Reflux and Heartburn | Dyslexic Dietitian

What reflux means

Reflux happens when stomach contents travel back into the oesophagus—the tube that carries food from the mouth to the stomach. The lower oesophageal sphincter and diaphragm usually help limit this movement, but temporary relaxation, pressure or anatomical factors can allow reflux to occur.

Occasional reflux is common. Gastro-oesophageal reflux disease (GORD) describes reflux that causes troublesome recurring symptoms, inflammation or other complications. Stomach contents are acidic, but reflux symptoms are not always caused by “too much acid”; sensitivity, movement and the function of the junction also matter.

Medical illustration comparing a normal gastro-oesophageal junction with refluxed stomach contents entering the lower oesophagus and causing inflammation. — **Reflux and oesophageal irritation**
The comparison shows stomach contents moving into the oesophagus and irritation of its lower lining. Symptoms and inflammation do not always match, so the image cannot determine an individual diagnosis.
© 2026 Dyslexic Dietitian / DD Medical Atlas. All rights reserved.

Common symptoms

Burning behind the breastboneAcid or food coming back upSour or bitter tasteUpper abdominal discomfortBelchingNauseaHoarse voiceNight-time cough

Chest pain should not automatically be assumed to be heartburn. New, severe or unexplained chest pain—especially with breathlessness, sweating, dizziness, or pain spreading to the arm, jaw, back or stomach—needs urgent medical assessment.

Notice your symptom pattern

A short record can help identify patterns without imposing unnecessary restrictions. Note meal size and timing, symptoms, position, alcohol, smoking, relevant medicines and sleep. A single episode does not prove that a food is a trigger; look for repeated associations.

Does discomfort follow large meals or eating quickly?
Is it worse when bending, exercising or lying down after food?
Are symptoms mainly daytime, night-time or both?
Do particular foods repeatedly trigger symptoms in a realistic portion?
Have any medicines recently started or changed?

Meals and possible food triggers

Smaller meals may be more comfortable than large portions because a very full stomach can increase pressure and reflux. Eat at a comfortable pace and remain upright after eating.

Drinks that may affect symptoms

Caffeine: coffee, tea, cola and energy drinks can worsen reflux for some people. Try reducing the amount or changing the timing before excluding them completely.
Alcohol: alcohol may increase symptoms and can affect the barrier between the stomach and oesophagus. Notice whether the type, quantity or drinking close to bedtime makes a difference.
Fizzy drinks: carbon dioxide in soft drinks and carbonated water can expand the stomach and increase belching. Belching involves brief opening of the lower oesophageal sphincter and may allow reflux to occur. Still water may be more comfortable.
Acidic drinks: citrus, tomato and some other fruit juices may irritate an already sensitive oesophagus or trigger symptoms. Limit them only when there is a consistent link, and choose a suitable non-acidic alternative.

Foods and activity after meals

High-fat or fried meals can delay stomach emptying and may worsen reflux. Spicy foods trigger symptoms for some people but not everyone. Chocolate, peppermint, tomatoes and citrus are also commonly reported triggers. Reduce only foods that repeatedly affect you, then review whether the change helped.

Remain upright after eating. Bending, heavy lifting or vigorous exercise soon after a meal can raise abdominal pressure and provoke symptoms. Allow time for the meal to settle; gentle walking may be more comfortable than strenuous activity.

Smoking, vaping and nicotine

Smoking can weaken or relax the lower oesophageal sphincter and is associated with reflux. Stopping smoking has benefits far beyond symptom control. Vaping and nicotine products—including lozenges—may also aggravate symptoms in some people, although the evidence is less certain and differs between products.

If a nicotine-replacement product seems to worsen reflux, speak to a pharmacist or stop-smoking adviser about the dose, timing or an alternative rather than abandoning a quit attempt. Do not return to smoking to manage these symptoms.

If weight reduction is personally appropriate, supported and desired, it may improve reflux for some people. Symptoms and health concerns should still be assessed on their own merits and not attributed to body size without investigation.

Night-time and positional reflux

Try to finish the main evening meal at least three hours before lying down. If symptoms occur at night, raising the head end of the bed may help; use a wedge or safely elevate the bed rather than simply stacking pillows, which can bend the body and increase abdominal pressure.

Some people find left-side sleeping more comfortable than lying on the right. Avoid tight clothing around the abdomen if it worsens symptoms, and stop smoking if you smoke.

Two-panel illustration showing an adult sleeping on their left side and an adult lying on their back with the whole upper body elevated on a continuous wedge. — **Positions that may reduce night-time reflux**
Left-side sleeping may reduce reflux for some people. When elevating the upper body, support the shoulders and torso on a continuous wedge or safely raise the head end of the bed. Stacking pillows only beneath the head can bend the body and may increase abdominal pressure.
© 2026 Dyslexic Dietitian / DD Medical Atlas. All rights reserved.

Medicines for reflux

Antacids neutralise acid for short-term relief. Alginates form a barrier above stomach contents and may reduce reflux. A pharmacist can advise on their safe use and interactions with other medicines.

Proton pump inhibitors (PPIs), such as omeprazole, reduce acid production and are commonly used for a defined treatment course or longer-term control when clinically appropriate. H2-receptor antagonists are another option in some circumstances.

Take prescribed medicines as directed. Do not stop long-term acid-suppression treatment abruptly without advice, as symptoms may rebound. Treatment should be reviewed periodically so the lowest effective dose and appropriate duration can be considered.

Tests and possible complications

Many people can be treated based on their symptoms, but persistent, severe or unusual symptoms may require tests. A gastroscopy uses a thin flexible camera to examine the oesophagus and stomach and can identify inflammation, narrowing, ulcers or Barrett’s oesophagus. Other specialist tests can measure reflux or oesophageal function.

Long-term reflux can sometimes cause oesophagitis, ulceration, scarring or Barrett’s oesophagus, but these complications do not occur in everyone. Assessment and follow-up should be based on individual risk and findings.

When to seek medical help

Arrange a medical review if symptoms occur frequently, persist for several weeks, worsen, disturb sleep, require regular over-the-counter treatment or do not respond to treatment.

Seek prompt assessment for difficulty or pain when swallowing, food sticking, persistent vomiting, vomit containing blood or material resembling coffee grounds, black stools, unexplained weight loss, anaemia, a new abdominal mass or severe persistent pain.

How a dietitian can help with reflux

A dietitian can review when reflux occurs and how it relates to meal size, eating speed, food and drink, exercise, body position and bedtime. Together, you can identify repeated patterns and test practical changes one at a time, rather than removing a long list of foods without knowing which changes are helping.

Advice may include adapting portion size and meal timing, finding alternatives to confirmed triggers and maintaining a varied, nutritionally adequate diet. A dietitian can also support people whose reflux occurs alongside swallowing difficulty, food avoidance, poor appetite or unintentional weight loss, working with the medical team when further assessment is needed.

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Understanding reflux and heartburn