Acid Reflux & Heartburn Treatment Online

What is acid reflux?

Acid reflux (also called gastro-oesophageal reflux disease, or GORD, when chronic) is stomach acid flowing back into the oesophagus. It affects up to one in five Australians regularly. The most common symptom is heartburn, a burning sensation in the chest that often worsens after eating or when lying down.

Occasional reflux after a heavy meal is common and rarely a concern. Persistent symptoms, symptoms that disturb sleep, or symptoms that don't respond to simple measures are worth a GP assessment. Reflux is well suited to a bulk billed telehealth consultation because initial diagnosis and management are based on history and symptom pattern rather than physical examination.

Symptoms of acid reflux

Typical symptoms include:

• Heartburn: a burning sensation in the chest, often after eating
• Regurgitation of food or sour liquid into the mouth or throat
• Difficulty swallowing or a sensation of food sticking
• A feeling of a lump in the throat (globus sensation)
• Chronic cough, hoarseness, or frequent throat clearing
• Worse symptoms at night or when lying flat
• Belching, bloating, or nausea

Symptoms can overlap with cardiac, asthma, or ear-nose-throat conditions. Your GP will help distinguish the likely cause and order investigations where needed.

When to see a doctor, and when to go straight to an ED

Attend an emergency department, or call 000, if you have any of the following features that may point to a serious condition rather than simple reflux:

• Severe, crushing, or new chest pain (especially with breathlessness or sweating)
• Vomiting blood, or material that looks like coffee grounds
• Black tarry stools or visible blood in stool
• Sudden inability to swallow food or fluids
• Severe abdominal pain

Book a GP (in person or via telehealth) if:

• Symptoms occur more than twice a week
• Over-the-counter antacids are not providing adequate relief
• Symptoms are interfering with sleep, eating, or daily life
• You have had ongoing reflux for months without a medical review
• You notice unintentional weight loss, persistent trouble swallowing, or early satiety
• You have been on acid-suppressing medication long term without a recent review

For less-urgent scenarios, telehealth is a fast way to be seen. Your GP will tell you if an in-person review, gastroscopy, or gastroenterologist referral is appropriate.

How a telehealth GP can help with reflux

During the consult, your GP can:

• Assess symptom pattern, medical history, current medications, and alarm features
• Send an eScript for acid-suppressing medication (PPI or H2 blocker) where clinically appropriate
• Issue a repeat prescription for existing reflux medication, with step-down review where possible
• Discuss personalised dietary and lifestyle changes
• Order pathology where anaemia, H. pylori, or other contributors are suspected
• Refer you to a gastroenterologist for gastroscopy or complex cases
• Review and adjust treatment at follow-up appointments

For eligible Medicare cardholders, the consultation and everything issued during it are bulk billed with no out-of-pocket cost.

Common reflux triggers

Triggers vary between people, but common contributors include:

• Fatty or fried foods
• Spicy foods
• Citrus fruits and tomato-based products
• Chocolate, coffee, and other caffeinated drinks
• Alcohol (particularly red wine and spirits)
• Carbonated drinks and large meals
• Eating within 3 hours of bedtime
• Smoking, which weakens the lower oesophageal sphincter
• Carrying excess abdominal weight
• Pregnancy (hormonal and mechanical changes)
• Some medications (including NSAIDs, calcium-channel blockers, and others)

A short food and symptom diary often helps identify your personal triggers. Your GP can review the diary and tailor management accordingly.

Reflux medications: PPIs, H2-blockers, and antacids

Most reflux responds to a combination of medication and lifestyle change. Australian Therapeutic Guidelines (eTG) and the Gastroenterological Society of Australia (GESA) recommend a stepped approach. Where clinically appropriate, your GP can prescribe:

Proton pump inhibitors (PPIs) — first-line for GORD

PPIs are the most effective acid suppressants and the first-line treatment for confirmed GORD or moderate-to-severe reflux. They are typically reviewed after 4–8 weeks, with a step-down trial once symptoms are controlled. PBS-listed options include:

• Esomeprazole 20–40 mg (Nexium) — first-line for moderate-to-severe GORD
• Pantoprazole 20–40 mg (Somac) — well-tolerated, fewer drug interactions than other PPIs; preferred when patients are on clopidogrel
• Omeprazole 20 mg (Losec, Acimax) — established and effective; the 10 mg dose is available OTC
• Lansoprazole 30 mg (Zoton) — alternative when omeprazole or pantoprazole are not tolerated
• Rabeprazole 20 mg (Pariet) — option for patients who do not respond to other PPIs

PPIs are best taken 30–60 minutes before the first meal of the day. Most patients can step down to alternate-day or on-demand dosing after symptom control. Long-term continuous use is reviewed annually because of low-but-real risks of B12 deficiency, hypomagnesaemia, and increased fracture risk in older adults.

H2-receptor antagonists — for milder or breakthrough symptoms

• Famotidine 20–40 mg (Pepcid, Pepcidine) — the only H2-receptor antagonist currently registered in Australia; available OTC at low strength and on prescription at full dose; useful for breakthrough nocturnal symptoms or as a step-down from PPIs

H2-blockers act faster than PPIs but the effect is shorter-lived. Tachyphylaxis (reduced effect) can develop with continuous daily use, so they work best for intermittent or on-demand control.

Antacids and alginate-antacids — for quick symptomatic relief

• Gaviscon Dual Action — alginate plus antacid; forms a protective raft on stomach contents and is the preferred option for nocturnal regurgitation and reflux in pregnancy
• Mylanta, Quick-Eze, Rennie — calcium-carbonate or aluminium/magnesium antacids for rapid relief of occasional heartburn

Your GP will choose an approach based on the severity, frequency, and impact of your symptoms, your other medications, and pregnancy status, and will review ongoing prescription medication at least annually.

Helicobacter pylori, Barrett's oesophagus, and when gastroscopy is needed

Where symptoms are persistent, atypical, or accompanied by alarm features (trouble swallowing, weight loss, anaemia, vomiting blood, age over 50 with new symptoms), your GP can:

• Order a Helicobacter pylori urea breath test or stool antigen test, and prescribe PBS-subsidised eradication therapy (clarithromycin + amoxicillin + PPI) if positive
• Order a full blood count and iron studies to assess for occult bleeding or anaemia
• Refer you to a gastroenterologist for gastroscopy, biopsies, and assessment for Barrett's oesophagus or oesophagitis
• Discuss surgical options (Nissen fundoplication, LINX) for refractory GORD that fails medical therapy

Long-standing GORD increases the risk of Barrett's oesophagus, a precursor to oesophageal adenocarcinoma. Surveillance gastroscopy is sometimes recommended for Barrett's, and your gastroenterologist will discuss the appropriate interval.

Dietary and lifestyle tips for reflux

• Eat smaller, more frequent meals rather than large portions
• Avoid lying down for 2 to 3 hours after eating
• Elevate the head of your bed by 15 to 20 centimetres
• Identify and avoid your personal trigger foods and drinks
• Maintain a healthy weight to reduce abdominal pressure
• Wear loose-fitting clothing around the waist
• If you smoke, quitting may strengthen the lower oesophageal sphincter
• Chew food slowly and thoroughly
• Keep a short food and symptom diary to identify patterns

A bulk billed telehealth GP can review your diary and tailor a sustainable plan. If lifestyle changes alone are not enough, your GP can discuss medication options or arrange a specialist referral.