What is silent acid reflux?

Acid reflux is common and many of us suffer from occasional heartburn caused by stomach juices containing digestive acids and enzymes flowing up the oesophagus (the gullet), causing a burning sensation in the middle of the chest and other heartburn related symptoms.^3/4

Laryngopharyngeal reflux is a form of acid reflux where small amounts of stomach acid travel all the way to the throat (pharynx) and voice box (larynx).

Although the stomach lining can withstand these strong digestive acids, they can irritate these more sensitive areas³ and may even affect the back of the mouth and nose⁵.

It’s sometimes called silent reflux as many people with LPR don’t have the classic symptoms of heartburn making it harder to diagnose.^2/4

The cause is not always clear and while it can be down to stomach issues or a problem with the sphincter muscle – the valve between the stomach and the oesophagus – it’s often due to lifestyle factors such as being overweight and smoking.⁴

What are the symptoms of silent acid reflux?

Silent reflux symptoms can vary and some can be mistaken for other conditions, such as allergies or sinusitis.⁶

Common silent acid reflux disease symptoms include:⁵

• Hoarseness or voice problems
• Throat clearing
• Excess mucous or phlegm in the throat
• Difficulty swallowing
• A feeling of a lump or something ’stuck’ in the throat
• An irritable cough
• Choking episodes, particularly at night
• Breathing difficulties
• Sore throats 
• Burning or dryness in the throat
• Heartburn and indigestion symptoms – although this is less common with silent reflux
• Sinus problems⁶
• Bad breath⁶
• A nasty taste in the mouth⁶

Silent acid reflux diet

Diet and lifestyle changes can help to reduce reflux symptoms.⁵

A silent acid reflux diet is based on the same advice for those who suffer from classic heartburn and indigestion symptoms:⁵

• Avoid fatty and spicy food⁴
• Avoid or reduce alcohol, particularly wine and spirits
• Avoid or reduce your caffeine intake as well as citrus juice, highly acidic drinks and fizzy drinks
• Eat smaller meals more frequently rather than large meals and don’t rush meal times, eat slower and chew every mouthful well.⁴

Lifestyle changes can make a difference in reducing the likelihood of silent acid reflux.

Smoking can be a factor in acid reflux as the chemicals in cigarettes can relax the sphincter muscle which increases the risk of reflux.⁵

Being overweight can put extra pressure on the stomach so losing weight can help.⁵

Try not to wear tight fitting clothes, especially around the waist.⁵

Don’t eat too close to bedtime – aim to eat at least three hours beforehand – and don’t lie down straight after eating as this can allow the acid to rise up.⁵

Learn more about Pyrocalm Control

Pyrocalm Control 20mg Gastro-Resistant Tablets (omeprazole) are used in adults for the short-term treatment of reflux symptoms (e.g. heartburn, acid regurgitation, acid reflux). 

Can acid reflux and heartburn cause back pain?

If you’ve ever felt a pain in your back while experiencing acid reflux and heartburn you may assume they’re related.

While back pain isn’t usually a symptom of acid reflux and heartburn¹ if the burning sensation is felt deeply within the chest, it can sometimes feel like there is also pain within the back.^2/3

There may also be a crossover of the same biological and social risk factors such as being overweight and smoking,⁴ both of which are linked to back pain.⁵

Poor quality or disturbed sleep is also linked to back pain5 so if acid reflux and heartburn are keeping you awake at night this could be another associated factor.

