Understanding Reflux: Symptoms, Causes and Treatment Options

What is Reflux?

Reflux, also called acid reflux or gastro-oesophageal reflux, occurs when stomach contents rise back up into your oesophagus. This backward flow of acid creates an uncomfortable burning sensation in your chest that many people find distressing, particularly when it happens frequently.

When reflux causes troublesome symptoms or complications, we diagnose it as gastro-oesophageal reflux disease, or GORD for short. This is sometimes spelled GERD. Not everyone with GORD experiences obvious symptoms, but when they do occur, they typically include heartburn and acid regurgitation.

Common Reflux Symptoms

The most typical symptom of reflux is heartburn, which is a burning discomfort rising from your lower chest to your neck. This often occurs after meals or when lying down. Some people also experience acid regurgitation, where food or fluid rises into the throat or mouth. If you’re experiencing these symptoms regularly, say a few days a week or even daily, they may be distressing enough to need treatment.

Some people have other symptoms that may be related to acid reflux, though they could equally be caused by something else entirely. A persistent cough, sore throat, tooth decay, chest pain or disturbed sleep can all potentially stem from reflux. These less typical presentations are why proper assessment is important.

When to be concerned: If you experience reflux symptoms regularly, even just a few days each week, they may be distressing enough to warrant treatment.

Potential Complications

While most people with reflux experience only symptoms, some develop complications from reflux they’ve had for a long time. Persistent inflammation can cause scarring and narrowing of the oesophagus, leading to difficulty swallowing or food becoming stuck. In rare cases, prolonged exposure to stomach acid can result in oesophageal cancer, though this outcome remains uncommon.

What Causes Reflux?

Reflux is usually caused by a weakness in the muscle at the lower end of the oesophagus. This muscle (a sphincter) normally helps to keep fluid, food and acid in your stomach where they belong. Several factors can contribute to this weakness or increase the likelihood that it will occur.

Risk Factors

You’re more likely to experience reflux if there’s higher pressure in your abdomen because of overweight or obesity. This is one of the most common contributing factors we see. Pregnant women also often develop reflux symptoms due to the increased abdominal pressure from the growing baby. Some people have a hiatus hernia, where part of the stomach is pushed up through the diaphragm’s hiatus (the opening that the oesophagus uses) into the chest, which makes reflux more likely. People who have had surgery for weight loss, particularly laparoscopic sleeve gastrectomy or a gastric balloon insertion, may also develop reflux symptoms.

The foods we eat can sometimes make reflux symptoms worse. Common culprits include fatty foods, chocolate, coffee, alcohol, cola drinks and peppermint, although triggers can vary between individuals, so you may find your own particular triggers. When you eat a large meal it makes the stomach expand, which can increase the likelihood of reflux. Smoking is also known to cause and or increase reflux symptoms.

Simple Steps to Reduce Reflux

There are some straightforward things you can do to reduce reflux symptoms, and many people find these lifestyle modifications are enough to manage occasional symptoms without needing medication.

Timing and portion size matter when it comes to eating. Allow at least two to three hours between your last meal and bedtime, and consider eating smaller portions more frequently rather than three large meals. How you position yourself during sleep can also make a difference. Elevating the head of your bed by 15 to 20 centimetres and lying on your left side (instead of right side or back) can help keep acid where it belongs. If you’re carrying extra weight, shedding even a modest amount can substantially improve symptoms by reducing pressure on your stomach. Simple wardrobe choices can also reduce symptoms, such as avoiding tight belts and fitted clothing around your waist, to reduce abdominal pressure. For those who smoke, quitting represents one of the single most beneficial changes you can make for reflux control.

Do You Need Tests?

In most cases, we can diagnose reflux and begin appropriate treatment based on your symptoms alone, without requiring any investigations. That said, certain circumstances warrant further assessment through diagnostic procedures.

When Testing Becomes Necessary

If you have reflux with unexplained weight loss, difficulty or pain with swallowing, or vomiting of blood, then special investigations will be needed. Similarly, if medication doesn’t work well for your symptoms, speak with your doctor about having a gastroscopy or endoscopy test.

