Reflux: what helps, and when to see a doctor
Reflux is when stomach contents travel back up into the food pipe. It is common, and in babies it is usually harmless. In adults it can cause heartburn, and sometimes a lump in the throat, throat clearing, hoarseness or a cough.
- Adults, first step: lifestyle measures. Finish eating two to three hours before lying down, find and cut back your own triggers, and avoid smoking and tight waistbands.
- Medicines: an alginate such as Gaviscon Advance is a sensible first choice. Proton pump inhibitors (PPIs) suit heartburn and regurgitation, but did not beat placebo for throat symptoms alone in a large UK trial.
- How long: try lifestyle changes and one medicine for four to six weeks, then review. Treatment should not simply continue for ever.
- Babies: regurgitation affects at least 40% of infants and settles in about 90% by their first birthday. Always lay a baby on their back to sleep.
- See a doctor: for difficulty or pain swallowing, weight loss, vomiting blood, black stools, a neck lump, or hoarseness lasting three weeks or more.
Reflux is one of the most common reasons people come to see a doctor, in adults and in children. In babies it often looks alarming but is usually harmless. In adults it can cause heartburn, but it can also cause a lump in the throat, throat clearing, hoarseness or a persistent cough. This page explains what the evidence shows, what you can do at home, and when to see a doctor. It has a section for adults and a section for children and young people.
What is reflux?
Reflux happens when stomach contents travel back up into the food pipe (the oesophagus). This is normal and happens to everyone, often after meals. It becomes a problem when it causes symptoms or damage. Doctors call this gastro-oesophageal reflux disease, or GORD, when it causes heartburn, regurgitation or inflammation of the food pipe.
Some people have reflux that reaches the throat and voice box. This is called laryngopharyngeal reflux, or LPR. Reflux that reaches the throat is often weakly acid or alkaline, and enzymes from the stomach can remain active in the throat lining [3]. Throat symptoms are common and have many causes, including allergy, sinus problems, voice strain and anxiety. A throat symptom does not prove reflux, and the consensus statements are clear that objective evidence is needed when throat symptoms are the only problem [1].
For adults
What can I do at home?
Lifestyle measures are the foundation of management. NICE recommends simple lifestyle advice, including healthy eating, weight reduction and stopping smoking. It also advises people to avoid the things they associate with their symptoms, such as smoking, alcohol, coffee, chocolate, fatty foods and being overweight [18]. The measures below are the ones I most often discuss with patients, and the evidence for each is described.
Eating later in the day makes reflux worse. Try to finish your last meal at least two to three hours before lying down. NICE advises having your main meal well before going to bed [18], and the European consensus recommends a smaller evening meal as part of first-line management [2].
Certain foods and drinks often make symptoms worse. Caffeine, alcohol, fizzy drinks, chocolate, mint, fatty or fried foods, spicy food, and citrus or tomato-based foods are the most commonly reported triggers.
In a small uncontrolled study of a diet that was low in fat and quick-release sugar, high in protein, alkaline and plant-based, 74% of 50 patients with objectively confirmed LPR reported significant improvement at six weeks. About half of these continued to improve to twelve weeks [11]. This was not a controlled trial, so the figures should be read with caution. A food and drink diary kept for two to four weeks can help you identify your own triggers, which vary a great deal.
Raising the head of the bed may help some people [18]. Use bed blocks or a wedge under the mattress rather than extra pillows, which bend the body at the waist and can press on the stomach.
Sleeping on your left side is often suggested, and it is a simple measure to try. I could not find controlled trial evidence for it in throat symptoms in the sources reviewed for this page, so treat it as a practical suggestion rather than a proven treatment.
Weight matters. In a prospective study of patients with laryngopharyngeal reflux, those who were obese had more severe symptoms and a higher proportion had acid reflux. The authors suggest they may need acid-suppressing treatment more often [9]. NICE advises weight reduction as part of simple lifestyle advice [18]. I did not find controlled trial evidence showing that weight loss improves throat symptoms specifically.
Stopping smoking helps reflux, and it also helps the voice and throat in its own right [18].
Some medicines can cause or worsen reflux-type symptoms. These include some calcium channel blockers, nitrates, theophyllines, bisphosphonates, steroids and anti-inflammatory painkillers such as ibuprofen [18]. If you take any of these, please tell me, as I may be able to change the treatment.
Repeated throat clearing irritates the lining of the throat and tends to make the urge stronger. Replace it with a gentle swallow or a sip of water. Avoid whispering, which can strain the voice more than normal speech, and rest your voice if it is hoarse.
