Reflux, heartburn and swallowing problems

Why are these three symptoms together?

Most people who have these three symptoms are really asking: “Is this from the stomach or somewhere else?” and “Could it be something bad?” In most cases the answer is simpler than the fear. Still, a few symptoms should not be underestimated, and a large part of this page is about recognising them.

What is reflux?

The NHS describes acid reflux as stomach acid coming back up towards the throat, and heartburn as its main symptom, a burning feeling in the middle of the chest. If this happens repeatedly, it is called reflux disease. NIDDK makes the same distinction: occasional backflow of stomach contents into the oesophagus is common and often causes no symptoms, but reflux disease is a more lasting condition that causes repeated troublesome symptoms or leads to complications in the long term.

In simple terms: between the stomach and the oesophagus there is a valve (a ring of muscle) that should close after food passes. NIDDK says reflux occurs when this valve is weak or relaxes when it should not.

Symptoms

• Heartburn: a burning feeling in the middle of the chest that may rise up to the throat.
• Regurgitation of food or liquid: a sour taste or food in the mouth.
• Less well-known symptoms: the NHS also names a repeated cough, hiccups, a hoarse voice, bad breath, bloating and nausea. NIDDK also lists chronic cough and hoarseness.
• When it gets worse: the NHS writes that symptoms often get worse after eating, when lying down or when bending over.

What makes it worse?

Sometimes no clear cause is found. Even so, the NHS and NIDDK name several factors: being overweight, smoking (and second-hand smoke), pregnancy, and stress and anxiety. Many people also find certain foods and drinks to be triggers, such as coffee, tomatoes and citrus, chocolate, fatty and spicy food, mint and alcohol. NIDDK stresses that this list reflects findings in some patients and that triggers differ from person to person. So you do not need to give up all of these at once; find what causes a problem for you. Keeping a record of symptoms helps with this, and it is described in the symptom diary guide.

Some medicines can also start or worsen reflux. NIDDK names non-steroidal anti-inflammatory painkillers, some blood pressure medicines, some asthma medicines, sedatives and some antidepressants. If you suspect one of your medicines, tell your doctor. Do not stop it yourself, because it may have been prescribed for a more important condition.

A hiatal hernia is also one of the background conditions; it means part of the stomach moves up through the opening in the diaphragm into the chest. NIDDK says this can raise the risk of reflux or make symptoms worse.

Which changes help?

• Smaller, more frequent meals. The NHS suggests this.
• A gap between dinner and sleep. The NHS says 3 to 4 hours and NIDDK says at least about 3 hours. Both advise against eating close to bedtime.
• Raising the head of the bed by about 10 to 20 centimetres (NHS), not extra pillows.
• Losing weight, if you are overweight. NIDDK and the NHS both mention this. Do it with the help of a dietitian or doctor and do not rush.
• Stopping smoking and avoiding clothes that are tight around the waist (NHS).
• Cutting down on alcohol if you drink.
• Calming the mind. The NHS lists stress among the recognised factors and ways to relax among its recommendations.

If symptoms do not ease after a few weeks, or if you have heartburn almost every day, make an appointment with a doctor. The NHS gives these same two as reasons to see one.

A swallowing problem is a separate matter

The NHS treats a swallowing problem as a separate problem that is usually caused by another illness or medicine. Symptoms can include coughing or choking while eating, a feeling of food stuck in the throat or chest, food or liquid coming back up (sometimes through the nose), a wet, gurgly voice after eating, drooling, and difficulty chewing. If it continues for some time, weight loss, dehydration and repeated chest infections can also occur.

The NHS lists several possible causes: reflux, allergic inflammation of the oesophagus, nerve and brain conditions, some medicines, and rarer ones such as achalasia or cancer of the mouth or oesophagus. The purpose of this list is not to frighten you; it is so you know why a doctor will not let a swallowing problem go without follow-up. Assessment is based on history and examination and, if needed, referral to a specialist or tests such as endoscopy. Treatment depends on the cause: from medicine for reflux to swallowing therapy with a speech therapist, changing the texture of food or, in particular cases, procedures to open the oesophagus.

If a doctor has told you that you have a swallowing problem and you need nutrition support or swallowing therapy, the patient support section introduces related services.

Which symptoms are not “just reflux”?

NIDDK and the NHS both treat these as reasons to see a doctor:

• Food sticks in the throat, or swallowing is painful or difficult.
• Repeated vomiting or a lasting loss of appetite.
• Unexplained weight loss.
• Chest pain.
• Vomiting blood or material that looks like coffee grounds, or bloody or black, tarry stools. NIDDK regards these as possible signs of gastrointestinal bleeding.
• Symptoms do not improve with lifestyle changes and over-the-counter medicines.

Over time, NIDDK warns, untreated reflux can inflame or ulcerate the oesophagus and narrow it. A few patients develop Barrett’s oesophagus (a change in its lining), and a small share of those go on to a type of oesophageal cancer. The main message is: do not ignore long-standing, uncontrolled reflux.

What does an assessment look like?

The doctor takes a history (symptoms, when they get worse, food, medicines and family history), examines you and, on that basis, decides whether tests or imaging are needed. Not everyone needs an endoscopy. The NHS lists endoscopy and a test for stomach bacteria among the assessments that are usually done through specialist referral. Who needs it and when is the doctor’s decision. If you are going to prepare for an endoscopy, read the preparation guide, but the instructions of the centre doing the procedure always come first.

When to act urgently

Call 115 (Iran’s emergency number) right now: sudden chest pain or pressure, especially if it spreads to the arm, neck, jaw or back, or comes with sweating, shortness of breath, nausea or dizziness. Do not assume this is reflux. Vomiting blood or material that looks like coffee grounds. Being completely unable to swallow saliva or fluids.

See a doctor or the emergency department the same day: black, tarry stools, persistent vomiting, food that is stuck and will not go down, or shortness of breath after eating (the NHS lists this among the signs needing urgent attention in its swallowing problem page).

Book an appointment soon: nearly daily heartburn, difficult or painful swallowing, weight loss without dieting, or symptoms that have not improved with changes in habits.

See the full list in urgent signs.

This page is for information and does not replace an examination.