Managing acid reflux, heartburn and back pain

While acid reflux and heartburn are unlikely to be the cause of back pain, adopting lifestyle changes can help to reduce the chances of these digestive issues occurring as well as improve your overall physical health, wellbeing and fitness.⁵

These include lowering your intake or avoiding heartburn triggers such as rich, spicy and fatty food, alcohol and caffeine as well as quitting smoking, losing weight and maintaining a healthy weight.^1/5

If heartburn keeps you awake at night, try to avoid eating three to four hours before going to bed and raise your head and shoulders up when lying in bed to prevent stomach acid from travelling up while you’re sleeping.¹

Back pain is very common and can be the result of many different causes.⁵

Alongside muscular problems, common factors include poor fitness and low physical activity levels, a lack of muscle strength and flexibility and posture – particularly if you’re in the same position for a long time.⁵

Activities such as swimming, Pilates and yoga can help to ease back pain while also strengthening muscles and improving flexibility.⁶

When to seek help

Lifestyle changes really can make a difference.

Keeping a diary to better understand potential food and drink triggers and being more physically active is a great place to start but if you feel you need further help and advice to control your symptoms speak to your pharmacist.

They may recommend an over the counter treatment such as an antacid or alginate to ease your symptoms.¹

Over the counter PPIs (proton pump inhibitors) such as omeprazole 20mg – the main ingredient in Pyrocalm Control – work by reducing the amount of acid the stomach makes⁷ and are a widely used treatment for indigestion, heartburn and acid reflux.⁸

If pharmacy medicines aren’t helping and you have heartburn most days speak to your GP.

Learn more about Pyrocalm Control

Pyrocalm Control 20mg Gastro-Resistant Tablets (omeprazole) are used in adults for the short-term treatment of reflux symptoms (e.g. heartburn, acid regurgitation, acid reflux). 

What can cause heartburn and acid reflux?

There are a number of foods and drinks associated with heartburn and acid reflux including alcohol, coffee and food that is rich, spicy or high in fat.²

Lifestyle factors can also play a part such as smoking, being overweight, stress and anxiety.²

It can also be linked to an increase in hormones such as progesterone and oestrogen and some medicines can cause or make heartburn and acid reflux worse including anti-inflammatory painkillers such as ibuprofen.²

How is alcohol linked to heartburn and acid reflux?

The muscular valve (lower oesophageal sphincter) which connects the tube (the oesophagus) from the mouth to the stomach is there to ensure food and drink can pass through but stomach contents don’t leak out and go upwards.³

But when this one-way system fails and sufficient quantities of stomach acid pass into the oesophagus, acid reflux and heartburn can strike.³

Alcohol can relax the muscular valve causing acid to leak through.³

According to the digestive system charity Guts UK, alcohol alters the amount of acid the stomach produces and can affect the stomach lining causing inflammation.¹

Are some drinks more likely to cause heartburn and acid reflux?

It’s something that’s bound to get asked but unfortunately, it’s not really a question of ‘what is the best alcoholic drink for acid reflux and heartburn’.

There’s a suggestion you should avoid drinks known to be higher in acidity such as ciders, white wine and cocktails containing citrus fruits, mint, chocolate, coffee and tomato.⁴

A scientific study carried out in 1993 showed beer and wine to be a strong stimulant of stomach acid production, particularly beer.⁵

But if you think alcohol is triggering your acid reflux and heartburn you should try to avoid it as much as possible. If you choose to have a drink on a social or special occasion, moderation is key to avoiding heartburn.²

Cutting down on alcohol

While it’s tempting to have a drink when everyone else around you is raising a glass, cutting down won’t just lower your risk of heartburn and acid reflux, it has so many health and wellbeing benefits too.⁷

You’re likely to sleep better, have more energy and be in a better mood – alcohol can make stress and anxiety worse.⁷

Alcohol irritates the gut so lowering your intake or quitting completely means you’re less likely to suffer from stomach pain, ulcers and longer-term health conditions such as heart disease and stroke.⁷

And think of the waistline – alcohol contains seven calories per gram!⁷

When to see a pharmacist or GP about heartburn and acid reflux

Lifestyle changes can help to prevent or relieve your acid reflux and heartburn symptoms but if you need further advice speak to your pharmacist.²

If lifestyle changes and pharmacy medicines such as antacids aren’t helping and you have heartburn for three weeks or more, make an appointment with your GP.²

A GP can provide stronger treatments such as omeprazole which reduces the amount of acid your stomach makes.²

Learn more about Pyrocalm Control

Pyrocalm Control 20mg Gastro-Resistant Tablets (omeprazole) are used in adults for the short-term treatment of reflux symptoms (e.g. heartburn, acid regurgitation, acid reflux). 

