A ‘lump’ in the throat, a burning sensation in the chest, embarrassing digestive issues or an unpleasant sour taste in the mouth.
For some there is also chronic coughing, hoarseness, bloating or the uncomfortable feeling that food is not going down properly – all symptoms commonly linked to acid reflux.
And they will be all-too-familiar to the estimated seven million people in the UK it hits each year. Pharmacy shelves heave with remedies promising quick relief, while millions more rely on prescription drugs to keep symptoms under control.
At least one in ten adults suffers persistent heartburn or reflux symptoms. But, remarkably, some experts now believe a significant proportion of people being treated for acid reflux may not actually have the condition. A new analysis by researchers at The Functional Gut Clinic in London suggests that up to two-thirds of patients with suspected reflux do not meet the criteria for it when properly tested.
Instead, their symptoms may be driven by a range of other, often overlooked conditions that can look and feel almost identical.
So if it’s not acid reflux, what could it be? There are, say experts, multiple conditions that can closely mimic reflux, causing similar symptoms – from bacterial overgrowth in the gut to heightened nerve sensitivity in the digestive tract.
The good news is that many of these issues can often be improved with simple lifestyle changes or cheap, easy-to-obtain medication.
Professor Anthony Hobson, a gastrointestinal scientist at The Functional Gut Clinic, says acid reflux is often the first explanation doctors consider.
At least one in ten adults suffers persistent heartburn or reflux symptoms – around seven million
Paul Goldsmith, consultant surgeon at Spire Hospital Manchester, says acid reflux is the most common cause of a burning sensation in the chest
‘It’s the easiest culprit to think about in the first instance, and the treatment we have for people who do have acid reflux is very effective,’ he says.
In order to understand the conditions that mimic acid reflux, it helps to understand what acid reflux actually is and what causes it.
Paul Goldsmith, consultant surgeon at Spire Hospital Manchester, explains: ‘By far the most common cause of burning in the chest is straightforward acid reflux, also known as gastro-oesophageal reflux disease, or GORD – stomach acid repeatedly leaking the wrong way, up into the oesophagus.
‘Typical reflux symptoms include a burning pain rising from the upper stomach into the chest, often worse after caffeine, alcohol, fatty, spicy or acidic foods, and when lying flat in bed.’
Being overweight, smoking, pregnancy and stress can also increase the risk of reflux.
Many people find symptoms worsen in middle age. This can be due to weakening of the lower oesophageal sphincter – the valve that prevents stomach contents from flowing back into the oesophagus – the tube that connects the throat to the stomach.
For some, reflux is occasional and manageable through diet changes, eating smaller meals and avoiding trigger foods. But for others, it becomes a long-term condition. Left untreated, persistent reflux can lead to inflammation of the oesophagus and, in rare cases, an increased risk of oesophageal cancer.
NHS guidance advises patients to see a GP if symptoms persist despite treatments or lifestyle changes.
Lauren Jackson, 35, from Preston, says her chest pain symptoms were dismissed as acid reflux by doctors
‘Doctors typically start by suggesting things such as losing excess weight, cutting back on alcohol, caffeine, chocolate and spicy or citrus foods, stopping smoking and sleeping slightly propped up before or alongside medication,’ Mr Goldsmith says.
‘The most commonly prescribed drugs are proton pump inhibitors, or PPIs, which switch off acid production in the stomach and are highly effective for many people in the short term.’
PPIs are widely used medications that reduce stomach acid production at the source. Unlike antacids, they take a few days to work but provide longer-lasting relief.
‘PPIs are some of the most prescribed medications out there,’ says Mr Goldsmith. ‘For a lot of patients who go to their GP with heartburn and reflux symptoms, they will be started on one. And in many cases, that’s the right thing to do. They are very effective drugs.’
However, in some patients on long-term PPIs, the pattern of symptoms can change. Instead of burning, they may develop bloating, excessive wind and belching.
This is because, over time, acid-suppressing drugs can alter the balance of bacteria in the gut and reduce the stomach acid that normally helps keep harmful microbes in check.
