Reflux explained

Reflux

Symptoms, causes, treatments and when to seek help

That burning sensation in your chest after eating might seem minor, but recurring discomfort could signal something more serious than a simple upset stomach.

Reflux occurs when your stomach contents move back up into the oesophagus, the tube that carries food from your mouth to your stomach. It is common in Australia and can affect people of all ages.

For some people, reflux is occasional and manageable. For others, frequent symptoms can develop into Gastroesophageal reflux disease (GORD), which will need medical assessment and treatment.

Understanding the causes of reflux and recognising when symptoms need attention will help you manage the condition more effectively.

What is reflux?

Reflux happens when some stomach contents travel back up into your oesophagus, the tube that carries food from your mouth to your stomach.

Your digestive system has a built-in valve, the lower oesophageal sphincter, which helps prevent this. It opens when you swallow, allowing food into your stomach, then closes again.

Sometimes this valve relaxes too often or doesn't close properly. When that happens, stomach acid and other stomach contents move upwards into your oesophagus.

That's where the familiar burning feeling comes from. Unlike your stomach, the oesophagus isn't designed to handle stomach acid regularly, so repeated exposure irritates it.

Common reflux symptoms

Heartburn is probably the symptom most people associate with acid reflux, but it is not the only one.

Common reflux symptoms include:

A burning feeling or discomfort in the chest, particularly after eating
Food or stomach acid coming back into the mouth or throat
A sour or bitter taste
Difficulty swallowing
Chest discomfort
Bloating, burping or indigestion
A persistent cough, particularly at night
Hoarseness or a sore throat
An irritation in your throat

You might notice symptoms more often after a large meal, when bending over or when you're lying down.

And reflux doesn't always feel like classic heartburn. Some people mainly notice coughing, throat irritation or a sour taste.

If you have unexplained chest pain, don't assume it's acid reflux. Heart problems can sometimes feel similar to chronic heartburn and will need urgent medical attention.

What causes reflux?

Reflux doesn’t have a single cause. Several factors can increase the likelihood of reflux or worsen existing symptoms.

These can include:

A weak or frequently relaxed lower oesophageal sphincter
Being overweight and/or living with obesity
Pregnancy
A hiatus hernia
Smoking
Some medicines
Large meals
Problems with stomach emptying

Your everyday habits can also play a part.

For example, eating a big dinner and then lying down soon after makes it easier for stomach contents to move back up into the oesophagus.

What foods and habits can trigger reflux?

No single reflux diet works for everyone. Different foods affect different people, so you’re better off recognising your own patterns.

Common triggers can include:

Fatty or fried foods
Spicy foods
Chocolate
Coffee and other caffeinated drinks
Alcohol
Citrus fruits and juices
Tomato-based foods
Fizzy drinks
Peppermint

Large meals can also trigger symptoms.

If you regularly experience heartburn after a particular meal or drink, note it. You may start to see a connection.

Reflux vs GERD: What's the difference?

Occasional reflux is not necessarily the same thing as Gastroesophageal reflux disease, or GERD.

Most people experience heartburn or reflux from time to time. When reflux occurs regularly, like maybe twice a week or more, it may indicate GERD, and it’s worth discussing with a doctor.

The distinction matters because frequent reflux will affect your quality of life and, in some cases, cause damage to the oesophagus.

How is reflux diagnosed?

A diagnosis usually starts with a conversation with your GP.

Your doctor may ask about your symptoms, when they occur, what seems to trigger them and whether you have tried any treatments.

If symptoms are persistent, severe, unusual, or do not respond to treatment, your doctor may recommend more in-depth investigation.

A gastroscopy, also called an upper endoscopy, uses a thin flexible tube with a camera to examine the oesophagus and stomach. Other investigations, such as pH monitoring, will sometimes be used to measure acid exposure. Your doctor might consider imaging or other tests if they’re needed.

Reflux treatment: What can help?

The right reflux treatment depends on what's causing your symptoms and how often they happen.