Heartburn at Christmas

For heartburn sufferers, the well-known triggers that we more or less manage throughout the year seem to present themselves at every opportunity in an array of festive forms; Christmas parties, Christmas dinners, buffets, nibbles, movie treats – not to mention cheese boards and leftovers which lure us in when we’re already as stuffed as a Christmas turkey.

It’s hard to resist and we all want to unwind and enjoy ourselves but for those of us prone to heartburn it’s best to be a little more cautious.

Cautious doesn’t have to mean boring though.

With a little forward planning – and yes there does have to be an element of discipline involved! – you don’t have to miss out on the joys of the festive season.

There’s also all the stress of the extra workload of the festive season on top of our already busy lives.

It can be a cocktail, or trifle, of heartburn triggers!

What causes heartburn and acid reflux?

Aside from pregnancy, smoking and being overweight there are several lifestyle factors which can cause or make symptoms worse.¹

The festive season tends to have them all wrapped into one unappealing heartburn package – certain food, drink, stress and anxiety caused from acid reflux / heartburn ¹

Fatty foods, chocolate and alcohol are well known heartburn triggers¹ and there’s certainly plenty of those around as we celebrate and relax.

There can also be plenty of stress too – alongside the excitement of Christmas there’s usually a lot to do and think about and it can play a part in heartburn flare ups.

Festive heartburn culprits

We can thank – or blame! – the Victorians for our Christmas dinner, pudding, cake and mince pie traditions, although the ingredients have been influenced by others over the decades too.

These foods are all high in fat – the main event banquet of Christmas dinner alone can reportedly contain up to 7,000 calories – so how do you still manage to enjoy without missing out?

Christmas tips for heartburn & acid reflux

Here’s our tips to enjoying the traditions and trimmings while minimising the risk of heartburn & acid reflux.

• Christmas is a time for indulging but keep it to a minimum and if there’s a particular food or drink which causes your heartburn to flare-up, try to steer clear and substitute it for something else.
• When cooking, consider…
  • Turkey is low in fat so it’s a good option for the roast and there are plenty of lower fat gravy recipes out there.
  • Pack in plenty of vegetable sides – you could try being creative with some festive flavouring.
  • When it comes to cream-free desserts, jellies or meringues can be just as delicious, as can fruit-based puddings.
  • If you’re baking a pastry dish, try filo as it’s lower in fat than shortcrust or puff pastry.
• Try to avoid overeating². Reduce your portion size and eat smaller, more frequent meals¹ or lighter bites.
• We all enjoy getting dressed up at Christmas but clothes that are tight around the waist could make your symptoms worse so go for something looser and more comfortable.¹
• Sit up straight when eating and after a meal to stop stomach acid travelling up towards your throat. Raise your head above waist level by 10-20cms in bed.¹
• Avoid eating within three or four hours before bedtime, this can be difficult during the festive frenzy, but it lessens the chances of heartburn occurring and keeping you awake.¹
• If you do fancy a festive tipple don’t drink on an empty stomach. You could try eating bread or drinking something milky beforehand to coat and protect your stomach from any potential acid reflux.²

Pharmacy advice

If lifestyle changes and medicines such as antacids aren’t helping to prevent or relieve your heartburn symptoms, speak to your pharmacist for advice and taking suitable treatments.¹

Pyrocalm Control 20mg Gastro-Resistant Tablets contain omeprazole which is a widely used treatment for the symptoms of heartburn and acid reflux and works to reduce the amount of acid your stomach makes.¹

As the first branded omeprazole 20mg³ available over the counter it provides up to 24 hour³ confidence in heartburn control.

