Common and treatable — but persistent reflux over 55 needs investigating, not just suppressing.
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Acid reflux happens when the muscular valve between the oesophagus and the stomach relaxes when it should not, allowing stomach contents back up. The oesophagus has no protective lining, so acid there burns — hence heartburn.
Occasional reflux is normal. When it happens repeatedly, causes troublesome symptoms, or damages the lining, it is called gastro-oesophageal reflux disease.
The single most useful piece of information on this page is about when to take a PPI. Omeprazole and lansoprazole work by shutting down acid pumps that are actively producing — which means they must be taken 30 to 60 minutes before a meal, on an empty stomach. Taken with food or at bedtime on an empty stomach they are substantially less effective. A large number of people conclude their PPI does not work when the only problem was the timing.
The second point concerns stopping. PPIs cause rebound acid over-production when stopped abruptly — symptoms return worse than before, people conclude they need the drug permanently, and a cycle establishes itself. Stepping down gradually avoids this entirely.
These are common, frequently investigated for months as something else, and often the only complaint:
Reflux and heart pain can feel identical. Do not assume chest pain is indigestion — particularly if it comes with breathlessness, sweating, nausea, or pain spreading to the jaw or arm, or if it is brought on by exertion. That combination is a 999 call.
Worth reviewing before adding anything new:
Spicy food, tomatoes, citrus, chocolate, fatty meals, mint and fizzy drinks are all commonly blamed. The evidence for blanket avoidance is weaker than people assume, and eliminating a long list of foods usually achieves less than losing weight, stopping smoking and not eating late. Identify your own triggers rather than adopting someone else's list.
In someone under 55 with typical heartburn and no warning features, reflux is diagnosed on the history and treated without any investigation. That makes it well suited to a remote consultation.
A bacterium living in the stomach lining that causes ulcers and contributes to reflux-type symptoms. Current practice is test and treat: a stool antigen or breath test, and where positive, a one-week course of two antibiotics with a PPI.
You must be off PPIs for two weeks before the test, or it produces a false negative — a genuinely common reason people are told they do not have it when they do.
Not for typical reflux responding to treatment. It is indicated — urgently — for:
These warrant an urgent two-week-wait referral, and we arrange it rather than trialling a longer course of treatment.
Full blood count and ferritin to identify anaemia from blood loss, and liver function where gallstones are possible.
Cardiac pain; gallstones, where pain is in the upper right abdomen and radiates to the back or shoulder blade; peptic ulcer; and functional dyspepsia — see indigestion.
This is straightforward to assess remotely, and treatment reaches your pharmacy within minutes.
Gaviscon and similar form a physical raft on top of the stomach contents. They work best after meals and at bedtime, which is the opposite timing to a PPI. Used together they complement each other, and many people take both wrongly.
Long-term use is common and often appropriate. But where it can be stopped, do not stop abruptly. Acid production rebounds above baseline for a few weeks, symptoms return worse, and people conclude they cannot manage without it.
Instead: halve the dose for two to four weeks, then move to alternate days, then to as-needed — using an alginate to cover the gaps. Done this way, a substantial proportion of people come off successfully.
PPIs have been linked to B12 deficiency, low magnesium, fracture risk and gut infections. These associations are real but modest, and they are frequently overstated in a way that frightens people off treatment they need. The sensible position is to take the lowest effective dose for as long as it is genuinely required, review it periodically, and check B12 with long-term use — not to endure symptoms out of fear.
Any red-flag symptom, symptoms not controlled after eight weeks of proper treatment, or anyone needing long-term high-dose treatment goes for endoscopy. Surgical options exist for a small number of people.
Call 999 for:
Arrange urgent assessment — these need endoscopy, not another treatment trial — for:
Book a routine consultation if: symptoms occur more than twice a week; over-the-counter treatment has not worked after four weeks used correctly; you have been on a PPI for over a year without review; you want to stop a PPI and previous attempts failed; or you have a persistent cough or hoarseness that nobody has connected to reflux.
Rather than cutting out a long list, keep a brief diary and identify your triggers. Most people have two or three, not fifteen — and unnecessary restriction achieves nothing while making life harder.
