Acid Reflux and GORD
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Acid Reflux & GORD
A clinical overview of acid reflux and gastro-oesophageal reflux disease (GORD) — symptoms, causes, red flags, when to seek help, and UK treatment options including proton pump inhibitors.
Chest pain warning: Severe heartburn can feel like a heart attack — and the reverse is also true. If you have chest pain or tightness and are not sure why, call 999 immediately. Do not drive yourself to hospital.
Key fact: Acid reflux affects around 1 in 5 UK adults regularly. Heartburn is the symptom; acid reflux is the mechanism; GORD is the clinical diagnosis when reflux is frequent or severe. Most people respond well to a combination of lifestyle measures and proton pump inhibitor (PPI) treatment.
What Is Acid Reflux?
Acid reflux is the backflow of stomach contents into the oesophagus (food pipe). The stomach is lined to handle its own acidic contents; the oesophagus is not. When acid escapes upwards, it irritates and inflames the oesophageal lining, producing the burning sensation we call heartburn.
A muscular valve called the lower oesophageal sphincter (LOS) sits between the oesophagus and stomach. It normally stays closed except during swallowing. In acid reflux, this valve relaxes when it shouldn’t or doesn’t close tightly enough. Acid (and sometimes bile) escapes.
Occasional reflux happens to almost everyone and isn’t a disease. It becomes a clinical problem when it happens frequently, lasts a long time, or causes damage.
Symptoms
The classic symptom is heartburn — a burning sensation behind the breastbone, often rising up towards the throat. Other common symptoms include:
- Sour or acidic taste in the back of the mouth or throat (regurgitation)
- Worsening after meals, especially large, fatty, or late-evening meals
- Worsening when lying down or bending forward
- Relief from antacids such as Gaviscon or Rennies
- Bloating, belching, or hiccups
- Nausea, especially after eating
- Persistent dry cough, especially at night (reflux is a recognised cause of chronic cough)
- Hoarse voice or sore throat in the mornings
- Bad breath
- Disturbed sleep from waking with heartburn
Causes and Risk Factors
Acid reflux usually results from a combination of factors that weaken the lower oesophageal sphincter or increase the pressure pushing acid upwards.
Hiatus hernia
The most common structural cause. Part of the stomach pushes up through the diaphragm, weakening the LOS valve.
Pregnancy
Hormones relax the LOS and the growing uterus pushes the stomach upwards. Affects up to 80% of pregnancies.
Obesity
Increased abdominal pressure pushes stomach contents upwards. Weight loss is the single most effective lifestyle intervention.
Smoking
Nicotine relaxes the LOS, reduces saliva production (which buffers acid), and slows stomach emptying.
Diet
Large meals, fatty or spicy food, chocolate, citrus, tomato, mint, coffee, fizzy drinks, and alcohol all commonly trigger reflux.
Late eating
Lying down within 3 hours of eating allows acid to reflux into the oesophagus. Sleeping with the head elevated helps.
Medications
NSAIDs (ibuprofen, naproxen), calcium channel blockers, nitrates, bisphosphonates, and some antibiotics can worsen reflux.
Stress and anxiety
Stress doesn’t cause reflux but lowers the threshold for symptoms and can amplify perceived severity.
When Acid Reflux Becomes GORD
Gastro-oesophageal reflux disease (GORD) is the clinical diagnosis given when acid reflux happens regularly (typically more than twice a week), is severe, or causes complications. GORD is common — it affects around 10–20% of UK adults.
Most people with GORD respond well to lifestyle changes and PPI therapy. But untreated GORD can cause:
- Oesophagitis — inflammation and ulceration of the oesophageal lining
- Oesophageal stricture — narrowing from scar tissue, causing difficulty swallowing
- Barrett’s oesophagus — changes in the oesophageal lining that slightly increase risk of oesophageal cancer
- Chronic cough, asthma, dental erosion — from acid reaching the airways or mouth
For a deeper look at GORD diagnosis and treatment, see our Acid Reflux Explained guide.
