Your complete reference for heartburn and reflux.
Know occasional reflux from the disease, take the medicine at the right time, and walk into your appointment with a clear record.

It is called gastro-oesophageal reflux disease (GERD) when the symptoms recur or cause complications over time. Its best-known symptoms are heartburn behind the breastbone and a sour taste or food rising into the mouth.

Between the stomach and the oesophagus sits a muscular valve (the lower oesophageal sphincter) that should stay closed except when swallowing. When it relaxes at the wrong time or weakens, or when a full abdomen or excess weight presses on the stomach, acid rises upward.

Heartburn is a burning feeling behind the breastbone; regurgitation is liquid or food rising upward. Having them helps the doctor, but it does not turn every upper symptom into reflux disease.

Limits: Telling occasional reflux from the disease is done with the doctor, by frequency, impact and examination, not from this page.

Sources: NIDDK (2020) · ACG (2022)

Typical symptoms: heartburn after meals or when lying down, sour or bitter regurgitation, and sometimes mild pain in the upper abdomen or a feeling of food sticking.

Chest pain with breathlessness, sweating or spread to the arm is not managed through a reflux program; it needs urgent assessment. The ACG guideline says the heart must be ruled out first before chest pain is attributed to reflux.

Symptoms outside the oesophagus (chronic cough, hoarseness, throat clearing, a lump feeling in the throat, asthma) have many causes; intermittent acidity is not enough to attribute them automatically to reflux. The guideline advises evaluating other causes (ear-nose-throat, lungs) before reflux is taken as the cause.

Limits: Reflux is not diagnosed from cough or hoarseness alone.

Sources: NIDDK (2020) · ACG (2022) · AGA (2022)

The doctor may start from the history in typical, uncomplicated symptoms and change course when there is an alarm feature or diagnostic doubt. For typical heartburn and regurgitation without alarm features, the ACG guideline suggests a trial of a proton pump inhibitor once a day before a meal for 8 weeks.

Endoscopy matters with difficulty swallowing, bleeding or suspected complications, but a normal result does not exclude every form of reflux.

Ambulatory reflux monitoring helps when reflux needs to be proven or persistent symptoms need explaining in a specific setting. When reflux has not been proven before (no oesophagitis on endoscopy and no Barrett's), the guideline suggests monitoring off acid-suppressing medicine, agreed with the doctor.

Oesophageal manometry helps assess motility disorders and prepare for some procedures; on its own it does not prove reflux.

Limits: No single test explains every pattern; the doctor chooses the test by the question to be answered.

Sources: ACG (2022) · AGA (2022) · Lyon Consensus 2.0 (2024) · NIDDK (2020)

For people troubled at night, the guideline suggests raising the head of the bed. NIDDK mentions raising the head by about 15 to 20 cm (6–8 inches) during sleep.

With night symptoms a patient may discuss the timing of the last meal, raising the head of the bed, or sleeping on the left side rather than changing ten habits at once.

Smaller, less fatty meals, not lying down straight after eating, and loosening clothes that press on the abdomen are simple measures mentioned by the NHS and NIDDK.

There is no list of foods forbidden for everyone. The guideline advises avoiding what triggers your own symptoms (commonly: fat, chocolate, coffee, citrus, tomato, fizzy drinks, mint, hot spices) once you have noticed it yourself, not a broad ban.

Limits: General principles; there is no food list forbidden for everyone, and triggers differ from person to person.

Sources: ACG (2022) · NIDDK (2020) · NHS (2023)

The ACG guideline recommends taking the PPI half an hour to one hour before a meal. For people whose symptoms improved and who have no severe oesophagitis or Barrett's oesophagus, the guideline suggests discussing stopping the medicine or using it on demand rather than continuing automatically.

Alginates (such as Gaviscon) form a layer that floats on the stomach contents and are taken after meals and at bedtime; the ACG guideline mentions them for intermittent after-meal symptoms, and they are preferred in pregnancy together with antacids.

H2 blockers (such as famotidine) are weaker than PPIs but may be added at bedtime for people whose night symptoms persist despite a PPI; their effect fades with continuous daily use.

Vonoprazan (a potassium-competitive acid blocker) is a newer class that works faster and does not need timing before a meal; it is available in some countries for erosive oesophagitis and its maintenance, on prescription.

The guideline does not recommend prokinetics (such as metoclopramide) for reflux unless delayed stomach emptying is proven, nor sucralfate outside pregnancy.

The medicine map: for which symptom, how it is taken, and its usual pattern ↓

Limits: No doses and no instructions to start or stop a medicine; any change is discussed with your doctor, who knows your diagnosis and medicines.

Sources: NIDDK (2020) · ACG (2022) · NICE CG184 (2019)

For people who responded to the trial and have no severe oesophagitis (Los Angeles grade C or D) and no Barrett's oesophagus, the ACG guideline suggests attempting to stop the PPI or switching to on-demand use; symptoms may return briefly after stopping (acid rebound) and then settle.

