Private acid reflux and indigestion clinic in London, same-day gastroenterology.

Arrange assessment promptly if you have

• difficulty swallowing, or food sticking
• unintentional weight loss
• persistent vomiting, or a feeling of fullness after small amounts
• new indigestion over the age of 55 that persists despite treatment
• a lump in the abdomen, or unexplained anaemia

What causes it

The valve between the gullet and stomach relaxes and stomach contents move upwards, irritating the lining. Common contributors are being overweight, smoking, alcohol, large or late meals, pregnancy, a hiatus hernia, stress, and certain medicines — anti-inflammatories, some blood pressure tablets, bisphosphonates and steroids among them.

What genuinely helps

Medicines, and how to take them

• Antacids and alginates neutralise acid and form a raft on top of the stomach contents. Take them after meals and at bedtime rather than before — this is when they work.
• Proton pump inhibitors such as omeprazole or lansoprazole reduce acid production. Take them 30 to 60 minutes before breakfast, on an empty stomach. Taken with or after food they are considerably less effective, which is the usual reason people believe they are not working.
• A course is normally four to eight weeks, then a review. Long-term use is sometimes appropriate but should be a decision, not a drift.
• Do not stop a proton pump inhibitor abruptly after months of use — acid can rebound. Reduce it gradually with advice.

Testing

Helicobacter pylori is a bacterium that causes ulcers and indigestion, and it is easily detected on a breath or stool test and cleared with a short course of treatment. Testing is worthwhile in persistent indigestion. You need to be off proton pump inhibitors for two weeks before the test, or the result will be falsely negative.

Endoscopy — a camera test — is indicated where there are warning symptoms, where treatment has not worked, or where symptoms have persisted for years, to check the lining of the gullet and stomach.