Stress and muscle tension can make throat symptoms feel worse. NICE notes that psychological therapies may reduce symptoms in the short term [18], and the European consensus includes stress reduction as part of first-line management [2]. Relaxation, regular walking or swimming, and gentle neck and shoulder stretches may also help.
Tight clothing around the waist can press on the stomach and is worth avoiding, particularly after eating.
Which medicines can help?
NICE advises that people who need long-term management of reflux-type symptoms should use the lowest effective dose, try "as-needed" use where appropriate, and return to self-treatment with antacid and/or alginate therapy where this is safe [18]. The choice of medicine depends on whether you also have heartburn or regurgitation.
Alginates
Alginates, such as Gaviscon Advance, form a raft on top of the stomach contents and can reduce reflux, particularly after meals and at night [10]. European consensus recommends alginates or antacids for the initial treatment of throat reflux, because they act on both acid and non-acid reflux events [2]. A 2026 specialist review suggests that alginates and magaldrate may be more suitable than proton pump inhibitors for the alkaline reflux seen in the throat [3]. Adding an alginate to a PPI gave a modest extra benefit in patients with persistent reflux symptoms [13]. Switching from one class of medicine to another can also help some people whose symptoms have not responded [14].
The throat-specific evidence is less settled. In a placebo-controlled trial of liquid alginate in laryngopharyngeal reflux, both the alginate and the placebo improved symptoms, and the alginate was not shown to be better than placebo [7]. A large pragmatic trial comparing liquid alginate with placebo in persistent throat symptoms is under way [15]. An alginate is therefore a sensible first step for many people, but it is not a guaranteed cure.
Antacids such as Peptac
Peptac is a liquid antacid widely used for indigestion. I have not found trial evidence that it helps throat symptoms specifically, so I would not expect it to be more effective than an alginate for this problem. If it helps your heartburn or indigestion, it is reasonable to continue.
Proton pump inhibitors (PPIs)
Proton pump inhibitors, such as omeprazole, lansoprazole and esomeprazole, are the most commonly prescribed reflux medicines, and NICE supports them for reflux-type symptoms. NICE advises an empirical full-dose PPI for four weeks for dyspepsia (indigestion), and a full-dose PPI for four or eight weeks for GORD, with a lower dose if symptoms recur [18]. However, NICE's guidance does not address throat symptoms on their own.
For throat symptoms alone, the trial evidence is disappointing. A large, placebo-controlled trial in ear, nose and throat clinics found that lansoprazole twice daily for 16 weeks did not improve throat symptoms more than placebo, and this was still the case at 12 months [4, 5]. Earlier trials and meta-analyses found mixed results [6, 16].
PPIs remain appropriate when you also have heartburn, regurgitation, indigestion or signs of acid reflux. The European consensus keeps PPIs for patients with acid reflux findings, for as short a course as possible, with a planned reduction once symptoms settle [2]. If symptoms recur after starting treatment, NICE advises using the PPI at the lowest dose that controls symptoms. An H2 receptor antagonist (a different type of acid-reducing tablet) can be offered if there is an inadequate response to a PPI [18].
If a proton pump inhibitor was prescribed for reflux disease, stopping it suddenly can make symptoms return more strongly for a time. Speak to me first, and I can plan a gradual reduction with you.
How long should treatment last?
Treatment should be reviewed rather than continued indefinitely. NICE recommends an annual review for people who need long-term treatment, with encouragement to step down or stop where safe [18]. Most people who respond do so within the first month, and in one prospective study a one-month course was enough for about a third of patients [12]. Some people need three to nine months, and the best predictor is how severe the symptoms were at the start [12]. A reasonable approach is to try lifestyle changes and one medicine for four to six weeks, review progress, and then decide whether to continue, change or stop.
When should an adult see a doctor?
Please book an appointment if your symptoms have not improved after four to six weeks of home measures, if they are getting worse, or if you have any of the following:
- Difficulty or pain when swallowing
- Unexplained weight loss
- Vomiting blood, or black stools
- A lump in the neck
- A hoarse voice lasting three weeks or more
Persistent hoarseness needs to be examined, and NICE's guidance on suspected cancer advises prompt referral in this situation [17].
If you have significant bleeding with your symptoms, you need to be seen the same day. NICE advises immediate referral for dyspepsia with significant acute gastrointestinal bleeding [18]. Chest pain also needs assessment, as NICE advises considering cardiac and biliary (gallbladder and bile duct) causes in the differential diagnosis [18].
