That familiar burning sensation in your chest and the unpleasant sour taste that lingers in your mouth during the night are telltale signs of acid reflux, a condition that occurs when stomach acid travels up to the throat. This discomfort is something I’ve become quite accustomed to over the years.
Ironically, despite being a specialist in gastrointestinal conditions, I, like approximately 9.6 million others in the UK, am no stranger to acid reflux.
I’ve battled these symptoms for the majority of my life. However, I’ve found ways to manage them effectively through medication, helpful tips, and lifestyle adjustments. These strategies might offer relief to others as well.
My struggles with acid reflux began during my time at medical school. Back then, it felt as if a fire had been ignited in my chest. Yet, I don’t fit the typical profile of a reflux sufferer.
For instance, I’m not overweight; in fact, I’m quite slender. I also abstain from alcohol and smoking, both of which are known to relax the esophageal valve that prevents acid from escaping the stomach, and trigger increased acid production.
It wasn’t until the 2020 lockdown, during a gastroscopy for an unrelated issue, that I pinpointed the cause of my discomfort. It turned out to be a small hiatus hernia, where a portion of the stomach protrudes above the diaphragm into the chest cavity.
This stretches the lower oesophageal valve, reducing its pressure and allowing acid to flow upwards.
The hernia wasn’t large enough to warrant surgery, and I suspect I’ve had it all my life, but in hindsight, perhaps I shouldn’t have waited 40 years to find out.
Gut specialist Professor Peter Whorwell has suffered from acid reflux all his life
Eating certain foods triggers my symptoms – back in my 20s, pastries and pies were a complete no-no for instance, as were fruit juices. Other common causes in slimmer people include eating fatty foods, alcohol and eating too close to bedtime.
My treatment started with over-the-counter antacids (such as Rennies), which gave some relief. Then, in the mid-1990s, a class of drugs called H2 blockers – histamine receptor antagonists – became available without a prescription.
These work by blocking histamine, a chemical that stimulates acid production in the stomach.
I tried a medication called famotidine – taking it every night after eating and before bed – and it worked remarkably well, reducing the acid content of any liquid that refluxes into my oesophagus while I’m lying down.
I was able to occasionally eat fatty foods such as fish and chips and spicy things without any major problems. But as I still had some symptoms (albeit much less), I went on to try other medications too.
Proton pump inhibitors (PPIs), which are now the standard treatment for acid reflux and used by around 15 per cent of the UK population, became available in the 1990s. They block stomach acid far more powerfully than H2 blockers.
I phoned my GP to get a prescription for a PPI in the early 2000s – and they worked even better than famotidine.
But there are two important reasons why I decided to stick with famotidine.
First, stomach acid exists for a reason: it sterilises your food. Within two weeks of starting PPIs, I had a bout of gastroenteritis, which confirmed my fears about blocking stomach acid too much.
Without sufficient stomach acid, you are far more vulnerable to gut infections.
Second, PPIs can set up a self-perpetuating cycle.
By suppressing acid so dramatically, they cause the body to produce more of a compensatory hormone called gastrin, which drives acid production.
When you stop taking PPIs, gastrin levels remain elevated and acid surges back – sometimes worse than before. People assume their reflux has returned and restart the pills when, in fact, they’ve simply triggered a rebound effect.
They can end up on PPIs long-term, when they may not actually need them.
My advice: try an H2 blocker first. If it doesn’t control your symptoms, then a PPI is the logical next step and a very effective treatment.
Pills aside, the single-most effective thing I’ve done to relieve my reflux, is much more elementary.
I’ve put six-inch wooden blocks under the head of my bed to prop it up so that I sleep on a gentle slope.
It sounds simple – but it works.
Acid reflux is particularly troublesome at night because, when you lie flat, if the valve at the bottom of the oesophagus is leaky, it allows stomach acid to flow back up unchecked, rather than draining downward as gravity intends.
The result is, you wake with a bitter taste in your mouth and discomfort in your chest. Sleeping on a slope uses gravity to keep the acid down.
I’ve been doing this for over 20 years, and I recommend it to my patients. They tell me it works, too.
I know some people have tried propping themselves up on pillows instead at night – but it doesn’t work. Doing this causes you to bend in the middle, at roughly the level of your stomach, which can squash it and push acid upward.
Acid reflux is particularly troublesome at night because, when you lie flat, if the valve at the bottom of the oesophagus is leaky, it allows stomach acid to flow back up unchecked, rather than draining downward as gravity intends
I’ve also found that not eating after 7pm helps with the acid reflux. A full stomach puts pressure on the lower oesophageal valve, and I’ve learnt from painful experience that a late meal is always a bad idea.
Alcohol is a common trigger, but I don’t drink (I tried it when I was younger, but it just made me sleepy).
What I do have a problem with is acidic juices – I haven’t drunk apple juice in 40 years as I found it sets off my symptoms.
Coffee can also affect the oesophageal valve in some people. I’ll have the occasional cup as a treat, but I mainly stick to water.
For me, the symptoms have always been manageable – albeit persistent.
But acid reflux can seriously affect quality of life. If you’re a plumber bent over a boiler all day, or a gardener constantly stooping, I can well imagine how debilitating it could be.
If your symptoms are not controlled and are affecting your daily life, please see your doctor.
And if you develop any new symptoms – including difficulty swallowing, or the sensation of food sticking in your oesophagus – get checked immediately.
One further thing worth knowing: people who have suffered from long-standing reflux can, in some cases, develop a condition called Barrett’s oesophagus, where repeated acid damage causes changes to the lining of the food pipe.
In a small number of cases, this can lead to cancer – but it can be detected and managed if caught early through a screening programme.
If you have had reflux symptoms for 20 years or more, it is worth asking your GP whether you might be eligible for a gastroscopy.
As for me? I still wake up a couple of mornings a week with a mild discomfort in my chest – perhaps 0.5 out of 10. After all this time, I can live with that.
- Professor Peter Whorwell is Consultant Gastroenterologist at Manchester University NHS Foundation Trust and Professor of Medicine and Gastroenterology at the University of Manchester.
As told to JO WATERS
