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Gastroesophageal Reflux Disease

(GERD)

Overview

Gastroesophageal reflux disease happens when stomach acid flows back up into the esophagus and causes heartburn. It's often called GERD for short. This backwash is known as acid reflux, and it can irritate the lining of the esophagus.

Many people experience acid reflux now and then. However, when acid reflux happens repeatedly over time, it can cause GERD.

Most people can manage the discomfort of GERD with lifestyle changes and medicines. And though it's uncommon, some may need surgery to help with symptoms.

How common are acid reflux and GERD?

Occasional, uncomplicated gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) are both common. GERD is estimated to affect about 20% of adults and 10% of children in the U.S.

Symptoms

Common symptoms of GERD include:

A burning sensation in the chest, often called heartburn. Heartburn usually happens after eating and might be worse at night or while lying down.

Backwash of food or sour liquid in the throat.

Upper belly or chest pain.

Trouble swallowing, called dysphagia.

Sensation of a lump in the throat.

If you have nighttime acid reflux, you also might experience:

An ongoing cough.

Inflammation of the vocal cords, known as laryngitis.

New or worsening asthma.

When to see a doctor

Seek medical help right away if you have chest pain, especially if you also have shortness of breath, or jaw or arm pain. These may be symptoms of a heart attack.

Make an appointment with a healthcare professional if you:

difficulty swallowing (dysphagia)

pain when swallowing (odynophagia)

nausea or vomiting

weight loss

anemia

bleeding

Causes

For acid to get into your esophagus, it needs to get past the valve at the bottom of your esophagus that usually keeps things from coming back up. This valve is called your lower esophageal sphincter (LES).

Your LES is a circular muscle that opens when you swallow and then closes again to keep substances in your stomach. It also opens a little to let gas bubbles out when you’re burping or have hiccups.

Acid reflux happens when your LES weakens or relaxes enough to let acid pass. Some temporary things can relax your LES, like lying down after a large meal. But if you have GERD, it means your LES is relaxing often.

Many things can contribute to weakening your LES, either temporarily or permanently. Sometimes occasional acid reflux turns into chronic GERD when these factors overlap or persist for a long time.

Common causes of acid reflux and GERD include:

Hiatal hernia. A hiatal hernia happens when the top of your stomach pushes up through the hole in your diaphragm where your esophagus passes through. It squeezes in next to your esophagus, compressing them both and trapping acid. It also moves your LES above your diaphragm, where it loses some of its muscular support. Hiatal hernias are very common, especially as you get older. They usually occur gradually, and they can gradually worsen.

Pregnancy. Pregnancy is a common cause of temporary acid reflux. The pressure and volume in your abdomen can push, stretch and weaken the muscles in your diaphragm that support your LES. Pregnancy hormones may also encourage your LES to relax. Pregnancy brings high levels of the hormone relaxin, which relaxes your muscles so they can stretch to make room for the fetus. It also brings high levels of estrogen and progesterone, which may also relax your LES.

Obesity. Obesity increases the pressure and volume in your abdomen, which affects your LES similarly to how pregnancy does. Obesity also tends to last longer than pregnancy, which can weaken the muscles more permanently. It’s a common contributing factor to developing a hiatal hernia. Since fat tissue secretes estrogen, having more of it also raises your estrogen levels.

Smoking. Tobacco smoke relaxes your LES, whether you’re the one smoking or you’re exposed to second-hand smoke. Smoking also triggers coughing, which opens your LES. Smoking and chronic coughing can weaken your diaphragm muscles and contribute to developing a hiatal hernia. Smoking also slows down your digestion and causes your stomach to produce more acid.

Other possible causes of GERD include:

Birth defects. Congenital defects like esophageal atresia and hernias can affect your LES.

Connective tissue diseases. Diseases like scleroderma may affect your esophagus muscles.

Prior surgery. Surgery in your chest or upper abdomen may have injured your esophagus.

Medications. Certain medications can have a relaxing effect on your LES, including:

Benzodiazepines, a type of sedative.

Calcium channel blockers, which treat high blood pressure.

Tricyclic antidepressants, which treat depression and pain.

NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin and ibuprofen.

Theophylline, a common asthma medication.

Hormone therapy (HT) medications for menopause.

Can foods cause acid reflux?

