Quick answer: Acidity or heartburn is a burning feeling in the chest or throat when stomach acid flows back up; if it happens twice a week or more it may be GERD. Smaller meals, an earlier dinner and avoiding your triggers help. Antacids give short relief, while PPIs should be used at the lowest effective dose and reviewed by a doctor. Warning signs need a medical check.
What are the symptoms of acidity and GERD?
Typical symptoms are heartburn (a burning pain behind the breastbone), sour or bitter regurgitation into the mouth, bloating and burping. When these happen often, about twice a week or more, doctors call it gastro-oesophageal reflux disease (GERD). Left untreated, repeated acid exposure can inflame or injure the food pipe.
What triggers acidity?
Triggers differ from person to person, so it helps to keep a short diary. Common ones are:
- large or late meals, and lying down within 2 to 3 hours of eating
- fatty, fried or spicy food, tea and coffee, soft drinks
- smoking and alcohol
- being overweight and tight clothing around the waist
- some medicines, including NSAID painkillers and certain blood pressure and asthma medicines
Evidence for individual foods is mixed, and not everyone needs to cut out tea or spicy dishes. Change only what you notice makes your own symptoms worse.
In Bangladesh the usual culprits are oily bhuna and biryani, fried snacks, strong tea on an empty stomach, cola, achar, paan with jorda and a late heavy dinner.
What can I do at home to reduce acidity?
- Eat smaller meals and have the last meal 2 to 3 hours before bed.
- Raise the head of the bed by about 15 to 20 cm by placing blocks under the legs or using a wedge, rather than adding pillows.
- Lose weight if you are overweight.
- Stop smoking, including jorda and gul, and limit alcohol.
- Find and avoid your own triggers instead of cutting out many foods without reason.
How are antacids, H2 blockers and PPIs used?
Antacids neutralise acid and give short-term relief of occasional heartburn. They are sold over the counter (see OTC medicine).
H2 blockers such as famotidine reduce acid production for longer.
Proton pump inhibitors (PPIs) such as omeprazole, esomeprazole, pantoprazole, rabeprazole and lansoprazole reduce acid the most. They are usually taken once a day, about 30 minutes before the first meal. For GERD a course is typically 4 to 8 weeks, after which the doctor reviews whether to continue, reduce or stop.
Acid-reducing medicines at a glance
| Type | Examples | How it works | Starts working | Use without a doctor |
|---|---|---|---|---|
| Antacid | Calcium carbonate, magnesium or aluminium hydroxide, alginates | Neutralises acid already in the stomach | Within minutes; lasts 1 to 3 hours | Occasional use; not daily beyond 2 weeks |
| H2 blocker | Famotidine | Blocks the histamine signal for acid production | Within about 1 hour; lasts up to 12 hours | Up to 14 days |
| PPI | Omeprazole, esomeprazole and others | Switches off the acid pumps; strongest and longest-acting | Relief in 1 to 3 days; full effect up to 4 weeks | Up to 14 days, then see a doctor |
How to take a PPI correctly
- Take it once a day, 30 to 60 minutes before breakfast, when the acid pumps are most active.
- Swallow it whole with water; do not crush it.
- Take it every day of the course, even when you feel fine; taking it only when heartburn strikes works poorly.
Long-term PPI use: what the evidence says
- Use the lowest dose that controls symptoms, for the shortest time needed.
- Long-term or high-dose use is linked with low vitamin B12 and magnesium, a possible higher risk of fractures and some infections. Do not take a PPI for months without review. If you have been on one for a long time, ask about B12 (see vitamin B12 deficiency symptoms and food sources).
- The B12 and magnesium effects are well documented after a year or more and a blood test can check them. The links with fractures and with Clostridioides difficile (C. difficile) gut infection are associations seen in studies, not proven cause and effect, and the added risk for one person is small.
- With a clear reason such as Barrett's oesophagus, a bleeding ulcer or high-risk NSAID use, the benefit outweighs these risks; never stop a prescribed PPI on your own.
- Stopping suddenly after long use can cause rebound acid, so ask your doctor how to taper.
- Do not use acid-reducing medicines to cover up warning signs.
Antacids can affect how other medicines are absorbed, so ask a pharmacist about timing if you take other tablets. Heartburn is also common in pregnancy; ask a doctor before using any medicine.
