Acidity and Acid Reflux: Causes, Home Remedies and When to Worry

That burning feeling behind your breastbone after a heavy dinner has a name: heartburn, or what most people in India simply call acidity. It happens when stomach acid flows backwards into the oesophagus (food pipe), whose lining isn't built to handle it.

Occasional heartburn is common and harmless. When it happens twice a week or more, doctors call it gastro oesophageal reflux disease (GERD).

Symptoms

• burning pain in the chest, often after eating or when lying down
• sour or bitter taste in the mouth, or food coming back up (regurgitation)
• burping and bloating
• a persistent cough, hoarse voice or sore throat, especially in the morning
• a feeling of a lump in the throat

What causes acidity?

A ring of muscle at the bottom of the oesophagus normally acts as a valve. Reflux happens when it relaxes at the wrong time or is under pressure. Common triggers include:

• large meals and eating late at night
• lying down soon after eating
• fried, fatty or very spicy food
• tea or coffee on an empty stomach, carbonated drinks and alcohol
• smoking
• excess weight, especially around the belly
• pregnancy
• some medicines, such as painkillers (NSAIDs like ibuprofen), certain BP medicines and iron tablets
• stress and poor sleep, which make symptoms feel worse

Home remedies that help

1. Eat smaller meals, and finish dinner at least 2 to 3 hours before bed.
2. Raise the head of your bed by 15 to 20 cm using blocks under the legs: extra pillows alone tend to bend the stomach and don't work as well.
3. Sleep on your left side, which keeps the stomach below the oesophagus.
4. Identify your triggers with a simple food diary. Not everyone reacts to the same foods.
5. Lose excess weight, even a few kilos can reduce symptoms.
6. Stop smoking and limit alcohol.
7. Loosen tight belts and waistbands after meals.

Cold milk can bring brief relief, but its fat and protein can trigger more acid later. Popular remedies such as fennel (saunf) after meals are harmless to try, but evidence is limited.

Medicines

• Antacids and alginate syrups neutralise acid for quick, short term relief.
• H2 blockers such as famotidine reduce acid production.
• Proton pump inhibitors (PPIs) such as pantoprazole, omeprazole and rabeprazole are the most effective for GERD. Take them 30 to 60 minutes before breakfast.

PPIs are among the most overused medicines in India. Long term daily use should be reviewed by a doctor, who can help you step down to the lowest dose that works.

When to see a doctor

See a doctor if you need antacids more than twice a week or symptoms persist despite lifestyle changes. Seek prompt care if you have:

• difficulty or pain when swallowing
• vomiting, especially with blood or "coffee grounds"
• black, tarry stools
• unintended weight loss or loss of appetite
• symptoms starting after age 50

Chest pain isn't always acidity. Pain that comes on with exertion, spreads to the arm, jaw or back, or comes with breathlessness or sweating could be a heart attack. Call 112 immediately.

Related reading

Constipation and bloating often travel with acidity: read our guide to constipation relief.