Long-term continuation is recommended for people with severe oesophagitis, Barrett's oesophagus or a stricture, at the lowest dose that controls symptoms. Do not stop it on your own in these cases.

If symptoms do not improve within 8 weeks, the review starts with timing (half an hour to one hour before a meal) and adherence; the doctor may then discuss increasing to twice daily, switching the type, or testing to prove reflux.

On long-term safety: the guideline notes that most published associations (fractures, kidney, dementia, infections) are weak and no causal link has been proven, that a PPI is used when it has a clear benefit and at the lowest effective dose, and it does not recommend routine tests (bone density, vitamin B12, magnesium) merely because of use.

Limits: No change in medicine or dose from this page; the decision is with your doctor according to what the endoscopy showed.

Sources: ACG (2022) · AGA (2022) · NICE CG184 (2019)

If symptoms do not improve with lifestyle changes and medicine, the doctor may need further tests to confirm the diagnosis or look for another cause.

A diagnostic endoscopy is preferably done after stopping the PPI for 2–4 weeks when possible, so that any oesophagitis is visible; your doctor decides whether that is appropriate for you.

Endoscopy looks for oesophagitis (graded Los Angeles A–D), a stricture, Barrett's oesophagus and a hiatus hernia, and rules out other causes.

Limits: The decision to test is the doctor's, according to your case; this page neither requests a test nor rules one out.

Sources: ACG (2022) · NIDDK (2020) · NICE CG184 (2019)

Erosive oesophagitis means erosions in the oesophageal lining seen on endoscopy; it usually heals with a PPI for 8 weeks, and severe grades need continued treatment and an endoscopy to confirm healing.

A stricture causes a feeling that food sticks; it is treated by dilatation during endoscopy and a PPI.

Barrett's oesophagus: the lining of the lower oesophagus is replaced by cells resembling intestinal cells. Most people with Barrett's never develop cancer, but the risk is slightly higher, so it is monitored by endoscopy at intervals the doctor sets (usually every 3–5 years when there is no dysplasia).

The ACG guideline suggests a one-time endoscopy to screen for Barrett's in people with chronic reflux and multiple risk factors: male sex, over 50, central obesity, smoking, and a family history of Barrett's or oesophageal cancer.

Limits: No symptoms does not exclude Barrett's, and severe symptoms do not mean it is present; only endoscopy determines it.

Sources: ACG (2022) · NIDDK (2017) · NIDDK (2020)

The discussion starts by checking the name of the treatment and how it is taken as prescribed, adherence, and any change in the symptom pattern or a new alarm feature.

The doctor may discuss reflux monitoring, manometry or overlapping causes, depending on the case.

Concepts that may enter the specialist assessment: reflux hypersensitivity, functional heartburn, rumination, or supragastric belching. These are not results that Madar issues.

When symptoms persist despite a PPI and monitoring shows acid is controlled, treatment may go in another direction: pain-signal modulators (such as low-dose amitriptyline) or behavioural therapy for rumination and belching, not a higher acid dose.

Limits: Throat symptoms or cough have many causes; intermittent acidity is not enough to attribute them automatically to reflux.

Sources: ACG (2022) · AGA (2022) · Lyon Consensus 2.0 (2024)

In a usual episode: smaller meals, stay upright for two to three hours, raise the head of the bed, and use the antacid or alginate your doctor advised when needed.

Contact your doctor this week if symptoms return after a quiet period, if you need the antacid more than two days a week for weeks, or if new night symptoms wake you.

Do not wait for the appointment if there is difficulty or pain swallowing, vomiting blood or black stools, unexplained weight loss, or chest pain with breathlessness, sweating or spread to the arm.

Limits: The signal is a descriptive aid for your decision, not a diagnosis.

Sources: ACG (2022) · NHS (2023) · NIDDK (2020)

When fasting: have the pre-dawn meal two to three hours before sleep, avoid one large fatty meal when breaking the fast, and discuss with your doctor the timing of the PPI (half an hour to one hour before the evening or pre-dawn meal).

In pregnancy: heartburn is common. Antacids and alginates are preferred first, then H2 blockers, and PPIs when needed at the doctor's decision; all three are widely used in pregnancy.

Surgery (fundoplication) or endoscopic procedures are an option for people with objectively proven reflux who need permanent medicine or have regurgitation that does not respond; the ACG guideline notes they need careful assessment beforehand, with benefits and risks discussed with a specialist team.

Other medicines worsen reflux in some people (such as some blood-pressure medicines, non-steroidal painkillers and large calcium tablets); do not stop any of them yourself, and mention them to your doctor.

Limits: Every medicine adjustment is arranged with your doctor.

Sources: ACG (2022) · NICE CG184 (2019) · NHS (2023) · BNF (NICE) (2026)