Pyrocalm Control 20mg Gastro-Resistant Tablets are used in adults for the short-term treatment of reflux symptoms (e.g. heartburn, acid regurgitation, acid reflux). Pyrocalm Control’s gastro resistant tablets is an over the counter omeprazole available from your local pharmacy. Always read the label.

Medicines can affect the unborn baby. Always talk to your doctor or pharmacist before taking any medicine in pregnancy.

How can you reduce your chances of heartburn at night?

So what can you do to reduce your chances of getting night time heartburn? 

Here are 5 tips to reduce the risk of night time heartburn.

1. Try not to eat too close to bedtime. The usual rule of thumb is to eat three to four hours before going to bed.³
2. Eat smaller, more frequent meals during the day rather than three large meals.³ 
3. Many heartburn sufferers have food or drink triggers which can cause or make their symptoms worse. Try to avoid these if you can. Common triggers include spicy and fatty food, acidic food, alcohol and caffeine.⁴
4. If exercise makes your acid reflux worse avoid working out later in the evening.⁴
5. Prop up your head in bed with a pillow. Elevating your head and chest above the level of your waist helps to stop the acid leaking upwards. Around 10 to 20cms should be enough.³

Benefits of sleep

We can all feel tired and grumpy after a poor night’s sleep but if it happens on a regular basis, it can have a big impact on our health and wellbeing.⁵ 

In fact, sleep is considered to be as important as eating, drinking and breathing and it’s essential for physical and good mental health.⁵

A few nights of struggling to get to sleep or waking up several times can happen to any of us and we usually manage to get back into a routine soon enough.⁶

If sleep struggles are an ongoing problem, whether heartburn or a stress-related cause is at the root of it, it can lead to sleep deprivation and ultimately insomnia.⁶

We spend around a third of our lives asleep, allowing our brain to recover and regenerate and our bodies to rest, rebuild and recharge.⁵ 

While we’re counting sheep, a complex process is taking place which allows our brain to process information and back up memory so we can function effectively during the day.⁵ 

The average amount of time we need to sleep as adults varies from person to person, ranging from five to 11 hours.⁵

But it’s not just the amount of sleep we get that’s important, it’s the quality as well.⁵ 

Ultimately, we all need good sleep to be happier, less stressed and cope with whatever challenges life throws at us.

Having a few tricks up your pyjama sleeve can really help when it comes to falling asleep faster and sleeping better.

Speaking to a GP about heartburn & over the counter treatment

If heartburn continues to disrupt your sleep – or you have heartburn most days for three weeks or more – and lifestyle changes and pharmacy medicines aren’t helping, speak to your GP.³

They can provide treatment such as omeprazole over the counter and help rule out any more serious causes.³

Available to buy in most major retailers and pharmacies, Pyrocalm Control 20mg Gastro-Resistant Tablets* contain omeprazole which is a widely used PPI treatment for the symptoms of heartburn and acid reflux and works to reduce the amount of acid your stomach makes.⁹

*Pyrocalm Control 20mg Gastro-Resistant Tablets. For the short-term treatment of reflux symptoms in adults.

Contains 20 mg Omeprazole. Always read the label.

The connection between acid reflux and stress – can stress trigger acid reflux?

Some experts believe a stress-induced nervous system response can increase the amount of acid in your stomach.⁴

It’s also thought anxiety may reduce pressure in the muscular band (the lower oesophageal sphincter) which prevents stomach contents and acid from entering the oesophagus – the food tube which links the mouth to the stomach.⁵

On the whole ongoing stress and anxiety is not good for the digestive system and can make existing conditions such as gastro-oesophageal reflux disease (GORD) – which is regular, reoccurring acid reflux – peptic ulcers and irritable bowel syndrome worse.⁴

Equally, frequent episodes of acid reflux and heartburn can also be a major source of stress and worry for sufferers if it regularly impacts day-to-day life leading to a vicious circle of anxiety.