Red Flags — When to Seek Urgent Care
Call 999 immediately for any chest pain or tightness that:
- Is severe, sudden, or unexplained
- Spreads to your jaw, neck, arm, or back
- Is accompanied by shortness of breath, sweating, or nausea
- Does not respond to antacids and a few minutes of rest
Severe heartburn can feel exactly like a heart attack. When in doubt, treat it as cardiac and call 999.
Same-day medical assessment for any of these:
- Difficulty swallowing or a sensation of food sticking
- Unexplained weight loss
- Persistent vomiting
- Vomiting blood or material that looks like coffee grounds
- Black, tarry, or bloody stools
- New or worsening dyspepsia symptoms in anyone over 55
These red flags can indicate peptic ulcer disease with bleeding, oesophageal or gastric cancer, or other conditions needing urgent investigation. NICE CG184 recommends urgent endoscopy for any of these.
Treatment Overview
NICE CG184 sets out a stepped approach to dyspepsia and GORD. Treatment combines lifestyle measures (for everyone), acid suppression (when needed), and investigation (for red flags or treatment failure).
Lifestyle measures
First-line for everyone. Smaller meals, weight loss, raising the head of the bed, avoiding triggers, stopping smoking.
Antacids & alginates
For occasional symptoms. Over-the-counter Gaviscon (alginate) and Rennies (antacid) work within minutes.
PPIs
For frequent or severe symptoms. Omeprazole, lansoprazole, esomeprazole. Typically a 4–8 week course initially.
Investigation
Endoscopy or H. pylori testing for red flags, treatment failure, or atypical presentations.
Lifestyle Measures
Lifestyle changes are first-line and remain important alongside any medication. The most evidence-backed measures are:
- Lose weight if overweight — the single most effective intervention
- Don’t eat within 3 hours of bedtime — gives the stomach time to empty
- Raise the head of the bed by 10–20cm with blocks under the legs (not just extra pillows)
- Eat smaller, more frequent meals rather than large meals
- Identify and avoid your triggers — common ones are coffee, alcohol, fatty/spicy foods, chocolate, mint, citrus, tomato, fizzy drinks
- Stop smoking — nicotine weakens the LOS
- Limit alcohol, especially in the evening
- Avoid tight clothing around the waist
- Review medications — NSAIDs, calcium channel blockers, nitrates and others can worsen reflux. Speak to your prescriber before stopping.
Proton Pump Inhibitors (PPIs)
Proton pump inhibitors are the most effective acid-suppressing medicines available. They block the “proton pump” enzyme in stomach cells that produces acid. Five PPIs are licensed in the UK: omeprazole, lansoprazole, esomeprazole, pantoprazole, and rabeprazole. NICE considers them clinically equivalent at equivalent doses.
| PPI | Typical dose | Notes |
|---|---|---|
| Omeprazole | 20mg once daily (range 10–40mg) | Most commonly prescribed UK PPI. Lower dose (10mg) available over the counter. |
| Lansoprazole | 30mg once daily (range 15–30mg) | Orodispersible (dissolves on tongue) formulation available for people who struggle to swallow tablets. |
| Esomeprazole | 20mg once daily (range 20–40mg) | The active enantiomer of omeprazole. Often used when omeprazole has not been effective. |
| Pantoprazole | 40mg once daily | Fewer drug interactions than omeprazole/esomeprazole. Useful with clopidogrel. |
| Rabeprazole | 20mg once daily | Less affected by CYP2C19 genetic variation. Faster onset of action. |
How to take a PPI: take 30 to 60 minutes before the first meal of the day, with water. The medication works by binding to active proton pumps, which need food to switch on. Taking on an empty stomach pre-meal maximises effectiveness.
How long? NICE recommends an initial 4 to 8 week course for uncomplicated GORD, then review. Many people can step down to a lower dose, switch to on-demand use, or stop. Some need long-term treatment (Barrett’s oesophagus, severe oesophagitis, certain other conditions).
For deeper detail, see our What Is a Proton Pump Inhibitor? and Complete PPI Guide.
Get Acid Reflux Treatment Online
Access Doctor provides prescription PPIs — omeprazole, lansoprazole, and esomeprazole — online following a short consultation with our GPhC-registered pharmacist independent prescribers. No GP referral needed.
