Acid reflux: everything you need to know
Ever woken up with a sour taste in your mouth? Or struggled to shake a tickly cough before bed? Acid reflux might be to blame, says Lauren Dunning.
Three years ago, I woke up with a sore throat and a voice so hoarse I could barely squeak out a sentence. Honey and lemon soothed the pain, but every morning the burn was back – and, as the weeks passed, it found company with hiccups, a cough and an unshakeable need to clear my throat. Weeks of scouring Google and gallons of gargled salt-water later, I left my GP with a diagnosis of acid reflux.
Unfortunately, I’m far from alone – in the UK, roughly 25% of us are affected by reflux, which happens when stomach acid flows back up into the chest and oesophagus. Often linked to age, its poster patient is a middle-aged man with a fondness for fry-ups and frequent heartburn – but, as diagnoses increase, evidence shows that this may not be the full story. A US study from 2018 recorded a ‘significant increase’ in those in their thirties with reflux disease, and women are increasingly at risk.
According to Nicholas Boyle, medical director at the London-based Reflux UK, about 20% to 30% of us experience symptoms on a regular basis. Sore throats, a sour taste in your mouth, bloating, hiccups and a cough are just as common as the classic heartburn we associate with reflux. The trouble is, we don’t link these symptoms to a possible gastric condition, and many of us just put up with the discomfort and don’t seek treatment. In fact, laryngopharyngeal reflux (LPR) in particular – where the stomach contents make it all the way up to the throat – has been dubbed silent reflux, due to the absence of telltale signs.
‘Acid reflux can present in a whole host of ways,’ Nicholas Boyle explains. ‘Some are obvious – if you are getting heartburn after eating a curry, it’s usually pretty clear that it’s reflux. But it can present in more esoteric ways. I have done a gastroscopy on a lady whose only symptom was a persistent cough, which she’d had for years. I can remember a patient who just kept losing their voice. Some people can get problems with their lungs, and asthma.’
Adding in conditions which can mimic or worsen symptoms – stress, sinus problems and digestive issues, for example – only muddies the water further. And acid reflux is a problem that’s not going away. A Norwegian study found the number of people experiencing acid reflux more than once a week had risen by 50% in 10 years; increasing awareness adds to diagnoses, but lifestyle changes are also behind the rise – think stress, obesity and poor diet, says Nicholas Boyle. While heartburn after a big, fatty meal is rarely a cause for concern, regular symptoms – twice or more a week – might point to gastro-oesophageal reflux disease (GORD). Around one in 10 people with GORD will develop Barrett’s oesophagus, a condition where cells in the oesophagus change, and a precursor to cancer. ‘It’s important to understand that oesophageal cancer is one of the fastest growing cancers in the United Kingdom, and that’s caused by acid reflux,’ Boyle says. So if you are regularly suffering symptoms, make an appointment with your GP.
Medication can be a huge help – proton- pump inhibitors (PPIs), which reduce the stomach’s acid production, offer relief, and a referral for an endoscopy might be made to rule out anything more sinister. Boyle says those with red flag symptoms – sudden weight loss, difficulty swallowing and sudden, persistent abdominal pain – should be assessed urgently. But for most of us, a few simple changes are all that’s required to relieve that persistent sore throat and acidic taste.
Nutritionist and gastric specialist Nadiya Kondratyeva advises avoiding common triggers like highly processed food, caffeine, alcohol and fatty foods, and the NHS recommends limiting chocolate and spicy foods, losing weight and stopping smoking. But there are also some dietary staples that might be triggering reflux – Kondratyeva singles out tomatoes, lemon, soy sauce and onion as common culprits. ‘Try cutting these out and seeing if you experience any change to your symptoms,’ she says. ‘Then add them slowly back in, one by one, to effectively isolate which are affecting you.’
And there are other simple, at-home tweaks you can make, too. ‘Getting more exercise – even just a half hour walk a day if you’re not used to activity – and not lying down after meals helps a lot of people, as well as having smaller meals, more often.’ she says. ‘And remember – the earlier you can catch the signs, the better.
How to relieve reflux:
DOWNSIZE YOUR DINNER – eat smaller meals, more frequently
CHEW GUM – studies say chewing sugar-free gum after meals can ease symptoms.
SLEEP ON YOUR LEFT SIDE – several studies have found this can calm reflux, and sleeping on your right can aggravate it.
RAISE YOUR SLEEPING ANGLE – but don’t just pile on the pillows (which can actually make it worse). Use bricks, blocks or books to raise the bedhead by about six to eight inches.
LIMIT YOUR INTAKE OF TRIGGERS, including alcohol, coffee, chocolate and spicy, fried or fatty foods; introduce more vegetables, fish, lean meat, ginger and porridge.
These over-the-counter or off-the-shelf medications might help – but check with the pharmacist before buying, always follow pack instructions and consult your GP if you have any concerns.
GAVISCON ADVANCE Gaviscon Advance is stronger than its original and double-action cousins, and works by creating a thick layer that sits on top of stomach contents. Best for... Those with stubborn reflux.
NEXIUM CONTROL Promising 24-hour protection from heartburn, it’s easy to see why Nexium is a popular choice. Best for... a once-a-day remedy.
RENNIE HEARTBURN AND INDIGESTION RELIEF TABLETS Rennie uses two naturally-occurring antacids, calcium carbonate and magnesium carbonate, to neutralise excess stomach acid. Best for... On-the-go relief.
PEPTAC LIQUID ANTACID Peptac promises its liquid antacid will reduce symptoms of bloatedness and heartburn. A budget-friendly choice, at £3.49 for 500ml. Best for... A more affordable option.