I had been suffering from acid reflux for 20 years… then I discovered exactly what causes it, the foods that make it worse and how experts say you can cure yourself permanently

Paula Gresty would gasp in pain as the terrible – and all-too-familiar – scorching sensation rose up into her throat at night.

‘It was as though someone had lit a fire in my stomach,’ she says. ‘It was coming up into my throat. I’d gasp for breath as I couldn’t deal with the pain.’

Paula’s ‘excruciating’ heartburn regularly struck four or five times a week after mealtimes and at night – ‘I wanted to scream but my throat was also too sore,’ she recalls.

But extreme heartburn wasn’t the only unpleasant acid reflux symptom that Paula, now 60 and a retired customer services manager, had to endure.

From the age of 56, she also began regurgitating her food after meals.

‘Suddenly I’d have to dash to the bathroom to regurgitate – once I even got a black eye when I tripped in my haste and hit the basin. Life was completely miserable,’ says Paula, who lives near Norwich with her husband Nick, 66, a retired delivery driver.

By this time, in 2021, Paula had been suffering from acid reflux for around 20 years – and despite taking the medication prescribed by her GP for two decades, matters were getting worse.

More than eight million people in the UK are estimated to have acid reflux. Normally, a muscle that works as a one-way valve at the base of the oesophagus – known as the lower oesophageal sphincter – lets food into the stomach, but stops stomach acid escaping.

If this doesn’t work properly, acid leaks up the oesophagus, causing heartburn. It’s often worse at night because of the effects of gravity.

When stomach acid flows backwards from the stomach into the oesophagus, it irritates the lining, causing the burning sensation known as heartburn (although ‘heartburn’ is often commonly used to describe acid reflux – heartburn is in fact technically speaking one of the symptoms of reflux).

Other debilitating reflux symptoms include a bitter sour taste, burping, hiccups, nausea and bloating.

Regurgitation, which Paula experienced, is another very common symptom, affecting around 70 to 80 per cent of those with reflux, say experts.

Those with occasional symptoms may find their problems eased by lifestyle changes such as avoiding certain trigger foods or eating later (see box) and with over-the-counter remedies.

For others, it’s a more persistent and debilitating problem. Studies suggest that more than 5.5 million Britons, or one in ten, like Paula – suffer with regular reflux, also known as gastro-oesophageal reflux disease (GORD).

But as many people self-medicate, the exact number isn’t known: some experts believe the figure might be nearer to a third of the population.

First-line treatment is with proton pump inhibitor drugs (PPIs), which work by reducing the amount of stomach acid produced.

Yet many experts are now calling for greater awareness of GORD – among both doctors and patients themselves – because symptoms that appear to be due to reflux may in fact be due to other causes.

And improved testing will enable doctors to pick up complications from the continuous damage to the oesophagus from stomach acid – including Barrett’s oesophagus (which can develop into oesophageal cancer). Daily Mail columnist Nadine Dorries recently wrote about how she’s developed Barrett’s and is worried about cancer.

Paula was 38 when she was first plagued by hoarseness and started constantly losing her voice.

‘I’d try to speak but my throat was so dry that only a rough rasping noise would come out,’ she recalls.

At first, she put it down to working in a call centre and always being on the phone – but when she had to take a lot of time off work and began to fear she’d lose her job, she saw her GP. They diagnosed reflux and prescribed lansoprazole, a PPI.

‘I was just told to take the tablets and that was it,’ says Paula.

‘I managed my symptoms as best I could. I found that avoiding garlic, onions and fizzy drinks helped.

‘Over time my medication stopped working so well but I just accepted things.

‘My father had always suffered with heartburn and taken antacids so I just thought that was what being an adult was like. But it really dominated my life.’

Research shows persistent reflux symptoms can have as negative an impact on a patient’s quality of life as diabetes and depression, says Nick Boyle, a gastrointestinal surgeon and medical director of the private clinic Reflux UK, based in London.

As well as pain – heartburn – in the short term, sufficient quantities of acid reflux over the longer term can inflame the lining of the oesophagus [known as oesophagitis], even causing ulcers and bleeding in severe cases, says Dr Inder Mainie, a consultant gastroenterologist at Belfast NHS Trust.

There can be several reasons the lower oesophageal sphincter has been weakened.

Often, it’s linked to a hiatus hernia, where part of the stomach wall slides up into the chest through a hole in the diaphragm.

Carrying excess weight is another cause of reflux as it puts more pressure on the stomach. The expanding womb during pregnancy can also press on the sphincter.