Foods and drinks probably aren’t enough to cause acid reflux alone, but they can contribute to it. Chocolate, coffee, alcohol, mint, garlic and onions may have a relaxing effect on your LES in higher doses.

Fatty foods increase stomach acid and take longer to digest, so there’s more opportunity for acid to escape. If you have a heavier meal for dinner, it might not have time to digest before you lie down.

Risk factors

Conditions that can increase the risk of GERD include:

Obesity.

Bulging of the top of the stomach up above the diaphragm, known as a hiatal hernia.

Pregnancy.

Connective tissue disorders, such as scleroderma.

Delayed stomach emptying.

Factors that can aggravate acid reflux include:

Smoking.

Eating large meals or eating late at night.

Eating certain foods, such as fatty or fried foods.

Drinking certain beverages, such as alcohol or coffee.

Taking certain medicines, such as aspirin.

Complications

Stomach acid is powerful stuff, built to break down the food you eat for digestion. Your stomach has a tough inner lining to protect it from its own acid. But your other organs don’t have this protection.

Acid reflux mostly affects your esophagus, though sometimes it can get into your windpipe or even your airways. A little acid may just feel momentarily uncomfortable. But a lot of acid will injure these organs.

Possible complications include:

Esophagitis. Esophagitis is inflammation in the lining of your esophagus. Chronic esophagitis can cause chronic pain and complications, like ulcers in your esophagus. After a long time, it can cause tissue changes like scarring or intestinal metaplasia, a precancerous condition.

Barrett’s esophagus. Barret’s esophagus is the name for intestinal metaplasia of your esophagus. It means that the tissues lining your esophagus change to look like intestinal lining. This change happens after long exposure to acid and inflammation. It’s a risk factor for esophageal cancer.

Esophageal stricture. Your esophagus may also develop scar tissue to protect it from chronic inflammation and injury. Scar tissue can cause your esophagus to narrow. This is called stricture. Esophageal strictures can make it hard to swallow, which can make it hard to eat and drink.

Laryngopharyngeal reflux. Some people with GERD also develop LPR, which is reflux that travels into your throat. Acid might sneak up into your throat while you sleep. It can cause swelling, hoarseness and vocal cord growths, and you can also aspirate acid particles into your airways.

Asthma. Acid in your airways may aggravate existing asthma or cause asthma-like symptoms in people without any preexisting respiratory conditions. Tiny acid particles may irritate your bronchial tubes and cause them to contract, causing coughing and breathing difficulties.

Diagnosis

A healthcare professional might be able to diagnose GERD based on a history of symptoms and a physical examination.

To confirm a diagnosis of GERD, or to check for complications, a care professional might recommend:

Upper endoscopy. An upper endoscopy uses a tiny camera on the end of a flexible tube to visually examine the upper digestive system. The camera helps provide a view of the inside of the esophagus and stomach. Test results may not show when reflux is present, but an endoscopy may find inflammation of the esophagus or other complications. An endoscopy also can be used to collect a sample of tissue, called a biopsy, to be tested for complications such as Barrett esophagus. In some instances, if a narrowing is seen in the esophagus, it can be stretched or dilated during this procedure. This is done to improve trouble swallowing.

Ambulatory acid (pH) probe test. A monitor is placed in the esophagus to identify when, and for how long, stomach acid regurgitates there. The monitor connects to a small computer that's worn around the waist or with a strap over the shoulder. The monitor might be a thin, flexible tube, called a catheter, that's threaded through the nose into the esophagus. Or it might be a clip that's placed in the esophagus during an endoscopy. The clip passes into the stool after about two days.

X-ray of the upper digestive system. X-rays are taken after drinking a chalky liquid that coats and fills the inside lining of the digestive tract. The coating allows a healthcare professional to see a silhouette of the esophagus and stomach. This is particularly useful for people who are having trouble swallowing. Sometimes, an X-ray is done after swallowing a barium pill. This can help diagnose a narrowing of the esophagus that's interfering with swallowing.

Esophageal manometry. This test measures the rhythmic muscle contractions in the esophagus while swallowing. Esophageal manometry also measures the coordination and force exerted by the muscles of the esophagus. This is typically done in people who have trouble swallowing.

Transnasal esophagoscopy. This test is done to look for any damage in the esophagus. A thin, flexible tube with a video camera is put through the nose and moved down the throat into the esophagus. The camera sends pictures to a video screen.

