If you feel burning, tightness or irritation after meals, it’s easy to assume it’s caused by acid. But modern research shows there are actually three different conditions, all of which feel almost identical.
Understanding the difference is the key to choosing the right treatment — and avoiding years of frustration.
1. “Classic” acid reflux (true GORD)
This is the scenario most people imagine: acid escapes from the stomach and repeatedly irritates the oesophagus.
How to recognise it
- Symptoms correlate strongly with meals
- Lying down can worsen it
- Endoscopy may show oesophagitis
- PH testing shows high acid exposure
- PPIs usually help significantly
This one accounts for less than 30% of people with ongoing heartburn.
2. Functional heartburn
This describes heartburn-like symptoms where no reflux is actually occurring — acid or otherwise.
How to recognise it
- Symptoms do not consistently match meals
- Normal acid exposure on testing
- Normal oesophageal function
- PPIs don’t help
It’s essentially a misfire of the gut–brain axis, where nerves send pain signals without a physical trigger.
3. Reflux hypersensitivity
This is the most common — and the most misunderstood — category.
Here, small amounts of normal reflux occur (acidic or non-acidic), but the oesophagus reacts in an exaggerated way.
How to recognise it
- Reflux occurs, but in normal amounts
- Symptoms are out of proportion
- PH testing shows normal acid levels but symptoms correlate with minor events
- PPIs only partially help
- Stress and sleep have a huge effect
You feel every tiny splash, stretch or bubble as if something is wrong — even when it isn’t.
Why these distinctions matter
Because each condition responds to different treatments:
- True acid reflux: acid-lowering + lifestyle + weight management
- Functional heartburn: gut–brain therapies, mindfulness, TCA/SSRI if needed
- Reflux hypersensitivity: calming the nervous system, regulated eating, gradual exposure to foods, breathing tools, sometimes low-dose neural-modulating medication
This is why many people struggle on PPIs — their symptoms were never caused by acid alone.
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