UK health officials push early testing as chronic acid reflux cases rise

Paula Gresty’s life was increasingly consumed by a burning, persistent sensation in her chest and throat. For about two decades she lived with acid reflux, trying to manage the pain with medication prescribed by her GP. By 2021, after years of partial relief, the symptoms intensified: nights spent coughing and waking with a fiery sting, and regurgitation after meals that sometimes led to accidents and embarrassment. Gresty, now 60 and living near Norwich, represents millions of Britons who suffer from reflux, a condition that can range from a nuisance to a life-altering disease when not properly diagnosed or treated.

Acid reflux occurs when the lower oesophageal sphincter, the one-way valve between the stomach and the esophagus, fails to prevent stomach contents from flowing backward. When acid irritates the esophageal lining, heartburn follows. People with reflux may experience additional symptoms such as a bitter taste, belching, coughing, hoarseness, and even breathing difficulties. Health professionals call the core condition gastro-oesophageal reflux disease, or GORD, when symptoms are persistent and significant. While many people manage occasional reflux with lifestyle adjustments and over-the-counter remedies, others endure ongoing discomfort that can harm quality of life and raise the risk of complications over time.

GORD affects an estimated eight million people in the United Kingdom, and studies indicate more than five and a half million Britons experience regular reflux. However, because many patients self-medicate, exact numbers are uncertain. Researchers emphasize that persistent heartburn should not be dismissed as merely a nuisance, because long-term exposure to stomach acid can inflame the esophageal lining, cause ulcers, and in some cases lead to more serious conditions such as Barrett’s oesophagus, which can raise cancer risk. [Image: Paula Gresty with severe reflux symptoms]

Medical experts note that many people with reflux do not have the classic heartburn and may instead experience symptoms that mimic other conditions. For some, the problem presents as a sore throat, cough, or hoarseness—what clinicians refer to as “silent reflux.” The breadth of symptoms means doctors must consider GORD in a wide range of patients and pursue testing when symptoms persist beyond six to eight weeks or are accompanied by difficulty swallowing, weight loss, or vomiting. A small but critical minority of those with Barrett’s oesophagus may progress to cancer, highlighting the need for timely diagnosis and ongoing surveillance.

Within the medical community, there is growing emphasis on using targeted testing to identify Barrett’s and other complications early. The current gold standard diagnostic test is an endoscopy, a procedure in which a camera is passed down the throat to inspect the esophagus and sample tissue. But endoscopy is invasive and relies on referrals to specialist units, often constrained by waiting lists. A newer, less invasive option called Cytosponge has been developed to aid early detection. The Cytosponge is a capsule attached to a string that a patient swallows. Once the capsule dissolves in the stomach, a sponge expands and, after a few minutes, is pulled back up to collect cells for analysis. This approach can help identify Barrett’s oesophagus without immediate endoscopy access.

In a bid to bring testing closer to patients, the National Health Service announced a pilot program in July to offer the Cytosponge as part of a heartburn health check. The program targets about 1,500 people in London and the East Midlands who regularly purchase heartburn medications at pharmacies such as Boots. Researchers and clinicians involved in the Cytosponge project say the goal is to broaden availability in community settings, including shopping centers, so people who never visit their GP can still be screened for Barrett’s and related conditions. Professors and clinicians involved in the effort underscore that many with persistent heartburn are not tested promptly, and catching Barrett’s early can change outcomes for the minority who go on to develop cancer.

The patient story underscores the human impact of delayed diagnosis. Paula Gresty’s symptoms began in her late 30s with hoarseness and throat dryness. At first, she attributed the problem to working in a call center, but as episodes grew more frequent and severe, she sought medical advice. Initial treatment with a proton pump inhibitor (PPI) calmed symptoms for a time, and Paula adopted lifestyle changes—keeping a food diary, avoiding trigger foods, and elevating her head at night. Still, by 2022 her condition worsened, and endoscopy revealed a large hiatus hernia, GORD, and Barrett’s oesophagus. The diagnosis raised her cancer risk awareness and prompted discussions about treatment options and ongoing monitoring. While she has pursued non-surgical management for now, she remains in line for potential surgical intervention as doctors weigh the best course of action for her hernia and reflux.