If you think you’re suffering from stress-related acid reflux – or any of the stress-linked digestive issues – lifestyle changes can make a real difference.

Alongside cutting down or avoiding heartburn and acid reflux dietary triggers such as alcohol, coffee, fatty or spicy foods, tomatoes, citrus fruits and chocolate, try to find ways to help you relax and cope better with the stressful situations life can throw our way.

How can I stop or reduce acid reflux from stress?

Exercise – it isn’t a magic wand but being active and getting out for a walk, jog, bike ride or going for a swim can help to clear your thoughts and reduce emotional intensity. It also releases chemicals which can help lift your mood.⁶

Share your worries or concerns with friends and family, do activities together and have fun together – laughter is a great stress reliever.⁶

Make some time for yourself to do the things you enjoy. Shut the laptop, switch off the phone and leave the worries behind to focus on what makes you happy. It’s called self-care and means your looking after your needs instead of everyone else’s.⁶

Take control of the situations that are stressing you out – adopt some time management techniques, there’s some great tips⁷ here.

Try yoga, meditation or some calming breathing exercises, designed to relieve stress, anxiety and panic attacks.⁷

These lifestyle changes should start to have an impact if you give them time.

How to prevent acid reflux & heartburn symptoms

Other ways to reduce or prevent acid reflux and heartburn symptoms from occurring include losing excessive weight, stopping smoking – which can weaken the lower oesophageal sphincter allowing stomach acid to travel up towards the throat – and eating properly to aid digestion.

Busy lives mean we tend to gulp down food at work or when we’re dashing about and then grab a takeaway at teatime – our guts don’t thank us for that!

Try to take time eating your food, don’t eat too much – four or five smaller portions are better than three large meals – eat regularly and at meal times and avoiding eating two to three hours before bed.

Last but not least, drink plenty of water.

Difference between heartburn and acid reflux

There’s a reason for linking the terms heartburn and acid reflux together; both are types, or symptoms, of indigestion and one is caused by the other.

Heartburn

Heartburn is a burning, and sometimes painful, feeling in the chest* caused by stomach acid leaking upwards towards the throat.³

Signs of heartburn can include a recurring cough or hiccups, unpleasant sour taste, a hoarse voice, bad breath, bloating and feeling sick.³

Again, it tends to be worse after eating, lying down or bending over.³

When it happens regularly it’s known as gastro-oesophageal reflux disease (GORD).³

There are several lifestyle factors which can cause or make heartburn worse including diet – certain food and drinks known as triggers are fatty, spicy or rich food, coffee, tomatoes, chocolate, citrus fruits and alcohol.

Other factors include stress and anxiety, being overweight, smoking and pregnancy.

Pregnancy hormone changes can relax the muscular ring, which connects the stomach to the gullet (the oesophagus) and works to prevent stomach contents passing through.⁴

In the later stages of pregnancy, the growing baby can press against the stomach.⁴

What causes heartburn?

Well, that’s where acid reflux comes in.

Acid reflux occurs when the muscular ring fails for whatever reason, allowing stomach acid to travel the wrong way causing the pain of heartburn.⁵

We all need stomach acid to aid the digestion process but while the stomach can resist it, the gullet can’t so if there’s enough passing through, it can cause the pain of heartburn.⁵

Lifestyle changes to help with heartburn

Heartburn, particularly if it’s mild, can be eased or prevented by making some simple lifestyle changes such as avoiding food and drink triggers, eating smaller meals more frequently, finding ways to relax more, not eating within a few hours of going to bed and sitting up straight when you eat.³

Even wearing looser fitting clothes around the waist can make a difference.³

If heartburn is troubling you while you sleep, try raising one end of your bed by 10-20cms so your chest and head are above waist-level. This helps to stop stomach acid travel up towards your throat.³

Losing weight can help if you’re overweight, avoid smoking and cut down on alcohol.³

How to avoid heartburn?