I may refer you to a specialist if your symptoms do not respond to treatment, if the symptoms are unexplained, if you are thinking about surgery, or if you have not responded to H pylori eradication (treatment to clear a stomach bacterium) [18]. The San Diego consensus recommends upper endoscopy (a camera test of the food pipe and stomach) and reflux monitoring when throat symptoms persist, when they occur without oesophageal reflux symptoms, or when treatment needs to be escalated [1].
For children and young people
This section covers infants, children (1 to under 12 years) and young people (12 to under 18 years). NICE's guidance for children [19] distinguishes between normal reflux, which is very common, and gastro-oesophageal reflux disease, which needs treatment.
Regurgitation in babies is common
Effortless regurgitation of feeds is very common. It affects at least 40% of infants, usually begins before eight weeks of age, may be frequent, and usually becomes less frequent with time. It resolves in about 90% of affected infants before the age of one. It does not usually need investigation or treatment [19]. Reassurance is the first step.
Please come back to see me if the regurgitation becomes persistently forceful, if the vomit is green or yellow, if there is blood in the vomit, if there are new concerns such as marked distress, feeding difficulties or poor weight gain, or if regurgitation continues beyond the first year of life [19].
Safe sleep
Do not use positional management to treat reflux in a sleeping baby. Babies should always be placed on their back to sleep, in line with NHS advice on sudden infant death syndrome [19]. See my article on helping your newborn baby to sleep for safe sleeping advice.
Feeding measures for babies with frequent regurgitation and marked distress
If your baby has frequent regurgitation with marked distress, NICE suggests a stepped approach [19].
For a breastfed baby, a breastfeeding assessment by someone with appropriate training is the first step. If symptoms continue, an alginate can be tried for one to two weeks. If it helps, continue it, but try stopping it at intervals to see whether your baby has recovered [19].
For a formula-fed baby, the steps are:
- Review the feeding history.
- Reduce the feed volume, but only if it is excessive for your baby's weight.
- Offer smaller, more frequent feeds, while keeping the total daily amount of milk appropriate.
- Try a thickened formula.
- If these steps do not work, stop the thickened formula and try an alginate for one to two weeks. Again, continue it only if it helps [19].
Medicines for children
NICE advises not to offer acid-suppressing medicines, such as PPIs or H2 receptor antagonists, to treat regurgitation that occurs on its own in infants and children [19]. Medicines are used more selectively in other situations. In a randomised trial of lansoprazole in infants with symptoms attributed to reflux, lansoprazole was no better than placebo and caused more serious adverse events, mainly lower respiratory tract (chest) infections [20].
If a child cannot describe their symptoms, such as an infant or a young child, a four-week trial of a PPI or H2 receptor antagonist can be considered if they have overt regurgitation with unexplained feeding difficulties, distressed behaviour or faltering growth [19]. A four-week trial can also be considered for children with persistent heartburn, retrosternal pain (pain behind the breastbone) or epigastric pain (pain in the upper tummy). If symptoms do not settle or come back after stopping, referral for possible endoscopy is advised [19].
When choosing between a PPI and an H2 receptor antagonist, the availability of an age-appropriate preparation, the preference of the parent or child, and local cost are all taken into account [19]. Not all PPIs and H2 receptor antagonists are licensed for children, and licensing depends on age, so I will check the prescribing information with you [19].
Metoclopramide, domperidone and erythromycin are not licensed for use in children and are not offered for reflux unless the benefits clearly outweigh the risks, other treatments have been tried, and a specialist paediatric clinician agrees. Metoclopramide is contraindicated in infants and should only be used for up to five days [19].
Weight and heartburn in older children and young people
If a child or young person is overweight and has heartburn or acid regurgitation, losing weight may improve their symptoms [19]. The NICE guideline on overweight and obesity management is the place to start, and I can help you think about the practical steps.
When should I see a doctor about my child?
- Forceful or projectile vomiting, especially in a baby under two months old. This may need same-day specialist assessment for pyloric stenosis (a narrowing at the outlet of the stomach).
- Green or yellow vomit, which needs urgent paediatric surgical assessment.
- Blood in the vomit, which needs specialist assessment.
- Black, tarry stools.
- Difficulty swallowing. Please be seen the same day [19].
Please see a doctor, without waiting for the usual review, if your child has blood in their stools, a swollen or tender tummy, a fever with the vomiting, unexplained weight loss, a bulging soft spot on the head, a rapidly growing head, unusual drowsiness or irritability, or vomiting that starts after six months of age or continues after one year [19].