GORD’s impact on a patient’s daily life can be profound. The condition often disrupts sleep, complicates meals, and affects work and social activities. Medical professionals stress that while lifestyle changes can dramatically reduce symptoms for many, others require long-term medication or surgical options to restore quality of life and protect the esophagus from ongoing acid exposure.

Beyond patient anecdotes, clinicians point to several modifiable risk factors for reflux. Hiatal hernias, obesity, pregnancy, and age-related changes can weaken the lower esophageal sphincter. Certain foods and substances—fats that slow gastric emptying, spicy dishes that irritate the esophagus, alcohol, and nicotine—are commonly implicated in symptom flare-ups. Dr. Inder Mainie, a consultant gastroenterologist, notes that not all heartburn is reflux, and chest pain should be assessed promptly, as it can mimic a heart attack. The medical community also recognizes that the gut microbiome can influence digestive symptoms; conditions such as small intestinal bacterial overgrowth (SIBO) can produce reflux-like symptoms, complicating diagnosis and treatment.

Medication remains central to many patients’ treatment plans. Antacids neutralize stomach acid and are useful for occasional relief, while alginates form a protective layer over the esophagus. Proton pump inhibitors (PPIs) reduce acid production and are among the most commonly prescribed drugs in the UK. Some patients can obtain PPIs over the counter, while others require a prescription. However, PPIs do not work for everyone, and about one in five patients may continue to experience reflux symptoms despite treatment. Experts caution that PPIs can alter the gut microbiome and may contribute to issues such as SIBO, osteoporosis, kidney problems, and infections when used long term. Where PPIs fail, H2 blockers provide another option, though they tend to be less effective. Patients should discuss the most appropriate therapy with their GP, including timing and dosing to maximize effectiveness.

For patients whose symptoms persist despite medication, surgical options offer substantial relief. Fundoplication—wrapping part of the stomach around the lower esophagus to reinforce the valve—has a long track record of success and is commonly performed via minimally invasive techniques. In properly selected patients, surgeons report symptom relief in the majority of cases, with improved quality of life and reduced reflux episodes. A newer, less invasive option, the LINX procedure, uses a bracelet of magnetic beads placed around the lower esophagus. The beads loosely allow swallowing while preventing reflux; most patients report fewer side effects than with full fundoplication, though it may not be suitable for those who already have swallowing difficulties. A recently discussed option, RefluxStop, involves a small silicone device at the top of the stomach to help keep the valve closed and is available in a limited number of NHS hospitals and private clinics at substantial cost. Each procedure carries potential side effects, including gas-related pain, bloating, and swallowing difficulties, which patients should weigh with their clinicians during decision-making.

The evolving landscape of testing and treatment reflects a broader public health aim: to ensure that persistent reflux is diagnosed accurately and managed effectively before complications arise. Health researchers emphasize the importance of early recognition of Barrett’s oesophagus and related conditions, which, in a minority of cases, can progress to cancer. As Paula’s case illustrates, delays in follow-up can complicate outcomes and extend the period during which the esophagus remains exposed to acid. Her experience also highlights how patients can benefit from persistent advocacy—asking questions, pursuing referrals, and seeking second opinions when symptoms persist or worsen.

Public health advocates stress that anyone experiencing heartburn two or three times a week for more than six to eight weeks should consult a GP. While many patients respond to lifestyle changes and medications, others require more intensive evaluation and treatment, including endoscopy or cytology-based testing. The introduction of the Cytosponge in NHS pilot programs represents a potential shift toward more accessible screening, particularly for individuals who do not routinely engage with primary care. If widespread, such approaches could lead to earlier detection of Barrett’s oesophagus and improved cancer surveillance without the need for invasive endoscopic procedures in the initial assessment.

As researchers fine-tune diagnostic pathways and clinicians expand the range of therapeutic options, patients and clinicians alike acknowledge that individual care must be tailored. Paula Gresty’s journey—from years of untreated symptoms to a diagnosis of Barrett’s oesophagus and a looming decision about surgery—underlines the urgency of timely evaluation, patient education, and multidisciplinary care in managing reflux-related disease. For many, the path forward involves a combination of evidence-based medical therapy, targeted lifestyle changes, and, where appropriate, surgical intervention, with ongoing monitoring to mitigate long-term risks and improve daily living.