Gastroscopy (Endoscopy)

A gastroscopy involves passing a thin, flexible instrument through your mouth to visually inspect your oesophagus and stomach lining. This examination reveals any tissue damage, ulceration or areas of narrowing, and allows us to collect tissue samples (biopsies) when indicated. The results help guide our treatment recommendations and may prompt adjustments to your management plan. Occasionally, we need additional testing to assess oesophageal muscle function or quantify acid exposure over a set time period, though these tests are much less common.

Learn more about gastroscopy procedures →

Treatment Options for Reflux

How we approach your reflux depends on how often you experience symptoms, how severe they are, and whether any complications have developed.

Lifestyle Modifications (First-Line Approach)

Most people experience occasional reflux at some point. For many, the dietary and lifestyle adjustments described earlier provide sufficient relief without medication, particularly when symptoms are infrequent or mild.

Over-the-Counter Medications

For intermittent or mild discomfort, antacids offer a readily accessible option. These work by neutralising stomach acid and can be purchased from your pharmacy, where the pharmacist can recommend an appropriate product.

Prescription Medications

If your symptoms are more severe, you may need drugs that actually reduce the amount of acid your stomach makes. The main types are proton pump inhibitors and histamine receptor antagonists. If symptoms are frequent or persistent, it is recommended you see your doctor and to discuss a prescription. These prescription treatments are PBS-listed, making them more affordable for most patients.

Initially, your doctor will typically prescribe a proton pump inhibitor, as they are considered the most effective option for managing troublesome reflux symptoms, for most people. For the best long-term outcomes, medication works hand-in-hand with the lifestyle modifications discussed earlier—weight reduction being particularly valuable.

Will You Need Long-Term Medication?

The reality is that reflux symptoms tend to return for most people when they stop taking medication. That said, continuous daily treatment isn’t always necessary.

Tailoring Your Treatment

Once good symptom control is achieved, many patients can transition to intermittent dosing rather than daily medication. There’s growing evidence that prolonged, unnecessary use of acid suppressants carries risks ranging from magnesium depletion and impaired nutrient absorption to increased fracture risk and greater susceptibility to certain infections affecting the lungs or digestive tract.

There are some patients, however, who genuinely require ongoing daily therapy to maintain symptom control, particularly those with more severe disease. The key is finding your optimal dose, that is, enough to keep symptoms at bay, but no more than necessary. Working with your gastroenterologist, we can establish the right maintenance approach for your individual situation.

Surgical Treatment Options

Surgery becomes relevant for only a small minority of reflux patients. This option is generally reserved for those whose symptoms remain severe despite optimal medical therapy, or when a substantial hiatus hernia is present. With a large hernia, the anatomical disruption allows stomach contents to readily flow backwards into the oesophagus, making medical management less effective.

Laparoscopic Surgery

When surgery is appropriate, we use minimally invasive keyhole techniques. Before proceeding, several investigations are necessary to confirm you’re a good surgical candidate. It’s important to understand that surgical outcomes vary, and a significant proportion of patients eventually need to resume taking acid-suppressing medications. This is why decisions around surgery are carefully considered, rather than routinely offered.

When to See a Gastroenterologist

You should consider seeking specialist care if you have frequent reflux symptoms, such as a few times a week or more, particularly if they persist despite lifestyle changes. If you need ongoing medication management or have concerning symptoms like difficulty swallowing, specialist assessment is appropriate. Some people also like to discuss whether surgery might be suitable for their situation.

If you have troublesome reflux symptoms, don’t wait. Early assessment and appropriate treatment can prevent complications and significantly improve your quality of life.

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Related Conditions & Procedures

Related conditions include Barrett’s oesophagus, oesophagitis, hiatus hernia, peptic ulcer disease, eosinophilic oesophagitis, oesophageal stricture, and gastroparesis.

Related procedures include gastroscopy (upper endoscopy), oesophageal manometry, 24-hour pH monitoring, endoscopic dilation, and anti-reflux surgery (fundoplication).

This information has been adapted from patient education resources developed by the Gastroenterological Society of Australia (GESA).

Last reviewed: 5 December 2025