Doses and the right drug depend on your diagnosis, so follow the prescription. Prescribed acid-reducing medicines are listed under prescription medicine.
Timing matters for many medicines, not just PPIs; our guide on reading a prescription and taking medicines safely explains "before food" and "after food" instructions.
What about H. pylori, ulcers and painkillers?
Helicobacter pylori is a stomach bacterium that can cause gastritis and ulcers. It is diagnosed by tests and treated by a doctor with a combination of medicines, so do not self-treat. NSAID painkillers such as ibuprofen and diclofenac can also cause gastritis and ulcers, especially if taken often or on an empty stomach. Tell your doctor if you use them regularly, and do not keep taking an antacid or PPI to mask stomach pain caused by a painkiller.
How is H. pylori tested and treated?
The reliable tests are the urea breath test and the stool antigen test. Stop PPIs for 2 weeks and antibiotics for 4 weeks before testing, or the result may be falsely negative. Treatment is a 10 to 14 day course of two or more antibiotics with a PPI. Complete the full course even if you feel better early; a half-finished course breeds resistant bacteria. A repeat test at least 4 weeks after finishing confirms cure.
What tests will the doctor order and what do the results mean?
Typical heartburn usually needs no tests; they are ordered for alarm features or when a 4 to 8 week treatment trial fails.
- Upper endoscopy (gastroscopy): advised for difficulty or pain when swallowing, vomiting blood or black stools, unexplained weight loss, anaemia, persistent vomiting, or symptoms that begin after age 50 to 55 or do not settle after a full course. It can show oesophagitis, an ulcer, Barrett's oesophagus or, rarely, a cancer, and allows a biopsy.
How should I manage acidity during Ramadan?
Break the fast with a smaller iftar rather than a large meal, avoid fried and very spicy food, and drink enough water between iftar and sehri. Do not lie down straight after eating. Discuss the timing of any acid-reducing medicine with your doctor before Ramadan, as the schedule may need to change.
Acid-reducing medicines such as omeprazole and esomeprazole are listed on MedEasy. Take them exactly as your doctor or pharmacist advises, and do not extend a course on your own.
Is it acidity or a heart attack?
Reflux pain is burning, rises from the upper abdomen towards the throat and eases with an antacid. A heart attack more often feels like pressure or squeezing in the centre of the chest, may spread to the arm, neck, jaw or back, and comes with sweating, breathlessness, nausea or grey, clammy skin; in older people, women and people with diabetes it can feel exactly like indigestion. If in doubt, call 999 and do not drive yourself.
Common myths and questions in Bangladesh
- "Rice causes gastric." Plain rice is bland and low in fat; the amount, the oily curry with it and eating late are the problem.
- "Milk cures acidity." Milk briefly dilutes acid, but its fat and protein stimulate more acid later.
- "A gastric tablet is needed with every antibiotic." Antibiotics and paracetamol do not need a PPI; take them with food if they upset your stomach. A PPI with an NSAID is only for people at higher ulcer risk, and the doctor decides.
- "A PPI every day for life is harmless." Some people truly need it, but long-term users need review at least yearly on the lowest dose that works.
- "Baking soda (khabar soda) fixes it." It neutralises acid for minutes but causes gas and carries a lot of sodium; avoid it with high blood pressure, heart or kidney disease or pregnancy, and never use it regularly.
When should I see a doctor or call 999?
- Call 999 or go to hospital: chest pain with sweating, breathlessness, or pain spreading to the arm, jaw or back may be a heart attack. Do not assume it is acidity.
- Urgent assessment: vomiting blood, black tar-like stools, repeated vomiting, or difficulty or pain when swallowing.
- See a doctor soon: unexplained weight loss, anaemia, new symptoms after age 50 to 55, symptoms lasting 2 to 3 weeks despite treatment, or persistent hoarseness or cough.
- Also see a doctor if: you have needed an OTC acid medicine most days for over 2 weeks, or you take an NSAID or blood thinner regularly.
If you are unsure, speak to a doctor through online doctor consultation.
References
- Heartburn and acid reflux - NHS
- GERD - MedlinePlus
- Omeprazole - NHS
- Treatment for GER and GERD - NIDDK
- Acid Reflux - American College of Gastroenterology
- Stomach ulcer - NHS
This article is for general awareness only and is not a substitute for advice from a qualified doctor. Do not start or stop prescribed medicines without medical advice.