NSAIDs are the commonest culprit. If you take ibuprofen or naproxen regularly, ask whether it is still needed and whether a different painkiller would do — this alone resolves a good proportion of reflux.
Omeprazole and other acid-reducing treatments are available over the counter for a few pounds, and for occasional heartburn there is no need to pay for a consultation. Your NHS GP treats reflux free, and NHS endoscopy is free.
The most valuable thing a consultation does is ask a question that frequently gets skipped: have you ever been tested for Helicobacter pylori? It is a treatable infection, a one to two week course can eliminate the problem permanently, and the alternative — which happens constantly — is a proton pump inhibitor taken daily for a decade without anyone ever checking.
The second thing is a proper attempt at stopping. Rebound acid after abruptly stopping a long-term PPI feels worse than the original problem, which convinces people they need it permanently. A structured taper, with something to manage breakthrough symptoms, is rarely offered and is where a medication review earns its fee.
Free and genuinely effective: raising the head of the bed, not eating within three hours of lying down, weight loss where relevant, and reducing alcohol and smoking.
What must not simply be treated: difficulty swallowing, unintended weight loss, persistent vomiting, black stools, anaemia, or new symptoms over 55. Acid suppression is very good at masking things that need investigating, and those features warrant endoscopy.
NICE CG184, Gastro-oesophageal reflux disease and dyspepsia in adults, is the governing guideline. It recommends a test-and-treat approach for H. pylori in uninvestigated dyspepsia, and a full-dose PPI for four to eight weeks.
CG184 recommends annual review of people on long-term acid suppression, with a view to stepping down or stopping — the basis for the point above.
CG184 advises stopping PPIs for two weeks before H. pylori testing to avoid false negatives.
NICE NG12, Suspected cancer, defines the criteria for urgent direct-access endoscopy — dysphagia at any age, and upper abdominal symptoms with weight loss or aged 55 and over.
CG184 also covers Barrett's oesophagus surveillance, where long-term acid suppression is appropriate and continuing treatment is correct rather than something to withdraw.
Most often the timing. It must be taken 30 to 60 minutes before food, on an empty stomach — it blocks acid pumps that a meal activates, so it has to be in place first. Taken with breakfast, or at bedtime on an empty stomach, it works considerably less well. Also give it four to eight weeks; it is not an as-needed antacid.
The reported associations — B12 deficiency, low magnesium, fracture, gut infections — are real but modest, and they are widely overstated in a way that leads people to stop treatment they need and live with symptoms or, worse, with untreated oesophageal damage. Take the lowest effective dose, review it periodically, and check B12 with long-term use.
Rebound acid hypersecretion. Your stomach compensates for the suppression, and when the drug stops, acid production overshoots for a few weeks. It is a drug effect, not proof you need it for life. Stepping down gradually over several weeks, with an alginate to cover the gaps, avoids it.
No — and this is the commonest piece of wrong advice in reflux. Pillows bend you at the waist and increase pressure on the stomach. Raise the whole head of the bed by 10 to 20cm using blocks under the legs, or use a full-length wedge under the mattress.
No, and this assumption is dangerous. Cardiac pain and reflux can feel identical. Anything with breathlessness, sweating, nausea, jaw or arm pain, or brought on by exertion, is treated as cardiac until proven otherwise. Having reflux does not protect you from heart disease.
A bacterium in the stomach lining that causes ulcers and reflux-type symptoms, and is straightforward to test for and eradicate with a one-week course. Worth testing if symptoms persist. You must stop PPIs two weeks before the test, or the result may be falsely negative.
Not for typical reflux that responds to treatment. It is needed for difficulty swallowing, weight loss, persistent vomiting, anaemia, or new symptoms starting over 55 — and for symptoms not controlled after proper treatment. Those we refer urgently rather than continuing to treat.
The left. The anatomy of the stomach and the junction with the oesophagus means left-side sleeping measurably reduces reflux, while lying on the right worsens it. It costs nothing and helps more than people expect.
August 23, 2026
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