Treatment

A healthcare professional is likely to recommend trying lifestyle changes and nonprescription medicines as a first line of treatment. If you don't experience relief within a few weeks, prescription medicine and additional testing may be recommended.

Nonprescription medicines

Options include:

Antacids that neutralize stomach acid. Antacids containing calcium carbonate, such as Mylanta, Rolaids and Tums, may provide quick relief. But antacids alone won't heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or sometimes kidney complications.

Medicines to reduce acid production. These medicines — known as histamine (H-2) blockers — include cimetidine (Tagamet HB), famotidine (Pepcid AC) and nizatidine (Axid). H-2 blockers don't act as quickly as antacids, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Stronger versions are available by prescription.

Medicines that block acid production and heal the esophagus. These medicines — known as proton pump inhibitors — are stronger acid blockers than H-2 blockers and allow time for damaged esophageal tissue to heal. Nonprescription proton pump inhibitors include lansoprazole (Prevacid), omeprazole (Prilosec OTC) and esomeprazole (Nexium).

If you start taking a nonprescription medicine for GERD, be sure to inform your care provider.

Prescription medicines

Prescription-strength treatments for GERD include:

Prescription-strength proton pump inhibitors. These include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant). Although generally well tolerated, these medicines might cause diarrhea, headaches, nausea or, in rare instances, low vitamin B-12 or magnesium levels.

Prescription-strength H-2 blockers. These include prescription-strength famotidine and nizatidine. Side effects from these medicines are generally mild and well tolerated.

Potassium-competitive acid blockers (P-CABs). This new class of medicines may be recommended for someone with severe acid reflux if other medicines haven't worked. They include vonoprazan (Voquezna) and tegoprazan (K-Cab).

Deep-breathing training

A technique known as diaphragmatic breathing may help improve GERD symptoms for some people. This exercise is done after eating. It involves breathing deeply into the diaphragm rather than shallowly into the chest. Diaphragmatic breathing techniques should ideally be taught by a trained medical professional.

Surgery and other procedures

GERD can usually be controlled with medicine. But if medicines don't help or you wish to avoid long-term medicine use, a healthcare professional might recommend:

Fundoplication. The surgeon wraps the top of the stomach around the lower esophageal sphincter, to tighten the muscle and prevent reflux. Fundoplication is usually done with a minimally invasive, called laparoscopic, procedure. The wrapping of the top part of the stomach can be partial or complete, known as Nissen fundoplication. The most common partial procedure is the Toupet fundoplication. Your surgeon typically recommends the type that is best for you.

LINX device. A ring of tiny magnetic beads is wrapped around the junction of the stomach and esophagus. The magnetic attraction between the beads is strong enough to keep the junction closed to refluxing acid, but weak enough to allow food to pass through. The LINX device can be implanted using minimally invasive surgery. The magnetic beads do not affect airport security or magnetic resonance imaging.

Transoral incisionless fundoplication (TIF). This new procedure involves tightening the lower esophageal sphincter by creating a partial wrap around the lower esophagus using polypropylene fasteners. TIF is performed through the mouth by using an endoscope and requires no surgical incision. Its advantages include quick recovery time and high tolerance. If you have a large hiatal hernia, TIF alone is not an option. However, TIF may be possible if it is combined with laparoscopic hiatal hernia repair.

Because obesity can be a risk factor for GERD, a healthcare professional could suggest weight-loss surgery as an option for treatment. Talk with your healthcare team to find out if you're a candidate for this type of surgery.

Lifestyle and home remedies

Lifestyle changes may help reduce the frequency of acid reflux.

Try to:

Maintain a healthy weight. Excess pounds put pressure on the abdomen, pushing up the stomach and causing acid to reflux into the esophagus.

Stop smoking. Smoking decreases the lower esophageal sphincter's ability to function properly.

Elevate the head of your bed. If you regularly experience heartburn while trying to sleep, place wood or cement blocks under the feet at the head end of your bed. Raise the head end by 6 to 9 inches. If you can't elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Raising your head with additional pillows isn't effective.

Start on your left side. When you go to bed, start by lying on your left side to help make it less likely to have reflux.

Don't lie down after a meal. Wait at least three hours after eating before lying down or going to bed.

Eat food slowly and chew thoroughly. Put down your fork after every bite and pick it up again once you have chewed and swallowed that bite.