Certain foods are known to trigger or exacerbate reflux.

For instance, fatty foods slow the rate the stomach empties, meaning that acidic contents linger for longer; spicy dishes often contain a compound, capsaicin, which can irritate an already inflamed oesophagus, intensifying the feelings of heartburn. As can alcohol and nicotine in cigarettes.

‘But it’s important to realise that not everyone with heartburn symptoms has reflux,’ stresses Dr Mainie.

For example, chest pains which seem like indigestion can also sometimes indicate a heart attack – underlining why it’s always important to consult a GP about your symptoms, he adds.

Changes in the community of microbes that live in the gut can also trigger heartburn-like symptoms, says Mr Boyle.

He adds that small intestinal bacterial overgrowth (SIBO) – where ‘bad’ bacteria can flourish – can also trigger similar symptoms of indigestion and belching, as the bacteria ferment in the small bowel.

Anti-inflammatory medicines, such as ibuprofen, can also cause the stinging sensation of heartburn as a side-effect, as these irritate the stomach lining, causing pain.

But if it is acid reflux, heartburn is not the only symptom to watch for.

Regurgitation, which Paula suffered, is another problem as stomach acid and sometimes partially digested food rises into the back of the throat. This is also often accompanied by a bitter sour taste, belching and sometimes even difficulty swallowing.

Less well known ‘but actually just as common as heartburn’, says Mr Boyle – are a sore throat, cough, hoarseness and even breathing difficulties – as the acid causes inflammation to the respiratory system.

Collectively, these symptoms are known as ‘silent reflux’.

Quite apart from the discomfort involved, you should see your GP if you have symptoms of this sort two or three times a week that don’t go away for over six to eight weeks, says Dr Mainie. ‘The longer you have persistent heartburn, the greater your chances of developing other conditions including Barrett’s oesophagus, ulcers and internal bleeding,’ he adds.

A tiny minority of those with Barrett’s (1 to 3 per cent) subsequently go on to develop oesophageal cancer, which kills 8,000 Britons a year.

The ‘gold standard’ test for Barrett’s and oesophageal cancer is an endoscope, where a tiny camera is inserted down the throat on a tube to inspect the food pipe for signs of damage and to sample damaged cells.

But it’s invasive and requires referral to a specialist unit, which ‘isn’t always easy and depends on individual GPs as well as local waiting lists,’ says Rebecca Fitzgerald, a professor of cancer prevention at the University of Cambridge and an honorary consultant in gastroenterology at Addenbrooke’s Hospital.

But it’s hoped a recently-developed ‘sponge on a string’ test could make it much easier for patients to get early, accurate diagnosis.

Developed by a team led by Professor Fitzgerald, the Cytosponge is a sponge contained inside a tiny capsule attached to a thin string. This is swallowed by the patient. The capsule then dissolves in the stomach and the sponge expands to the size of a 1p coin. After a few minutes it is then pulled back up using the string – in the process collecting cells to be tested for Barrett’s.

The test is currently available in some hospitals, but in July the NHS announced a pilot ‘heartburn health check’ scheme which will see it offered to 1,500 people in London and the east Midlands who regularly purchase over-the-counter or prescribed heartburn drugs at Boots.

‘We eventually hope it will be widely available in community settings, such as shopping centres, in order to reach people who never visit their GP,’ says Professor Fitzgerald.

‘Currently too many people with persistent heartburn aren’t tested and just put up with things. Most won’t get cancer, but for the minority that do, we often see it too late.’

It was only when Paula’s symptoms got dramatically worse, when the extreme burning sensations began, that she went to see her GP again in 2022. She was referred for an endoscope which revealed she had a large 5cm hiatus hernia, GORD and Barrett’s oesophagus.

‘I’d never heard of Barrett’s before, but was horrified when I learned that this meant I was at increased risk of developing cancer,’ she says.

No other treatment was offered at this point, Paula says, so she managed with lifestyle advice from the charity Heartburn Cancer – keeping a food diary to identify her triggers, and sleeping with a special raised pillow (see box). She also lost some weight.

In 2024, she was having difficulty swallowing. ‘I could stand it no more and went back to my GP and asked for another endoscopy.’

This took place in April 2024. Paula then waited nearly a year to see a consultant in June and is currently still waiting for the result of a biopsy and for a final decision on her hernia operation. She’s hopeful she will finally get surgery.

‘I wish I had pressed my GP for more follow-up years ago,’ she says. ‘I tried to battle on, but I was wrong – I’d urge others not to make the same mistake.’

