitivity: the amount of reflux is normal, but the oesophagus is unusually sensitive, so ordinary reflux episodes are felt as heartburn. Tests show symptoms lining up with reflux events even though the total amount is normal.
• Functional heartburn: burning chest pain with no link to reflux at all on testing, and no other structural cause. Like irritable bowel syndrome, it is considered a disorder of gut-brain interaction.

These conditions often respond poorly to PPIs, which explains why some people feel their medicine is not working. Treatments that reduce nerve sensitivity, such as low-dose tricyclic medicines or selective serotonin reuptake inhibitors, and psychological approaches such as gut-directed hypnotherapy and cognitive behavioural therapy, can help. Getting the right diagnosis prevents years of escalating acid-suppressing medicines that are not addressing the real problem, and avoids surgery that is unlikely to help.

Eosinophilic oesophagitis: an important lookalike

Eosinophilic oesophagitis is an allergic inflammatory condition of the oesophagus. It has become much more commonly recognised over the past two decades, particularly in young men and in people with asthma, eczema, hay fever or food allergies. The main symptom in adults is difficulty swallowing, especially solid foods such as bread and meat, and episodes where food becomes stuck and has to be brought back up or removed in hospital. Children may have vomiting, feeding problems, abdominal pain or poor growth.

It is diagnosed by taking biopsies during an endoscopy. Treatment may include PPIs (which help some people), swallowed steroid preparations that coat the oesophagus, elimination diets guided by a dietitian, newer biological medicines in some countries, and stretching of the oesophagus if it has narrowed. If you have reflux-like symptoms with food sticking, ask specifically whether eosinophilic oesophagitis has been considered.

Reflux, asthma, cough and sleep apnoea

Reflux and breathing problems often occur together. Acid in the lower oesophagus can trigger a reflex that narrows the airways, and small amounts of refluxed material can reach the throat and airways. Asthma medicines and the pressure changes of difficult breathing can, in turn, make reflux more likely. For people with poorly controlled asthma and frequent reflux symptoms, treating the reflux may help, although studies show that acid suppression does not improve asthma in people without reflux symptoms.

Chronic cough is a common reason people are given PPIs, but the evidence that PPIs help cough is mixed. They are more likely to help when there are also typical reflux symptoms. If a cough lasts longer than three to eight weeks, it needs a full assessment for other causes, such as asthma, post-nasal drip, medicines (especially some blood pressure tablets), smoking-related lung disease, infections including tuberculosis, and, in smokers and former smokers, lung cancer.

Obstructive sleep apnoea, where the airway repeatedly collapses during sleep, is also linked to night-time reflux. If you snore loudly, stop breathing during sleep, wake gasping or feel very sleepy in the day, ask to be assessed. Treating sleep apnoea can improve night-time reflux.

Reflux and food: a practical eating plan

Rather than a long list of banned foods, many people find it easier to follow a simple framework:

• Build meals around lower-fat proteins such as fish, chicken, beans, lentils, eggs and tofu, with plenty of vegetables and wholegrains.
• Choose cooking methods such as grilling, baking, steaming and boiling rather than deep frying.
• Keep portions moderate and make lunch, rather than dinner, the main meal of the day if your routine allows.
• Slow down: put your fork down between bites and aim for meals to last at least 15 to 20 minutes.
• Drink water between meals rather than large volumes with meals.
• Test your triggers one at a time: if you suspect coffee, tomatoes or spicy food, remove one for two weeks and then reintroduce it to see if it truly makes a difference.

Traditional diets in many regions are high in vegetables, legumes and grains and lower in processed fats, and these patterns tend to suit people with reflux. There is no need to give up all the foods you enjoy. The goal is a way of eating you can sustain, not perfection.