Don't consume foods and drinks that trigger reflux. Common triggers include alcohol, chocolate, caffeine, fatty foods or peppermint.

Don't wear tight-fitting clothing. Clothes that fit tightly around the waist put pressure on the abdomen and the lower esophageal sphincter.

What to do during an acid reflux attack?

If it’s happening right now, try:

Standing up. Gravity is on your side.

Taking a sip of water. Don’t drink a lot, but small sips may help wash the acid down.

Loosening your waistband. Take off your belt or change your pants if it helps.

Taking an antacid. If you don’t have one, Pepto Bismol® might work.

FAQ's

How do you know if you have GERD?

Only a healthcare professional may provide an accurate GERD diagnosis. If you’re experiencing acid reflux symptoms or indigestion more than twice per week, you may have GERD. A healthcare professional may want to assess your symptoms, perform a physical exam, and consider your medical history to rule out other possible causes.

What are the 8 symptoms of GERD?

Not everyone experiences the same symptoms of GERD or with the same intensity. Also, there’s not a specific number of symptoms of the condition. The most common GERD symptom is persistent acid reflux, which may involve a burning feeling in your upper stomach, chest, or throat, a sour or bitter taste in your mouth, and regurgitation of food or liquid back into your mouth. Chronic cough, a hoarse voice, nausea, pain swallowing, and weight loss may also be symptoms of GERD.

What can be mistaken as GERD?

Other conditions may cause symptoms similar to those of GERD. For example, peptic ulcers, esophagitis (inflammation of the food pipe), gallstones, anxiety, hiatal hernias, and esophageal cancer. A healthcare professional can help you explore possible causes of acid reflux and related symptoms.

What are the four stages of GERD?

GERD may start as mild and infrequent symptoms (stage 1) and progress to moderate symptoms that present at least twice per week (stage 2). Unmanaged GERD could advance to habitual and severe acid reflux symptoms with a persistent cough and changes to your voice (stage 3). Although rare, some people may enter a fourth stage with severe symptoms that turn into precancerous lesions in the esophagus (food pipe) and throat.

What is the fastest way to cure GERD?

Following the advice of a healthcare professional may help you heal GERD permanently or manage symptoms. Strategies may include dietary changes, medications, and lifestyle modifications. For example, avoiding trigger foods and liquids, managing your weight, not using tobacco, limiting alcohol intake, and waiting 2–3 hours after eating to lie down. If these don’t help, you may need surgery.

Preparing for your appointment

You may be referred to a doctor who specializes in the digestive system, called a gastroenterologist.

What you can do

Be aware of any pre-appointment restrictions, such as restricting your diet before your appointment.

Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.

Write down any triggers to your symptoms, such as specific foods.

Make a list of all your medicines, vitamins and supplements.

Write down your key medical information, including other conditions.

Write down key personal information, along with any recent changes or stressors in your life.

Write down questions to ask your doctor.

Ask a relative or friend to go with you, to help you remember what was talked about.

Questions to ask your doctor

What's the most likely cause of my symptoms?

What tests do I need? Is there any special preparation for them?

Is my condition likely temporary or chronic?

What treatments are available?

Are there any restrictions I need to follow?

I have other health concerns. How can I best manage these conditions together?

In addition to the questions that you've prepared, don't hesitate to ask questions during your appointment anytime you don't understand something.

What to expect from your doctor

You're likely to be asked a few questions. Being ready to answer them may leave time to go over points you want to spend more time on. You may be asked:

When did you begin experiencing symptoms? How severe are they?

Have your symptoms been continuous or occasional?

What, if anything, seems to improve or worsen your symptoms?

Do your symptoms wake you up at night?

Are your symptoms worse after meals or lying down?

Does food or sour material ever come up in the back of your throat?

Do you have trouble swallowing food, or have you had to change your diet to avoid difficulty swallowing?

Have you gained or lost weight?

One Final Note..

Almost everyone gets acid reflux from time to time. Heartburn, indigestion and acid regurgitation can make for an unpleasant evening. You can take certain steps to reduce the frequency of these events.

If you have acid reflux often and it significantly affects your life, you might have GERD. It’s worth talking to a healthcare provider about your symptoms. They can assess whether treatment might help.

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Most recent revision May 08, 2025 04:16:09 PM