NICE also advises that a child with hoarseness, a chronic cough or a single episode of pneumonia, without overt regurgitation and without other features, should not routinely be investigated or treated for reflux [19]. Persistent hoarseness or cough is still worth assessing, and I will do so with you.
Specialist referral for an endoscopy with biopsies is recommended if a child has blood in the vomit, black stools, difficulty swallowing, no improvement after the first year, faltering growth with regurgitation, unexplained distress when they cannot communicate well, pain that needs ongoing medicine or does not respond to it, feeding aversion with a history of regurgitation, unexplained iron-deficiency anaemia, or a suspected diagnosis of Sandifer's syndrome [19].
Specialist care
Enteral tube feeding for children with faltering growth and overt regurgitation is reserved for situations where other causes have been excluded and feeding measures have not worked. Fundoplication (an operation that tightens the valve at the top of the stomach) is considered only for severe, intractable reflux after appropriate medical treatment has failed [19]. These decisions are made by paediatric specialists, and I would refer any child who might need them.
Summary
For adults, reflux can cause throat symptoms, but throat symptoms are not always caused by reflux. Lifestyle measures are the foundation of treatment and are worth trying properly for several weeks. An alginate is a reasonable first medicine for many people with throat symptoms. Proton pump inhibitors are not effective for throat symptoms on their own, and NICE supports them for reflux-type symptoms within a planned course.
For children, regurgitation in a baby is usually normal and settles by the first birthday. Acid-suppressing medicines are not used for regurgitation alone, and safe sleep comes first. Please seek help if your child has any of the warning signs listed above.
If symptoms have not settled, or if you have any warning signs, please get in touch.
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Book an Appointment 0207 935 1711Frequently asked questions
What is the difference between reflux, GORD and LPR?
Reflux is when stomach contents travel back up into the food pipe. This is normal and happens to everyone, often after meals. Doctors call it gastro-oesophageal reflux disease (GORD) when it causes heartburn, regurgitation or inflammation of the food pipe. Laryngopharyngeal reflux (LPR) is reflux that reaches the throat and voice box, where it is often weakly acid or alkaline.
Can reflux cause a lump in the throat, hoarseness or a cough?
Yes, it can. In adults, reflux can cause heartburn, but it can also cause a lump in the throat, throat clearing, hoarseness or a persistent cough. However, throat symptoms are common and have many causes, including allergy, sinus problems, voice strain and anxiety. A throat symptom does not prove reflux, and objective evidence is needed when throat symptoms are the only problem.
What can I do at home to help reflux?
Lifestyle measures are the foundation of treatment. Finish your last meal at least two to three hours before lying down, and keep a food and drink diary to find your own triggers. Common triggers are caffeine, alcohol, fizzy drinks, chocolate, mint, fatty or fried foods, spicy food, and citrus or tomato-based foods. Raise the head of the bed with blocks or a wedge, stop smoking, avoid tight clothing around the waist, and aim for a healthy weight.
Do proton pump inhibitors (PPIs) help throat symptoms?
For throat symptoms alone, the trial evidence is disappointing. A large placebo-controlled trial found that lansoprazole twice daily for 16 weeks did not improve throat symptoms more than placebo, and this was still the case at 12 months. PPIs remain appropriate when you also have heartburn, regurgitation, indigestion or signs of acid reflux. Please do not stop a PPI suddenly if it was prescribed for reflux disease.
Does Gaviscon Advance help reflux?
Alginates such as Gaviscon Advance form a raft on top of the stomach contents and can reduce reflux, particularly after meals and at night. European consensus recommends alginates or antacids for the initial treatment of throat reflux. The throat-specific evidence is less settled, so an alginate is a sensible first step for many people but not a guaranteed cure.
How long should reflux treatment last?
Treatment should be reviewed rather than continued indefinitely. A reasonable approach is to try lifestyle changes and one medicine for four to six weeks, review progress, and then decide whether to continue, change or stop. Most people who respond do so within the first month. Some need three to nine months, and NICE recommends an annual review for anyone on long-term treatment.
Is reflux in babies normal?
Effortless regurgitation of feeds is very common. It affects at least 40% of infants, usually begins before eight weeks of age, and resolves in about 90% of affected infants before the age of one. It does not usually need investigation or treatment, and reassurance is the first step. Always place your baby on their back to sleep. Seek help if the vomiting is forceful, green, yellow or bloody, or if your baby has feeding difficulties or poor weight gain.
When should I see a doctor about reflux?
