Acid Reflux & GERD: When to See a Doctor

Nearly everyone has experienced heartburn at some point — that uncomfortable burning sensation behind the breastbone after a large meal, a few too many coffees, or an ill-advised late-night kebab. Occasional acid reflux is normal. Your oesophagus has a sphincter at the bottom that is supposed to keep stomach acid where it belongs, and sometimes it does not do its job perfectly. That is life.

But when reflux becomes frequent — multiple times a week, disrupting sleep, or making you rearrange your eating habits around it — you may be dealing with gastro-oesophageal reflux disease (GERD). In Australia, GERD affects roughly 10-15% of the adult population, making it one of the most common gastrointestinal conditions managed in general practice.

How Reflux Actually Works

Your stomach produces hydrochloric acid to break down food. The lower oesophageal sphincter (LOS) — a ring of muscle at the junction of the oesophagus and stomach — normally prevents this acid from travelling upwards. In reflux, the LOS relaxes at inappropriate times or is weakened, allowing acid to wash back into the oesophagus.

The oesophagus lacks the protective mucous lining that the stomach has, so even brief acid exposure causes irritation and that characteristic burning sensation. Over time, repeated acid exposure can cause inflammation (oesophagitis), narrowing (stricture), or cellular changes in the oesophageal lining.

Recognising the Symptoms

GERD presents with more than just heartburn. The symptom profile can be surprisingly varied:

• Heartburn — burning sensation behind the breastbone, often worse after eating or when lying down
• Regurgitation — acid or food coming back up into the throat or mouth
• Difficulty swallowing (dysphagia) — a sensation of food getting stuck
• Chest pain — this one deserves extra attention because it can mimic cardiac pain. Always get chest pain assessed
• Chronic cough — particularly a dry cough that worsens at night
• Hoarseness or sore throat — acid irritating the vocal cords
• Dental erosion — stomach acid gradually wearing down tooth enamel
• Nausea — particularly after meals
• Bloating and excessive belching

Lifestyle Changes: The Foundation

Before reaching for medication, lifestyle modifications can make a meaningful difference. These are not just things doctors say to be polite — they genuinely work for many people with mild to moderate reflux.

Dietary Adjustments

• Eat smaller, more frequent meals rather than large ones — a full stomach puts more pressure on the LOS
• Identify your personal triggers. Common culprits include spicy food, fatty or fried food, citrus, tomato-based sauces, chocolate, peppermint, caffeine, and alcohol. Not everyone reacts to all of these — it is individual
• Avoid eating within 2-3 hours of lying down
• Reduce carbonated drinks — the gas increases stomach pressure
• Consider keeping a food diary for two weeks to identify patterns

Sleep Position Science

This one is backed by good evidence. Elevating the head of your bed by 15-20 centimetres (using bed risers or a wedge pillow, not just extra pillows) reduces nocturnal reflux by using gravity to keep acid in the stomach. Sleeping on your left side also helps, because the oesophageal junction sits on the right side of the stomach — left-side sleeping keeps the junction above stomach acid level.

If you have ever wondered why reflux is worse at night, it is because lying flat removes gravity from the equation. Your stomach acid does not care what time it is — it just goes wherever physics allows.

Other Lifestyle Factors

• Weight loss — even modest weight loss (5-10%) can significantly reduce reflux symptoms by decreasing abdominal pressure
• Quit smoking — nicotine relaxes the LOS and increases acid production
• Wear loose-fitting clothing — tight waistbands increase abdominal pressure. This sounds trivial but it genuinely matters
• Manage stress — stress increases acid production and oesophageal sensitivity, creating a feedback loop

Medication Options

When lifestyle changes are not sufficient, several medication classes can help. Your doctor will recommend the most appropriate option based on your symptom severity and frequency.

Antacids neutralise stomach acid and provide rapid but short-lived relief. They are available over the counter and are suitable for occasional symptoms. They do not treat the underlying cause.

H2 receptor blockers reduce acid production and work for several hours. They are available over the counter or on prescription at higher doses. They are useful for mild to moderate symptoms.

Proton pump inhibitors (PPIs) are the most effective acid-reducing medications, blocking acid production at the source. They are used for moderate to severe GERD and typically taken once daily before breakfast. PPIs are available on prescription and some lower-dose versions are available over the counter.

When to Get an Endoscopy

Most reflux is managed without endoscopy. However, your doctor may recommend one if:

• Symptoms persist despite medication — something else may be going on
• You have difficulty swallowing or pain when swallowing
• You have unintended weight loss alongside reflux symptoms
• You are over 50 with new-onset reflux symptoms
• There are concerns about complications such as Barrett's oesophagus
• You have been using PPIs long-term and your doctor wants to assess the oesophageal lining

An endoscopy (gastroscopy) involves a thin, flexible camera being passed through the mouth to examine the oesophagus and stomach. It is done under sedation and takes about 15-20 minutes. It is not as dramatic as it sounds.

Barrett's Oesophagus: What You Should Know

Barrett's oesophagus is a condition where the cells lining the lower oesophagus change in response to chronic acid exposure. It occurs in a small percentage of people with long-standing GERD. Barrett's itself does not cause symptoms — it is detected on endoscopy.

The reason it matters is that Barrett's carries a small but real increased risk of developing oesophageal adenocarcinoma. The absolute risk is low (around 0.5% per year), and regular surveillance endoscopies can detect any concerning changes early. This is not intended to alarm you — it is intended to explain why doctors take persistent reflux seriously and why long-term management matters.

Reflux During Pregnancy

Reflux is extremely common during pregnancy, affecting up to 80% of pregnant women — particularly in the second and third trimesters. The causes are twofold: progesterone relaxes the LOS, and the growing uterus increases abdominal pressure.

Management during pregnancy focuses on lifestyle changes first. Antacids are generally considered safe, but some formulations should be avoided. H2 blockers and certain PPIs may be used in pregnancy when symptoms are severe, but only under medical guidance. Always discuss medication use with your doctor or midwife during pregnancy.

Long-Term Management

GERD is often a chronic condition that requires ongoing management rather than a one-time fix. The good news is that most people manage it well with a combination of lifestyle changes and, when needed, medication. The goal is to find the minimum effective intervention — lifestyle changes alone if possible, the lowest medication dose if not.

Regular check-ins with your GP help ensure your management plan is working and that no complications are developing. If you have been managing reflux on your own with over-the-counter medications for more than a few weeks, it is worth having a proper discussion with a doctor about a longer-term plan.