Lifestyle changes

For some people, relatively simple changes can make a difference. These may include:

Eating smaller meals
Identifying and reducing foods that trigger your symptoms
Eating more slowly
Avoiding meals close to bedtime
Staying upright after eating
Raising the head of the bed if night-time reflux is a problem
Maintaining a healthy weight
Stopping smoking
Avoiding tight clothing around the abdomen

You don't need to make all these changes at once. Identifying the habits that seem to affect your symptoms is a smart place to start.

Medicines

Medicines can also form part of reflux treatment.

Antacids can neutralise stomach acid and may provide short-term relief. H2-receptor antagonists reduce acid production, while proton pump inhibitors (PPIs) reduce stomach acid more strongly and are commonly used for GERD.

The right medicine and treatment duration depend on your situation. Some reflux medicines are available without a prescription, but that doesn’t mean they suit everyone or should be taken indefinitely. A doctor or pharmacist will give the best advice.

Surgery

Most people with reflux don’t need surgery. However, a procedure may sometimes be considered when symptoms are severe, are persistent despite appropriate treatment or are associated with problems like a hiatus hernia.

One approach is anti-reflux surgery performed using keyhole techniques. Whether surgery is needed is assessed by a medical specialist.

What happens if reflux isn't treated?

Occasional reflux isn't usually a serious problem.

Persistent reflux is different.

Repeated exposure to stomach acid can irritate and damage the oesophagus. Possible complications include oesophagitis (inflammation of the oesophagus) and strictures, in which scar tissue narrows the oesophagus and makes swallowing difficult.

Long-term reflux can also be associated with Barrett's oesophagus. This involves changes to the lining of the oesophagus and can increase the risk of oesophageal cancer.

Barrett's oesophagus does not mean you have cancer. However, people diagnosed with it may need ongoing medical monitoring.

Can reflux be prevented?

There isn't a guaranteed way to prevent reflux, but some everyday habits may reduce the chance of symptoms.

Eating moderate-sized meals, avoiding foods that trigger your symptoms, staying upright after eating, maintaining a healthy weight, and avoiding smoking can all help prevent reflux.

The key is finding what works for you.

You don't need a strict diet or a long list of forbidden foods. In many cases, understanding your triggers and making a few changes is more realistic.

When should you see a doctor?

Don’t accept frequent or chronic heartburn.

See your GP if you have any of these reflux symptoms:

Occur regularly, such as twice a week or more
Continue despite treatment
Are getting worse or changing
Cause difficulty or pain when swallowing
Are associated with unexplained weight loss
Cause repeated vomiting
Include blood in vomit or black or bloody stools

Chest pain needs particular care. If you have severe or worsening chest pain, chest pain lasting 10 minutes or more, or shortness of breath, sweating, nausea, dizziness, pain spreading to the arm, jaw, back or neck, make an appointment with your doctor.

The bottom line

Reflux is common, and many people experience occasional heartburn. But frequent symptoms shouldn't become part of everyday life.

Small changes to your meals, eating habits, and daily routine can help in managing acid reflux. Medicines can also help when appropriate.

If heartburn happens regularly, or is getting worse, or is accompanied by warning signs like difficulty swallowing or unexplained weight loss, speak with your GP.

Getting persistent reflux checked out can help identify the cause and whether you need further investigation or treatment.

Need help?

Make an appointment with your GP. Services like Doctors on Demand also offer an initial consultation. For general health advice in Australia, Healthdirect also provides a 24-hour helpline on 1800 022 222

FAQs

Can reflux cause a cough or hoarse voice?
Yes. Reflux can be associated with symptoms such as a persistent cough, particularly at night, hoarseness and throat irritation. However, these symptoms can have other causes, so it's best to have a healthcare professional check them.

What is the best diet for acid reflux?
No single reflux diet works for everyone. Common triggers include fatty foods, spicy foods, coffee, alcohol, chocolate, citrus, tomato products and large meals. Tracking your symptoms will help you identify which foods affect you.

Is reflux the same as heartburn?
Not exactly. Reflux is the backflow of stomach contents back up into the oesophagus. Heartburn is the burning sensation that can result from reflux. Heartburn is one of the most common reflux symptoms.

Is chronic heartburn a sign of GERD?
It can be. Regular heartburn, twice a week or more, could be Gastroesophageal reflux (GERD). It’s best to make an appointment with your doctor.

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