Please book an appointment if symptoms have not improved after four to six weeks of home measures, if they are getting worse, or if you have difficulty or pain when swallowing, unexplained weight loss, vomiting blood or black stools, a lump in the neck, or a hoarse voice lasting three weeks or more. Significant bleeding needs same-day assessment, and chest pain also needs to be assessed.
Sources
- Yadlapati RH, et al. The San Diego Consensus for laryngopharyngeal symptoms and laryngopharyngeal reflux disease. American Journal of Gastroenterology. 2025. doi:10.14309/ajg.0000000000003482
- Lechien JR, et al. European clinical practice guideline: managing and treating laryngopharyngeal reflux disease. European Archives of Oto-Rhino-Laryngology. 2024. doi:10.1007/s00405-024-09181-z
- Lechien JR, et al. Evaluation and management of laryngopharyngeal reflux disease: an updated state of the art review. Otolaryngology-Head and Neck Surgery. 2026. doi:10.1002/ohn.70413
- O'Hara J, et al. Use of proton pump inhibitors to treat persistent throat symptoms: multicentre, double blind, randomised, placebo controlled trial. BMJ. 2021. doi:10.1136/bmj.m4903
- Wilson JA, et al. Lansoprazole for persistent throat symptoms in secondary care: the TOPPITS RCT. Health Technology Assessment. 2021. doi:10.3310/hta25030
- Lechien JR, et al. Clinical outcomes of laryngopharyngeal reflux treatment: a systematic review and meta-analysis. Laryngoscope. 2019. doi:10.1002/lary.27591
- Tseng WH, et al. Double-blind, placebo-controlled study with alginate suspension for laryngopharyngeal reflux disease. Laryngoscope. 2018. doi:10.1002/lary.27111
- Lechien JR, et al. Validity and reliability of the reflux symptom score. Laryngoscope. 2019. doi:10.1002/lary.28017
- Lechien JR, et al. Laryngopharyngeal reflux disease is more severe in obese patients: a prospective multicenter study. Laryngoscope. 2021. doi:10.1002/lary.29676
- Sweis R, et al. Post-prandial reflux suppression by a raft-forming alginate (Gaviscon Advance) compared to a simple antacid documented by magnetic resonance imaging and pH-impedance monitoring. Alimentary Pharmacology and Therapeutics. 2013. doi:10.1111/apt.12318
- Lechien JR, et al. Is diet sufficient as laryngopharyngeal reflux treatment? A cross-over observational study. Laryngoscope. 2022. doi:10.1002/lary.29890
- Lechien JR. Minimum effective duration of laryngopharyngeal reflux disease treatment: a prospective study. Otolaryngology-Head and Neck Surgery. 2024. doi:10.1002/ohn.878
- Reimer C, et al. Randomised clinical trial: alginate (Gaviscon Advance) vs. placebo as add-on therapy in reflux patients with inadequate response to a once daily proton pump inhibitor. Alimentary Pharmacology and Therapeutics. 2016. doi:10.1111/apt.13567
- Herman E, et al. Effectiveness of changing drug classes in patients with refractory laryngopharyngeal reflux disease. Otolaryngology-Head and Neck Surgery. 2024. doi:10.1002/ohn.996
- Morton M, et al. Trial of alginates in throat symptoms: protocol for a pragmatic, multicentre, placebo controlled, double blind, parallel, randomised controlled trial of liquid alginate (Gaviscon Advance). BMJ Open. 2025. doi:10.1136/bmjopen-2024-087729
- Steward DL, et al. Proton pump inhibitor therapy for chronic laryngo-pharyngitis: a randomized placebo-control trial. Otolaryngology-Head and Neck Surgery. 2004. doi:10.1016/j.otohns.2004.03.037
- NICE. Suspected cancer: recognition and referral (NG12). nice.org.uk/guidance/ng12
- NICE. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management (CG184). Last updated 18 October 2019. nice.org.uk/guidance/cg184
- NICE. Gastro-oesophageal reflux disease in children and young people: diagnosis and management (NG1). Last updated 9 October 2019. nice.org.uk/guidance/ng1
- Orenstein S, et al. Multicenter, double-blind, randomized, placebo-controlled trial assessing the efficacy and safety of proton pump inhibitor lansoprazole in infants with symptoms of gastroesophageal reflux disease. Journal of Pediatrics. 2009. doi:10.1016/j.jpeds.2008.09.054
This information is for general guidance and does not replace an individual assessment. If you are unsure, or your symptoms are changing, please speak to your GP.