Heartburn and acid reflux in adults

You get heartburn when the valve (also called a sphincter) at the top of your stomach relaxes or weakens.

When this happens, acid or occasionally some of your stomach contents can flow back into your food pipe (oesophagus). This can irritate the lining of your food pipe.

Heartburn is very common. Almost everyone has it sometimes. If it keeps happening, it is called gastrooesophageal reflux disease (GORD).

Heartburn can be caused or made worse by:

• eating a large meal or snacking at night
• eating certain foods or drinks
• lying down after eating
• stress or anxiety
• being an unhealthy weight
• smoking
• being pregnant
• having a hiatus hernia — this is where a part of your stomach pushes up through your diaphragm into your lower chest
• some medicines such as anti-inflammatory pain relief like ibuprofen and opiates such as morphine or codeine.

Some people have silent reflux. With silent reflux, you do not get heartburn, but the acid can damage your throat and vocal cords.

Symptoms tend to come and go and are often worse after eating. Common symptoms may include:

• a burning feeling that rises from your tummy (abdomen) or lower chest up towards your neck
• pain in your upper abdomen and chest
• feeling sick (nausea)
• an acid taste in your mouth
• feeling bloated
• burping
• a burning pain when you swallow hot drinks.

The symptoms of silent reflux may include:

• feeling like something is stuck in your throat
• a hoarse voice
• clearing your throat often
• unexplained coughing
• a long-lasting (chronic) sore throat.

See your healthcare provider if you have heartburn and:

• you have lost weight without trying
• you have difficulty or pain swallowing food and fluid
• you are throwing up (vomiting)
• your heartburn does not improve after making eating and lifestyle changes or taking a short course of over-the-counter antacids.

Most people can manage heartburn and reflux with eating and lifestyle changes, and by taking antacids. Antacids work in one of 2 ways:

• by reducing the acid in your stomach
• by forming a gel over the top of your stomach contents, which helps stop acid going up into your food pipe.

Antacids are available as chewable tablets and liquids. You can buy antacids from a supermarket or pharmacy, including:

• Quick-Eze
• Mylanta
• Gaviscon.

Antacids are usually only used for a short time and are not recommended to be used long term.

Prescription medications for acid reflux

If you do not feel better with antacids and lifestyle changes within a few weeks, your healthcare provider may suggest a prescription medicine. These block or reduce the amount of acid your stomach makes.

GORD can usually be controlled with these medications. If they do not help, you may need surgery to reduce your symptoms.

There are several things you can do to ease your symptoms and reduce how often you have heartburn.

Do not smoke

Smoking can increase the amount of acid your stomach makes. It can also weaken the valve that stops acid flowing back into your food pipe.

Quitting smoking

Maintain a healthy weight

If you are an unhealthy overweight, losing weight may help ease your symptoms. Excess weight, especially if it is around your middle, puts extra pressure on your stomach and encourages acid to flow back into your food pipe.

Eating well for good health

Physical activity

Healthy weight BMI calculator

Avoid tight-fitting clothing

Clothes or belts that fit tightly around your waist put pressure on your stomach and encourage acid reflux. For example, sweatpants with a drawstring are often looser fitting than jeans or yoga pants.

Avoid foods and drinks that trigger heartburn

Some foods and drinks can make heartburn worse. Keep a food and symptom diary and record whether certain foods and drinks make your heartburn better or worse. You can then avoid those that make it worse.

Common foods and drinks that can trigger heartburn or make it worse include:

• fizzy drinks
• caffeinated drinks such as coffee, tea, and energy drinks
• alcohol
• citrus fruits such as oranges, grapefruit and lemons
• tomatoes
• onions and garlic
• mint or peppermint
• chocolate
• fatty or spicy foods such as chilli or curry.

Eat smaller meals

Eating too much food at once can make heartburn worse. Rather than having 3 large meals a day, try having smaller meals more often.

Eating slowly and chewing your food well will also help.

Do not lie down during or after eating

Wait at least 3 hours after eating before you lie down or go to bed.

Raise the head of your bed

If you often have heartburn at night, raising the head of your bed by around 20 centimetres (8 inches) may help. You can do this by:

• putting wood or blocks under the feet of your bed
• putting pillows under the upper part of your mattress.

Your food pipe needs to be higher than your stomach. Do not use extra pillows on top of the mattress — that will only raise your head and may give you a sore neck.

Try to get enough sleep and avoid sleeping on your right side

Lack of sleep and lying on your right side can make heartburn worse. If you have heartburn at night, try lying on your left side.

Herbal remedies

Herbal remedies sometimes used for heartburn include:

• liquorice
• slippery elm
• chamomile
• marshmallow.

These have not been proven to treat GORD or to reverse any damage to your food pipe. They can also interfere with any medicines you are taking. Ask your healthcare provider or pharmacist for advice before you begin any herbal remedy.

Manage stress

Getting enough sleep and being physically active can help to reduce stress. Relaxation techniques that may also help include:

• calming breathing
• progressive muscle relaxation
• yoga
• meditation.

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