This can affect how the body absorbs nutrients and, in some cases, may contribute to bone problems, kidney issues and a greater risk of infections.
Some experts also believe long-term use of these drugs may play a role in triggering a condition called SIBO – short for small intestinal bacterial overgrowth.
Short for small intestinal bacterial overgrowth is often mistaken for acid reflux
SIBO occurs when excessive bacteria build up in the small intestine, where relatively few microbes should normally live. This overgrowth can cause symptoms that closely mimic acid reflux, including heartburn, regurgitation, sore throat and coughing, as well as bloating, abdominal pain and symptoms similar to irritable bowel syndrome (IBS).
The problem is that people can end up stuck in a vicious cycle. They develop reflux symptoms and take acid-suppressing drugs such as PPIs, which help at first. But by lowering stomach acid for long periods, the medication may make it easier for bacteria to multiply.
This can trigger SIBO – which causes symptoms that feel similar to reflux. Patients may assume their acid reflux is returning or worsening, so continue taking the drugs or increase the dose, potentially prolonging the problem.
Diagnosis of SIBO is usually made using breath tests to detect gases produced by bacteria in the small intestine, though experts say the tests are imperfect and they are not routinely offered.
Professor Hobson says: ‘If strong reflux medication has not worked within six to eight weeks, doctors should stop repeating prescriptions and start looking for other causes, including testing for SIBO.’
SIBO treatments include antibiotics such as rifaximin, which costs the NHS as little as £2 a day.
However, Professor David Sanders, a gut disease expert at the University of Sheffield, warns: ‘Rifaximin is effective at killing bacteria in the small intestine, but it is not risk-free. It can also affect healthy gut bacteria, potentially leading to other problems. Overuse of antibiotics can contribute to drug-resistant bacteria.
‘You want to be sure the patient has SIBO before prescribing it.’
Dietary approaches include a low-FODMAP diet – a medically backed plan that involves limiting fermentable carbohydrates that feed gut bacteria. These include onions, garlic, apples, pears, beans and lentils, typically restricted for around six weeks before gradual reintroduction.
SIBO is only one of several conditions that can be mistaken for acid reflux. Another common one is functional dyspepsia – persistent indigestion symptoms without any obvious physical problem.
People may experience bloating, upper stomach pain, belching, nausea or a feeling of fullness after only a small meal.
Many also report burning chest pain or throat symptoms that feel almost identical to reflux. But when doctors investigate, they often find no sign of ulcers, inflammation or other visible damage.
Researchers increasingly believe the problem may instead lie in how the gut and brain communicate. In some people, the upper digestive tract appears unusually sensitive, meaning normal amounts of acid, stretching or digestion can trigger pain.
Mr Goldsmith says some patients can become trapped in a cycle similar to those with SIBO. They develop symptoms that feel like reflux and are prescribed acid-suppressing drugs, which may help temporarily. But if acid is not actually the root cause, symptoms can persist, leading people to stay on medication long term while searching for answers.
A related condition, called oesophageal hypersensitivity, can be even more confusing. Patients experience reflux symptoms despite having normal acid levels.
‘There are some patients who have no excess acid but they feel they’ve got acid,’ Mr Goldsmith says.
Doctors can sometimes identify this using a 24-hour test that measures acid levels in the oesophagus while patients record symptoms.
Treatment for both conditions tends to focus less on blocking acid and more on calming the digestive system through diet changes, stress management and avoiding personal triggers.
Another important mimic is Helicobacter pylori, a stomach bacterium that can cause gastritis and ulcers.
It produces protective substances that allow it to survive in stomach acid and irritate the lining of the stomach.
Symptoms can closely resemble reflux, including upper abdominal pain, bloating and nausea. It is diagnosed using breath, stool or biopsy testing and treated with a combination of antibiotics and acid suppression.
‘First-line treatment cures around 80 per cent of patients,’ says Mr Goldsmith, ‘but some require further courses and reinfection can occur.’
Because symptoms overlap closely with reflux, it is sometimes missed or masked by repeated PPI use.