Eating smaller meals throughout the day may help and it’s generally advised to avoid eating anything within three or four hours of going to bed, particularly the types of food and drinks listed above.

Foods that are less triggering – some of which can actually help the digestive system – include fibrous foods including wholegrains, green and root vegetables, bananas, lean meats, eggs, nuts, watermelon, ginger and probiotic-rich low-fat yoghurt.^5/6

Because a diet rich in fibre is recommended for a healthy digestive system, a vegan diet may reportedly help with it being plant-based⁷ but heartburn sufferers still need to be cautious around triggers such as tomatoes, fats and spices.

It may seem like the joy of food has been diminished if you have GORD, but there are alternatives⁸ which may not only help your heartburn symptoms but also lead to a healthier diet all-round.

Instead of crisps and creamy dips or salsa try veg sticks like carrot, pepper and cucumber and scoop up something low in fat.

Swap out mayo-rich and high fat salad dressings for homemade vinaigrette or yoghurt-based versions. There’s a number of online recipes to try.

Love burgers? Try grilled chicken, fish, pork tenderloin or a turkey burger which is also low in fat and season meat with a dry rub of herbs and olive oil.

When it comes to dessert it’s hard to convince anyone to part with treats containing chocolate or cream, but a fruity low-fat crumble can be equally delicious. And who can resist seasonal fruits such as berries, peaches and melon?

How can I prevent heartburn on holiday?

There are of course things you can do to lessen the chances of getting heartburn.

If you think you’re likely to suffer from heartburn on your hols here’s a couple of preparation tips⁴:

• Knowing your food and drink triggers – which can also include chocolate, fizzy drinks, coffee and acidic food such as citrus fruits – can help you to keep them to a minimum or avoid them altogether. If you’re not sure what your triggers are, try keeping a food diary for a couple of weeks ahead of your holiday to help you work them out.
• Speak to your GP or pharmacist about a heartburn remedy which prevents symptoms as opposed to one which treats them when they occur.

Generally, there are a number of lifestyle changes which can help to prevent or reduce heartburn and acid reflux.¹

Alongside pregnancy, being overweight and smoking are linked to causing or making the symptoms worse¹ so taking steps to combat these triggers can make a difference when it comes to heartburn and, of course, overall health.

How to relieve heartburn on holiday

For regular sufferers when it comes to food and drink it’s best to keep those triggers to a minimum or avoid them altogether if you can.

There are often tasty alternatives to rich and fatty food.

For example, lean, grilled meat and low-fat salad dressings – for more alternatives check out our Diet and heartburn blog.

Eating smaller more frequent meals can also help as overeating can cause or make heartburn worse.¹

Try to avoid eating within three to four hours of going to bed and if you do find heartburn interrupts your sleep, raise the head end of your bed 10-20cm so your chest is above waist level. This helps to stop acid from travelling up towards the throat.

Alcohol is thought to make your stomach produce more acid and can relax the muscular ring which joins the stomach to the oesophagus to stop the acid leaking through.⁵

While it may be hard to resist on holiday, if alcohol is one of your heartburn triggers it’s best to keep it to a minimum or cut it out completely.

Time to relax!

Holidays are a great opportunity to get away from it all and leave day-to-day worries behind which can be a good thing for those suffering from stress or anxiety related heartburn.

Stress and anxiety can both trigger acid reflux¹ so make the most of your relaxation time.

Exercise is great for both physical and mental wellbeing and on holiday you’ll probably end up being physically active without even realising!

A swim in the pool or sea, sightseeing walks, cycling along the coast or up a mountain – many of the things we love to do on our vacation or staycation trips which have all-round health benefits for body and mind.

You can find out more about stress and anxiety related heartburn and ways to tackle it in our blog.