How to Treat Acid Reflux: Causes & Symptoms

What is acid reflux?

How to treat acid reflux starts with understanding what causes it: acid reflux, or GERD (Gastroesophageal Reflux Disease), happens when acid from the stomach flows back up into the oesophagus because the lower oesophageal sphincter — the muscle ring at the bottom of the oesophagus — relaxes at the wrong time or has weakened.

Normally this sphincter opens only when you swallow, then closes tightly to keep acid from rising. When it becomes loose or relaxes too often, acid rises and irritates the lining of the oesophagus, causing a burning feeling, tightness in the chest, or a sour taste from regurgitation.

🔢 Facts worth knowing:

• 🌏 Roughly 8-33% of people worldwide experience acid reflux (WHO)
• 🇹🇭 In Thailand it is found in about 7-15% of people who see a doctor for digestive symptoms
• 📈 Rates keep climbing, especially among city dwellers under high stress with irregular eating habits

What causes acid reflux

Acid reflux rarely comes from a single cause — it is usually several factors combined.

A weak lower oesophageal sphincter — the main culprit. When it relaxes too often or does not close fully, acid rises easily.

Hiatal hernia — part of the upper stomach pushes up through the diaphragm, which stops the sphincter working properly.

Eating habits — eating late at night, lying down right after a large meal, very spicy or fatty food, or frequent coffee, soft drinks and alcohol.

Excess weight — abdominal fat presses on the stomach and pushes acid upward.

Stress — ongoing stress increases stomach acid production and weakens the sphincter.

Pregnancy — hormones and the growing womb put pressure on the stomach, making reflux more likely.

Certain medicines — some NSAID painkillers, muscle relaxants and blood pressure medicines can relax the sphincter.

📖 Read more: Want to know which symptoms really point to acid reflux? See Acid reflux symptoms — how to tell if it's really reflux

Common acid reflux symptoms

Acid reflux symptoms fall into two groups: the typical ones most people recognise, and the ones many people never connect to reflux at all.

Typical symptoms:

• Heartburn — a burning sensation, especially after eating or lying down
• Sour regurgitation, or a sour or bitter taste in the mouth
• Tightness in the throat, difficulty swallowing
• Nausea, especially in the morning

Symptoms many people don't realise are linked to reflux:

• Chronic cough, especially at night
• Hoarseness or a frequent sore throat without a cold
• Wheezing that feels like asthma
• Unusually frequent cavities (acid erodes tooth enamel)
• Chest pain that some mistake for a heart problem

Table: Comparing the two groups of acid reflux symptoms

⚠️ If you have severe chest pain, difficulty breathing, or vomit blood, seek medical care immediately.

Who is at risk of acid reflux

It is not just people who eat spicy food — the risk factors are broader than most people think:

• Being overweight or carrying extra weight around the abdomen — abdominal fat raises pressure inside the belly
• Eating late at night regularly — lying down within two to three hours of a meal
• Ongoing stress and poor sleep — the stomach produces more acid
• Smoking — nicotine relaxes the oesophageal sphincter
• Pregnancy — especially the second and third trimesters
• Regular use of certain medicines — such as painkillers or muscle relaxants

How is acid reflux treated

Treatment follows three main approaches, depending on severity:

1. Lifestyle changes — the most important first step, useful at every level of severity.

2. Medicine — if lifestyle changes are not enough, acid-reducing medicines help control symptoms and let the oesophagus heal.

3. Surgery — for severe cases that do not respond to medicine, or when complications develop, a doctor may consider surgery to reinforce the sphincter.

💡 Read more: Wondering how to manage chronic acid reflux long-term? See Chronic acid reflux — how to manage it long-term

Medicines used to treat acid reflux

Acid-reducing medicines come in several classes, each working differently and suited to different levels of symptoms.

Fast-acting antacids — such as aluminium hydroxide or magnesium hydroxide, neutralise acid immediately but wear off quickly, best for occasional symptoms.

H2 blockers — such as famotidine, reduce acid production moderately and last longer than antacids.

PPIs (Proton Pump Inhibitors) — such as Omeprazole or Esomeprazole (Nexium), are the strongest class, cutting acid production by up to 90%, and suit moderate to severe or chronic symptoms.

Table: Comparing the three classes of acid-reducing medicines

📖 Read more: Want a detailed comparison of acid-reducing medicines? See PPI vs antacid — how to choose the right one for you

Lifestyle changes to prevent acid reflux

Medicine alone is not enough — if habits stay the same, acid reflux tends to keep coming back.

Eating habits:

• Eat smaller, more frequent meals instead of eating until overly full
• Avoid acid-triggering foods such as very spicy or fatty dishes, chocolate, coffee, soft drinks and alcohol
• Avoid eating within at least three hours of bedtime

Sleep habits:

• Raise the head of the bed by 6-8 inches (not just stacking pillows higher)
• Sleeping on your left side reduces reflux better than sleeping on your right

Other habits:

• Lose weight if you are overweight
• Quit smoking
• Avoid tight clothing around the waist
• Manage stress and get enough rest

💡 Read more: Want to know what you can eat and what to avoid? See Acid reflux diet — what to eat and what to avoid

Complications to watch for

Leaving chronic acid reflux untreated can lead to serious complications over time.

Table: Complications of acid reflux