Reflux and medicines you might not suspect

Because many commonly used medicines can worsen reflux or irritate the oesophagus, a medicine review is a valuable step for anyone with persistent symptoms. Examples include:

• Anti-inflammatory painkillers and aspirin: irritate the stomach and oesophagus and increase the risk of ulcers and bleeding.
• Bisphosphonates such as alendronate for osteoporosis: must be taken with a full glass of water while sitting or standing upright, and you should stay upright for at least 30 minutes afterwards, otherwise they can cause severe oesophageal irritation.
• Doxycycline and some other antibiotics, iron tablets and potassium supplements: can cause “pill oesophagitis” if they lodge in the oesophagus. Take them with plenty of water and do not lie down straight afterwards.
• Calcium channel blockers and nitrates for blood pressure and angina: relax the sphincter.
• Some antidepressants, sedatives and medicines for bladder problems can relax the sphincter or slow stomach emptying.
• Theophylline for breathing problems.

Never stop a prescribed medicine on your own. Ask a pharmacist, nurse or healthcare provider whether any of your medicines could be contributing, and whether there is a suitable alternative.

When reflux affects your teeth

Acid reaching the mouth can wear away tooth enamel, especially on the inner surfaces of the back teeth. Sometimes a dentist is the first person to notice signs of reflux. To protect your teeth, rinse your mouth with water after reflux episodes, wait at least 30 to 60 minutes before brushing after an episode (brushing immediately can rub softened enamel away), use a fluoride toothpaste, and tell your dentist about your reflux.

Living with GERD long term

For many people, GERD is a long-term condition that comes and goes, with flare-ups during times of weight gain, stress, pregnancy, festive seasons with heavy meals, or after starting a new medicine. A personal plan helps you stay in control:

• Know your main triggers and the habits that help you most, such as meal timing and bed raising.
• Agree with your healthcare provider how to use medicines during flares, for example a short course of a PPI followed by on-demand use, or an alginate after meals and at bedtime.
• Have a medicine review at least once a year if you take acid-suppressing medicines regularly.
• Keep an eye on your weight, because even small gains can bring symptoms back.
• Know the warning signs that need prompt tests: difficulty swallowing, weight loss, vomiting, bleeding or black stools, and new symptoms in later life.

With the right approach, most people with reflux can eat well, sleep well and keep symptoms in the background of their lives rather than the centre.

Frequently asked questions

How long does it take for reflux to heal?

With a PPI and lifestyle changes, symptoms often improve within days to two weeks, and mild to moderate oesophagitis usually heals within four to eight weeks.

Can reflux go away on its own?

Occasional reflux often settles with lifestyle changes alone. GERD can come and go, and many people can manage with on-demand treatment once symptoms are controlled.

Is it safe to take antacids every day?

Antacids are generally safe for occasional use. If you need them most days for more than a few weeks, talk to a pharmacist or healthcare provider for a proper assessment.

Does coffee cause reflux?

Coffee can trigger symptoms in some people but not all. If you notice a pattern, try reducing it or switching to decaffeinated for a few weeks to see if it helps.

Can stress cause acid reflux?

Stress does not directly increase stomach acid in a meaningful way, but it can make the oesophagus more sensitive and make symptoms feel worse.

What is silent reflux?

Silent reflux, or laryngopharyngeal reflux, describes reflux that causes throat and voice symptoms, such as hoarseness, throat clearing and cough, often without typical heartburn.

But what if my acid tablets have stopped working?

When reflux treatment seems to fail, the most common reasons are taking the PPI at the wrong time, not taking it every day during the treatment course, ongoing triggers such as late meals, alcohol and smoking, or symptoms that are not caused by acid at all, such as functional heartburn, oesophageal hypersensitivity, eosinophilic oesophagitis or a motility disorder. Ask your healthcare provider to review your diagnosis, your medicine timing and whether tests such as endoscopy or pH monitoring would help. Do not simply keep increasing doses or buying stronger products without a review.

Related: Acid reflux and heartburn: quick tips · Weight management: the complete guide

Sources: World Gastroenterology Organisation global guidelines on GERD, American College of Gastroenterology clinical guideline for GERD, British Society of Gastroenterology guidelines on Barrett’s oesophagus, National Institute for Health and Care Excellence (NICE) dyspepsia and GORD guidance, Lyon Consensus on GERD diagnosis, American Gastroenterological Association clinical practice update on PPI deprescribing.