A gut specialist describes his lifelong struggle with acid reflux and the medications and lifestyle changes that made it manageable
That familiar burn behind the breastbone, the bitter taste that greets you at night and the occasional regurgitation are all hallmarks of acid reflux. I describe these sensations from personal experience: despite being a doctor who treats digestive disorders, I have lived with reflux for most of my life.
In the United Kingdom an estimated 9.6 million people are affected, so this is not an uncommon problem. Over the years I have combined medical treatments with straightforward behavioural changes to keep symptoms under control, and in this piece I set out what worked for me and why those approaches make sense physiologically.
My symptoms began when I was a medical student and often felt like a hot, sharp sensation in the chest. I do not fit the stereotypical profile associated with reflux: I am lean and I neither smoke nor drink alcohol, both of which can weaken the lower oesophageal sphincter.
The underlying reason for my reflux only became clear during a gastroscopy performed during the lockdown in 2026. The test revealed a small hiatus hernia — a condition in which part of the stomach slips up through the diaphragm — which can stretch and impair the seal at the lower end of the oesophagus, allowing stomach contents to travel upwards.
Treatment history and medication choices
My first relief came from over-the-counter antacids, which neutralise acid briefly. Later, H2 blockers — a class of drugs that block histamine receptors in the stomach — became available without prescription and I found famotidine particularly useful when taken nightly after dinner. In the 1990s, more powerful drugs called proton pump inhibitors (PPIs) became widely used; today roughly 15 per cent of people in the UK take them. I tried a PPI in the early 2000s and, unsurprisingly, it reduced acid production more effectively than H2 blockers. However, stronger acid suppression carries trade-offs that influenced my long-term choice.
Why I favoured an H2 blocker over long-term PPI use
There are two reasons I continued with famotidine rather than staying on PPIs. First, gastric acid has a defensive role: it helps sterilise food. Within a fortnight of starting a PPI I developed gastroenteritis, which reinforced the risk of increased susceptibility to gut infections when acid is suppressed excessively. Second, sustained PPI therapy raises levels of the hormone gastrin, which stimulates acid production. When the drug is stopped, elevated gastrin can drive a rebound surge of acid that convinces patients they need to restart medication. For many people, trying an H2 blocker first is sensible; if symptoms remain uncontrolled, a PPI is the logical and effective next step under medical supervision.
Practical lifestyle measures that made the biggest difference
Beyond pills, one of the simplest and most effective changes I made was raising the head of my bed by about six inches using wooden blocks so I sleep on a gentle incline. Gravity helps prevent stomach contents from travelling up the oesophagus at night; by contrast, simply piling pillows under your head tends to bend the body and can compress the stomach, making reflux worse. I also avoid eating after 7pm because a full stomach exerts pressure on the lower oesophageal valve. Certain foods and drinks are clear triggers for me: acidic juices such as apple juice provoke symptoms, and fatty or very spicy meals are best avoided close to bedtime.
Additional triggers and sensible moderation
Alcohol is a well-known reflux trigger because it relaxes the lower oesophageal sphincter; I do not drink for that reason among others. Coffee affects some people’s valve function, so I limit my intake to an occasional cup and mostly drink water. The goal is not perfection but predictability: identify which items provoke your symptoms and reduce or avoid them, particularly before lying down. For many people these modest adjustments, combined with appropriate medication, shift reflux from a daily burden to an occasional nuisance.
When to seek medical review and what to watch for
Reflux can impair quality of life, especially for those who work bent over or who regularly stoop. If symptoms are frequent, severe or disruptive, consult your doctor to explore treatment options. New or worrying signs — notably difficulty swallowing, persistent pain when eating or the sensation of food sticking — merit immediate evaluation because they could indicate complications. People with long-standing reflux may develop changes in the oesophageal lining known as Barrett’s oesophagus, which in a minority of cases can progress to cancer; if you have had reflux for two decades or more, ask your GP whether a gastroscopy is appropriate for surveillance.
After decades of experimenting, I still wake with mild chest discomfort a couple of mornings each week, perhaps a fraction of what it once was, and that level is tolerable. The combination of a targeted medication strategy, simple sleeping adjustments and dietary caution has allowed me to live and work comfortably while continuing to treat patients. I am Professor Peter Whorwell, Consultant Gastroenterologist at Manchester University NHS Foundation Trust and Professor of Medicine and Gastroenterology at the University of Manchester, and these are the practical measures that helped me manage my reflux.
