How do I know it is reflux and not my heart?
You often cannot, and that is why it matters. Heart attacks are mistaken for indigestion regularly.
Call 999 for chest pain with breathlessness, sweating, or pain radiating to the arm or jaw — particularly if it comes on with exertion. An antacid relieving it proves nothing.
Which symptoms mean I need an endoscopy?
Difficulty swallowing, food sticking, unintentional weight loss, vomiting blood, black tarry stools, anaemia, or new indigestion over 55.
These need investigating rather than treating. A PPI settles the symptom and delays the diagnosis, which is the specific harm to avoid.
Should I cut out gluten to see if it helps?
Not before being tested for coeliac disease. The test becomes unreliable once you have stopped eating gluten, and people lose the diagnosis this way.
Test first, then experiment.
Should I be on omeprazole long term?
Sometimes yes — but it should be a decision, not a default.
For Barrett's oesophagus or severe oesophagitis, long-term treatment is clearly right. For ordinary reflux, the aim is the lowest dose that controls symptoms, reviewed periodically.
Every time I stop it, it comes back worse.
Not dependence — rebound acid hypersecretion, which follows stopping a PPI abruptly after prolonged use and feels exactly like the reflux returning worse than before.
It settles within about two weeks. Step down gradually rather than stopping dead.
I was told I have IBS. Should I accept that?
IBS is a real diagnosis and a common one — but it should be made after excluding the things that mimic it, not instead of.
Coeliac disease, inflammatory bowel disease, bile acid malabsorption and, in the right age group, bowel cancer all present similarly. If nobody has tested for coeliac disease or checked inflammatory markers, that is worth asking about.
Are food intolerance tests worth buying?
No. IgG food intolerance testing has no scientific validity, and the usual outcome is an expensive list of foods to avoid for no benefit — sometimes with real nutritional cost.
Genuine food allergy is a different thing and is assessed on history, not on a mail-order panel.
What is H. pylori and should I be tested?
A bacterium causing persistent indigestion and ulcers, treatable with a course of antibiotics — and eradication resolves symptoms for a good number of people while reducing ulcer and stomach cancer risk.
Stop your PPI two weeks before testing, or the result will be falsely negative.
Should I take probiotics?
The evidence is mixed and strain-specific rather than general. There is reasonable evidence for particular strains in particular situations — antibiotic-associated diarrhoea, some IBS — and very little for the broad "gut health" claims on most packaging.
Not harmful, frequently oversold, and not a substitute for finding out what is actually going on.
I keep getting bloated. Is that serious?
Usually not — but persistent bloating in a woman is one symptom worth taking more seriously than it usually is.
Bloating that is persistent rather than intermittent, particularly with feeling full quickly, pelvic pain or urinary urgency, warrants assessment for ovarian cancer. It is a recognised presentation and it is missed because bloating is so common.