What acidity and GERD are
Your stomach makes strong acid to digest food. A ring of muscle at the lower end of the food pipe (oesophagus) normally stops this acid from coming back up. When the ring is weak or relaxes at the wrong time, acid leaks upward and causes a burning feeling in the chest. Most people call this acidity or gas.
When this reflux happens often, usually two or more times a week, or starts to damage the food pipe, doctors call it gastro-oesophageal reflux disease, or GERD. Occasional acidity after a heavy biryani is common. GERD is a long-term condition that needs a plan.
Common causes and triggers
Large, late-night meals are the most common trigger, especially when you lie down soon after eating. Extra body weight, particularly around the belly, pushes acid upward. Pregnancy does the same because of pressure from the growing baby and hormonal changes.
- Oily, fried and very spicy food, and heavy festival meals
- Tea, coffee, aerated drinks, alcohol and smoking
- Long gaps between meals followed by overeating
- Painkillers such as ibuprofen or aspirin taken on an empty stomach
- Stress and poor sleep
- A hiatus hernia, where part of the stomach slides up into the chest
Symptoms to recognise
The classic symptom is heartburn: a burning pain behind the breastbone that rises towards the throat, often after meals or at night. Many people also notice sour or bitter liquid coming into the mouth, frequent burping, bloating and a feeling of fullness.
Some people have less obvious signs, such as a dry cough at night, a hoarse voice in the morning, a sore throat that keeps coming back, or a feeling of a lump in the throat. Chest pain from the heart can feel like acidity, so never assume chest pain is only gas.
Children and infants can also have reflux. In babies, frequent spitting up after feeds is usually normal and settles by the first birthday. However, poor weight gain, refusal to feed, blood in the vomit or constant crying after feeds should be checked by a paediatrician without delay.
How doctors diagnose it
Most cases are diagnosed from your symptoms alone, and doctors often start treatment straight away. If you are over 45 to 50 with new symptoms, or have warning signs such as weight loss or trouble swallowing, the doctor may advise an upper GI endoscopy. A thin camera tube is passed through the mouth to look at the food pipe and stomach.
The doctor may also test for H. pylori, a common stomach germ that causes ulcers and inflammation, and check your blood count for anaemia caused by slow bleeding. An ECG may be done if the chest pain could be coming from the heart, especially in people with diabetes, high blood pressure or a smoking habit.
Treatment options for acidity and GERD
Antacids give quick, short relief for mild, occasional acidity. For frequent symptoms, doctors usually prescribe medicines that reduce acid production, such as proton pump inhibitors (PPIs) or H2 blockers. These work well, but long-term use should be reviewed by a doctor from time to time rather than continued on your own.
If H. pylori is found, the doctor will prescribe a specific combination course that includes antibiotics, only on a doctor's prescription, and may repeat the test later to confirm the germ has gone. Surgery is rarely needed and is kept for severe cases that do not respond to medicine and lifestyle changes.
Daily habits that help
Lifestyle changes make a real difference and often reduce the need for medicine. Give each change a few weeks before judging it. Pregnant women, the elderly and people with kidney disease should check with a doctor before using any antacid regularly, because some contain salts that build up in the body.
- Eat smaller meals at regular times; do not skip breakfast
- Finish dinner at least 2 to 3 hours before lying down
- Raise the head end of your bed a little using blocks under the legs
- Cut down on fried food, tea, coffee and aerated drinks
- Lose extra weight and stop smoking and alcohol
- Avoid tight belts and clothes around the waist
When to see a doctor for acidity and GERD
See a doctor if acidity happens more than twice a week, lasts more than two weeks despite antacids, or wakes you at night. Long-standing untreated GERD can cause narrowing of the food pipe and, rarely, changes that raise cancer risk. A doctor or pharmacist can guide you on safe medicine choices and tell you when further tests are needed.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- Antacids (magnesium or aluminium salts, sodium alginate)Neutralise stomach acid or form a protective layer for quick, short relief.Follow the label or your pharmacist's advice; people with kidney disease should ask a doctor first.
- Proton pump inhibitors (PPIs) such as pantoprazole or omeprazoleStrongly reduce the amount of acid the stomach makes.Long-term use should be reviewed by a doctor; do not continue for months on your own.
- H2 blockers such as famotidineReduce acid production and help with night-time symptoms.Use as your doctor or pharmacist advises and check before use in pregnancy or kidney disease.
- Prokinetics such as domperidone or itoprideHelp the stomach empty faster and reduce bloating and regurgitation.Only on a doctor's prescription; some can affect heart rhythm.
See a doctor urgently if
- See a doctor urgently if you have chest pain with sweating, breathlessness or pain spreading to the arm or jaw.
- See a doctor urgently if you vomit blood or material that looks like coffee grounds.
- See a doctor urgently if your stools are black and tarry.
- See a doctor soon if food sticks while swallowing or swallowing is painful.
- See a doctor soon if you are losing weight without trying or have poor appetite.
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.