Different ways to ease agonising symptoms

Lifestyle changes

• Avoid fatty foods and spicy dishes, and limit alcohol and smoking. Moderate your caffeine intake. Research shows citrus fruits and peppermint may also have the same effect, says gastrointestinal surgeon Nick Boyle.

• Don’t eat late. The charity Guts UK advises leaving at least three hours between your evening meal and bedtime to allow sufficient time for digestion.

• Losing weight can significantly reduce acid reflux symptoms. Research published in the journal Obesity in 2013 found that overweight patients who lost an average of just over 2st (13kg) improved symptoms for 81 per cent of participants, while 65 per cent found their symptoms completely stopped.

• Raise the level of your head at bedtime using pillows or blocks under the bed posts. Heartburn sufferers who raised their head by 20cm suffered significantly fewer night-time symptoms than those who slept flat, according to a 2012 study in the Journal of Gastroenterology and Hepatology. This is because gravity helps to reduce the backward flow of acid.

• Check your HRT medication. ‘Some HRT treatments can also relax the lower oesophageal sphincter – the hormone progesterone, in particular, can have this effect. Check with your GP, who may be able to switch you to another formulation,’ suggests Mr Boyle.

Medications

A range of drugs can also relieve the misery of reflux symptoms.

Antacids contain alkaline substances (e.g. calcium carbonate and magnesium) that neutralise the acidity of stomach acid.

They’re effective at treating occasional heartburn, but see your doctor for persistent symptoms, says pharmacist Nahim Khan. He adds that pharmacy-own brands are cheaper and just as effective as well-known brands, such as Rennie and Gaviscon.

Alginates (e.g. Gaviscon Advance) are derived from seaweed and help by coating your gullet with a protective layer.

Proton pump inhibitors (PPIs) are very effective and are among the most widely prescribed drugs in the UK. Some options, such as omeprazole and esomeprazole can be bought over-the-counter, while others (e.g. lansoprazole) require a prescription.

However, PPIs don’t work for everyone. ‘Some 18 per cent of patients will suffer with reflux symptoms despite taking medication,’ says gastroenterologist Dr Inder Mainie.

‘This is partly because the symptoms may not, in fact, be due to acid reflux, and also because the drugs themselves can become less effective over time.’ (Some people also don’t take the tablets at the correct time – which is 30-60 minutes before a meal – which reduces the medication’s effectiveness.)

‘There is also evidence that PPIs can change the composition of the gut microbiome – these can also cause SIBO (see above), so the irony is that the usual treatment for GORD can in fact lead to symptoms that appear to be due to reflux,’ says Mr Boyle.

Some research has linked long-term PPI use to an increased risk of osteoporosis, kidney damage and infections.

‘This is why it’s important to discuss whether long-term use is appropriate for you – and if there are alternative approaches – with your GP,’ says Dr Mainie.

Drugs known as H2 blockers are also sometimes used if PPIs have not helped. These include cimetidine, famotidine and nizatidine, and work by reducing stomach acid, but they generally aren’t as effective as PPIs.

Surgery

If medication hasn’t helped, there are surgical procedures for reflux which can significantly improve symptoms.

A technique known as fundoplication is the most common procedure. It involves wrapping part of the stomach around the lower oesophagus to reinforce the valve, preventing acid leaking upward.

A fundoplication ‘adds 20-50 per cent of the final strength of the new sphincter and also helps prevent recurrence’, says Mr Boyle.

Widely available on the NHS and performed with keyhole surgery, it’s highly effective in 80-90 per cent of cases, he adds. Repairing a hiatus hernia is also an essential part of all anti-reflux operations and can be performed at the same time.

Side-effects of fundoplication include gas becoming trapped in the stomach, causing pain, bloating and swallowing difficulties.

The LINX procedure is another, less invasive option: it involves strengthening the valve by placing a bracelet of tiny magnetic beads around it. Swallowed food temporarily pushes the beads apart, but they’re then magnetically drawn back together.

Side-effects are less common than for fundoplication, but include difficulty swallowing, bloating and wind. Available in some NHS hospitals and privately (costing £10,000 to £12,000), it has a high success rate, but it is unsuitable for those with pre-existing swallowing difficulties.

There is also a new procedure, RefluxStop, which involves a small silicone device being inserted at the top of the stomach to help keep the valve closed. As it doesn’t involve compressing the oesophagus, it’s suitable for patients with pre-existing swallowing problems.

Currently it’s only available in three NHS hospitals (two in London, one in Southampton) and privately (costing £15,000 to £17,000).