View Acid Reflux Treatments →Acid Reflux Guides
In-depth guides on specific aspects of acid reflux and PPI treatment:
Frequently Asked Questions
What is acid reflux?
Acid reflux happens when stomach acid escapes upwards into the oesophagus (food pipe). The stomach is built to handle its own acid; the oesophagus is not. The result is heartburn — a burning sensation behind the breastbone — often with a sour taste in the mouth. Occasional reflux is normal. Reflux that happens more than twice a week, or causes complications, is called gastro-oesophageal reflux disease (GORD).
What causes acid reflux?
The valve between the oesophagus and stomach — the lower oesophageal sphincter — normally stays closed except during swallowing. In acid reflux, the valve relaxes inappropriately or weakens, letting acid escape. Common contributors include hiatus hernia, pregnancy, obesity, smoking, large or late meals, alcohol, certain foods (fatty, spicy, chocolate, citrus, coffee), some medicines (NSAIDs, calcium channel blockers, nitrates), and stress.
What is the difference between heartburn, acid reflux and GORD?
Heartburn is the symptom — the burning chest sensation. Acid reflux is the mechanism — stomach acid escaping into the oesophagus. GORD (gastro-oesophageal reflux disease) is the clinical diagnosis given when reflux happens regularly (typically more than twice a week), is severe, or causes complications like inflammation (oesophagitis), narrowing of the oesophagus, or Barrett’s oesophagus.
When should I see a doctor about acid reflux?
See a clinician if heartburn happens more than twice a week, isn’t controlled by over-the-counter antacids after two weeks, or affects your sleep or quality of life. Seek urgent assessment (within 24 hours) for any red flag: difficulty swallowing, unexplained weight loss, persistent vomiting, vomiting blood, black or tarry stools, or new symptoms in anyone over 55. Call 999 for any chest pain you are unsure about — heart attack and severe heartburn can feel similar.
How is acid reflux treated in the UK?
Treatment follows a stepped approach. Lifestyle measures come first — smaller meals, weight loss if relevant, raising the head of the bed, avoiding trigger foods and late meals, stopping smoking. Antacids and alginates (Gaviscon, Rennies) help mild, occasional reflux. For frequent or severe symptoms, NICE recommends a proton pump inhibitor (PPI) — omeprazole, lansoprazole, or esomeprazole — typically for 4 to 8 weeks initially, then reviewed. H2 receptor antagonists (famotidine) are an alternative. Investigation (endoscopy or H. pylori testing) is offered for red flag symptoms or treatment failure.
Are PPIs safe to take long-term?
PPIs are among the most studied medicines in modern medicine and are considered safe for the vast majority of people who need them. Long-term use carries small increased risks of: vitamin B12 deficiency, magnesium deficiency, reduced calcium absorption (relevant to bone health), and certain gut infections (especially Clostridium difficile). For most people with confirmed GORD or peptic ulcer disease, the benefits outweigh these risks. Anyone on long-term PPI treatment should be reviewed at least annually to consider whether the dose can be reduced or stopped.
Can I just buy PPIs over the counter?
Low-dose omeprazole (10mg) is available over the counter in the UK for short-term use (up to 14 days) in adults with frequent heartburn. For longer treatment, higher doses, or other PPIs (lansoprazole, esomeprazole, pantoprazole, rabeprazole), a prescription is needed — either from your GP or through an online prescriber such as Access Doctor.
Speak to a UK Prescriber About Your Acid Reflux
If acid reflux is disrupting your life, a short online consultation with our GPhC-registered pharmacist independent prescribers can help you access the right treatment.
View Acid Reflux Treatments →References
- NICE CG184. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. nice.org.uk/guidance/cg184
- NICE CKS. GORD. Clinical Knowledge Summaries. cks.nice.org.uk/topics/gord
- NICE CKS. Dyspepsia — unidentified cause. cks.nice.org.uk/topics/dyspepsia-unidentified-cause
- NHS. Heartburn and acid reflux. nhs.uk/conditions/heartburn-and-acid-reflux
- British Society of Gastroenterology. Guidelines on the management of GORD and Barrett’s oesophagus.
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.
