Your doctor or specialist will usually take a detailed history and perform a physical examination. This may include an endoscopic examination of the throat, during which a miniature camera set on a slim tube (an instrument called a scope is inserted through the nose and passed to the level of the voice box. This is done in the clinic with some local anaesthesia, and is well tolerated by most patients.

Sometimes it may be necessary to examine the lining of the oesophagus and stomach with a flexible scope. It may be possible to do this in the clinic as well, or you may be referred for a formal upper gastro-intestinal endoscopy.

A minority of cases may need further tests, including investigations of acid (pH) levels in the food pipe over a 24-hour period, or biopsies of the lining of the food pipe.

Changes in diet and lifestyle are extremely important to manage acid reflux. These would include achieving and maintaining a healthy weight, and avoiding the following:

• Large meals and overeating
• Lying down within 2 hours after a meal (if you must, elevate the head of bed)
• Smoking and alcohol
• Caffeine, found in coffee, tea, green tea and colas
• Spicy or acidic food such as chilli, citrus fruits and juice, tomatoes
• Fatty foods that reduce the rate of stomach emptying
• Exercising immediately after meals

Your doctor may prescribe medication, most commonly drugs that reduce acid production in the stomach (e.g. proton pump inhibitors) or drugs that form a lining or "raft" on top of the stomach contents and prevent their reflux into the oesophagus. These medications may need to be taken for several months and gradually weaned off to reduce the risk of recurrence of symptoms.

Surgery is rarely required for reflux disease, and is reserved for severe cases where medication and lifestyle changes have not shown benefit.

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