That overlap was seen in the case of Lauren Jackson, 35, from Preston. She first began experiencing troubling symptoms in 2020, including a choking sensation, a lump in her throat and the persistent feeling that her food was not going down properly.
Amid wider health problems linked to long Covid, she was eventually told the throat symptoms were likely caused by reflux and advised to avoid trigger foods such as spicy dishes, tomatoes and peppermint tea.
At first the approach seemed to help. But in 2025 her symptoms returned – this time alongside bloating, belching and burning indigestion. Doctors suggested IBS and acid reflux, and prescribed PPIs.
Yet Lauren, a nurse, felt something was being missed. She had already tried cutting out trigger foods and keeping a food diary, but her symptoms persisted.
After researching it herself, she asked to be tested for Helicobacter pylori.
Although her GP initially thought it was unlikely, a stool test confirmed the infection.
Lauren is now undergoing antibiotic treatment to eradicate the bacteria.
She says she feels fortunate to have had the confidence to push for further testing. ‘Not everyone knows what to ask for,’ she adds. ‘And not everyone feels they can push back when something doesn’t feel right.’
Doctors also highlight rarer but important conditions that can mimic reflux.
Eosinophilic oesophagitis, or EoE, is an inflammatory condition often linked to allergy-type responses. It can cause difficulty swallowing and the sensation of food sticking in the throat.
‘Some patients’ symptoms of reflux present as difficulty swallowing. Food sticks,’ says Mr Goldsmith. ‘They have eosinophilic oesophagitis, or EoE, and it is often misdiagnosed as reflux.’
It can only be confirmed via endoscopy and biopsy showing eosinophil infiltration, and treatment may include steroid therapy and dietary exclusion.
Another rare condition is achalasia, where the oesophageal valve fails to relax properly. This leads to progressive swallowing difficulty and regurgitation.
Mr Goldsmith describes it as ‘rare as hen’s teeth’, affecting around one in 100,000 people.
Diagnosis involves scans and tests that measure the pressure and constriction of muscles as you swallow, and treatment is by a specialist.
Doctors also remain alert to oesophageal cancer, although this is rare. Long-term reflux can, in some cases, lead to pre-cancerous changes.
Red-flag symptoms such as progressive swallowing difficulty, weight loss, vomiting or black stools need urgent investigation.
For most people, burning in the chest after food or drink is simple acid reflux. But specialists now believe a significant minority may have a different underlying condition entirely.
The message from clinicians is clear: persistent symptoms should not simply be repeatedly treated with acid suppression without reassessment.
As Mr Goldsmith puts it: ‘In most people, it really is reflux. But if things aren’t improving, or there are other symptoms, like food sticking, it’s worth proper testing to make sure nothing else is going on.’
Gut bacteria that caused Selena Gomez’s bloating
American actor and singer Selena Gomez has previously spoken about being diagnosed with small intestinal bacterial overgrowth, or SIBO, and the impact it can have on her health.
In November 2024 she responded to social media comments after being criticised for visible changes in her appearance, explaining that bloating was linked to a SIBO flare-up.
Gomez, pictured left, was diagnosed with lupus, a chronic autoimmune condition, in the mid-2010s. She later underwent a life-saving kidney transplant in 2017 due to complications from the disease, with the donor being a close friend.
She has spoken more broadly about how chronic illness has affected her body and attracted public scrutiny, saying she does not see herself as a victim despite the challenges. Gomez used her platform to raise awareness of both lupus and SIBO, encouraging greater understanding of the conditions and their impact on daily life.
The former Disney star is not the only actor to speak out about their experience. Melissa Suffield, who played Lucy Beale in EastEnders, has also spoken candidly about her battle with SIBO, and the significant physical, emotional and financial toll the condition has taken on her life.
She said she endured months of tests before eventually seeking private treatment, and was diagnosed with the condition in 2023. Describing it as a ‘chronic health battle’, she said the illness caused ‘horrible nausea’, hair loss and dramatic weight loss, which saw her drop from a size 16 to a size 6/8.
