Reflux Disease - Understanding your symptoms and when to seek help
by Dr Anil Asthana, General surgery, Upper Gastrointestinal surgery and Endoscopy
What is reflux (GORD)?
Gastro-oesophageal reflux disease (GORD) occurs when stomach contents flow back into the oesophagus (food pipe), causing irritation.
Reflux is very common, but it’s not the same for everyone. It can range from mild symptoms to more serious conditions that may require medical care.
Common symptoms You might experience:
- A burning feeling in the chest (heartburn), often after meals
- Food or acid coming back up (regurgitation)
- Symptoms that are worse at night
Some people also have less typical symptoms, such as:
- Ongoing cough
- Frequent throat clearing
- Hoarseness or voice changes
- A sensation of a lump in the throat
- Chest discomfort
A real patient example
A woman in her 40s experienced reflux symptoms for over a year, including heartburn, regurgitation, cough, and throat clearing. Despite medication, her symptoms worsened and began occurring daily.
She also noticed:
- Food occasionally feeling “stuck” when swallowing
- Increasing symptoms at night
Further investigation with a gastroscopy (camera test) showed:
- Narrowing of the lower oesophagus (early stricture)
- Changes in the lining of the oesophagus known as Barrett’s oesophagus
This highlights an important point: Persistent reflux symptoms should not be ignored.
Why reflux can be complex
Reflux isn’t a single condition. It can include:
- Non-erosive reflux (symptoms without visible damage)
- Inflammation of the oesophagus
- Barrett’s oesophagus (cell changes from long-term reflux)
- Functional or sensitive gut conditions
Importantly: Symptoms don’t always match how serious the condition is.
When reflux doesn’t improve with medication
Proton pump inhibitors (PPIs) are commonly prescribed medications. However,
symptoms may persist due to:
- Medication not taken correctly (timing matters)
- Missed doses
- Non-acid reflux
- A different underlying condition
- Structural issues (such as narrowing or a hiatus hernia)
- Conditions like eosinophilic oesophagitis
If symptoms continue despite treatment, further assessment may be needed.
Understanding Barrett’s oesophagus
Long-term reflux can sometimes lead to changes in the lining of the oesophagus,
known as Barrett’s oesophagus. In some cases, this can progress over time:
Barrett’s → dysplasia → cancer
Not everyone with reflux develops this condition, but it is one reason ongoing symptoms should be assessed.
Symptoms that need urgent medical review
Seek medical advice promptly if you experience:
- Difficulty swallowing (food sticking)
- Pain when swallowing
- Unexplained weight loss
- Persistent vomiting
- Iron deficiency or anaemia
Reflux with difficulty swallowing should always be investigated.
Getting the most from your treatment
If you are prescribed reflux medication:
- Take it 30–60 minutes before meals
- Take it consistently as directed
- Allow enough time (usually several weeks) to assess effectiveness
If symptoms persist:
- Do not increase medication without medical advice
- Speak with your GP about next steps
When further testing may be needed
Your doctor may recommend a gastroscopy if:
- Symptoms continue despite treatment
- You have any “alarm” symptoms
- Symptoms have been present for a long time
- The diagnosis is unclear
Key takeaways
- Reflux is common, but it isn’t always harmless
- Symptoms alone don’t tell the full story
- Persistent or worsening symptoms should be assessed
- Early investigation can help prevent complications
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