Gastroesophageal Reflux Disease (GERD)

Medically Reviewed by Poonam Sachdev on June 24, 2024
Written by Kendall K. Morgan
11 min read

Gastroesophageal reflux disease, or GERD, happens when acid from your stomach backs up into your esophagus, the tube connecting your stomach to your mouth.

This digestive disorder affects the ring of muscle between your esophagus and your stomach. This ring is called the lower esophageal sphincter (LES). If you have GERD, you may get heartburn or acid indigestion. Doctors think that some people may have it because of a condition called hiatal hernia. In most cases, you can ease your GERD symptoms through diet and lifestyle changes. But some people may need medication or surgery.

The term “gastroesophageal” refers to the stomach and esophagus. Reflux means to flow back or return. Gastroesophageal reflux is when what’s in your stomach backs up into your esophagus.

In normal digestion, your LES opens to allow food into your stomach. Then, it closes to stop food and acidic stomach juices from flowing back into your esophagus. Gastroesophageal reflux happens when the LES is weak or relaxes when it shouldn’t. This lets the stomach's contents flow up into the esophagus.

More than 60 million American adults have heartburn at least once a month, and more than 15 million adults have heartburn every day, including many pregnant women.

Several other things can make it more likely that you’ll have GERD:

Hiatal hernia and GERD

Some doctors believe a hiatal hernia may weaken the LES and raise your chances of gastroesophageal reflux. A hiatal hernia happens when the upper part of your stomach moves up into the chest through a small opening in your diaphragm (diaphragmatic hiatus). The diaphragm is the muscle separating the abdomen from the chest. Recent studies show that the opening in the diaphragm helps support the lower end of the esophagus.

In many people, a hiatal hernia will not cause problems with heartburn or reflux. But it may allow stomach contents to reflux more easily into the esophagus.

Coughing, vomiting, straining, or sudden physical exertion can raise pressure in your belly and lead to a hiatal hernia. Many otherwise healthy people aged 50 or older have a small one. Although it’s usually a condition of middle age, hiatal hernias affect people of all ages.

Hiatal hernias usually don’t need treatment. But it may be necessary if the hernia is in danger of becoming strangulated, or twisted in a way that cuts off blood supply. You may also need to treat it if you have one along with severe GERD or esophagitis (inflammation of the esophagus). Your doctor may perform surgery to make the hernia smaller or to prevent strangulation.

GERD and pregnancy

GERD is especially common when you're pregnant. Most people will have it by the time they reach their third trimester. The reason is that pregnancy hormones can affect muscles in your stomach and esophagus, making acid reflux more likely. Pressure on your stomach from your growing baby also can make it worse.

GERD and weight

GERD is more common when you're overweight or obese. Your risk for it will go up as you put on extra pounds. Part of it may be related to your diet and other habits. But carrying around extra weight also puts pressure on your stomach, which can make acid reflux more likely.

GERD, diet, and other habits

Diet and lifestyle choices may make acid reflux worse if you already have it:

GERD and medications

Certain medications can cause heartburn or make it worse. Some things that could give you GERD include:

  • Antibiotics
  • Supplements, including iron and potassium
  • Pain relievers, such as aspirin or ibuprofen
  • Quinidine, used for irregular heartbeats
  • Bisphosphonates, used to slow bone loss

GERD in children

Recent studies show that GERD in infants and children is more common than doctors thought. It can cause vomiting that happens over and over again. It can also cause coughing and other breathing problems. Older kids and teens also can have GERD. But it's more common for young people to have an occasional bout of reflux without it being a more serious or ongoing problem.

Other risk factors for GERD in babies or children include:

  • Down syndrome
  • Muscular dystrophy
  • Cerebral palsy
  • Other neuromuscular disorders

Gastroesophageal reflux disease can cause a range of symptoms in addition to heartburn. Some signs to watch for include:

GERD heartburn

The most common symptom of GERD is heartburn (acid indigestion). It usually feels like a burning chest pain that starts behind your breastbone and moves upward to your neck and throat. Many people say it feels like food is coming back into the mouth, leaving an acid or bitter taste.

The burning, pressure, or pain of heartburn can last as long as 2 hours. It’s often worse after eating. Lying down or bending over can also result in heartburn. Many people feel better if they stand upright or take an antacid that clears acid out of the esophagus.

People sometimes mistake heartburn pain for the pain of heart disease or a heart attack, but there are differences. Exercise may make heart disease pain worse, while rest may relieve it. Heartburn pain is less likely to go along with physical activity. But you can’t tell the difference, so seek medical help right away if you have any chest pain.

GERD cough

Extra stomach acid in your esophagus and throat can make you cough. You may also have:

  • Wheezing
  • Hoarseness
  • Chest congestion

GERD chest pain

Acid reflux can make it feel like there's pressure, a squeezing sensation, or pain in your chest. Sometimes, you may think it's a heart attack.

Other GERD symptoms

Besides pain, you may also have:

Nighttime GERD symptoms

If you have acid reflux at night, you may also have:

  • A lingering cough
  • Laryngitis
  • Asthma that comes on suddenly or gets worse
  • Sleep problems

Severe GERD symptoms

If you're having more severe symptoms you think are GERD, you should see a doctor right away. It's possible that your symptoms aren't caused by GERD. You also could have more serious inflammation from your acid reflux, which may cause:

  • Inflammation
  • Bleeding
  • Open sores or ulcers
  • Trouble swallowing

GERD treatment aims to cut down on the amount of reflux or lessen damage to the lining of the esophagus from refluxed materials. Your doctor may recommend over-the-counter or prescription medications to treat your symptoms.

Antacids for GERD

These drugs can help neutralize acid in the esophagus and stomach, which helps stop heartburn. Many people find that nonprescription antacids provide temporary or partial relief. An antacid combined with a foaming agent helps some people. Researchers think these compounds form a foam barrier on top of the stomach that stops acid reflux. But long-term use of antacids can bring side effects, including diarrhea, altered calcium metabolism (a change in the way the body breaks down and uses calcium), and a buildup of magnesium in the body. Too much magnesium can be serious for people who have kidney disease. If you need antacids for more than 2 weeks, talk to your doctor.

H2 blockers for GERD

For chronic reflux and heartburn, the doctor may recommend medications to reduce acid in the stomach. These medicines include H2 blockers, which help block acid secretion in the stomach. H2 blockers include cimetidine (Tagamet), famotidine (Pepcid), and nizatidine.

Proton pump inhibitors (PPIs) for GERD

Also known as acid pumps, these drugs block a protein needed to make stomach acid. PPIs include dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), omeprazole/sodium bicarbonate (Zegerid), pantoprazole (Protonix), and rabeprazole (Aciphex).

Prokinetics for GERD 

In rare cases, these drugs help your stomach empty faster so you don’t have as much acid left behind. They may also help ease symptoms such as bloating, nausea, and vomiting. But they can also have serious side effects. Many people can’t take them, and those who can should do so only for a limited time. Examples of prokinetics include domperidone and metoclopramide (Clopra, Maxolon, Metozolv, Reglan).

Alternative treatments for GERD

In one study, treatment with acupuncture stopped reflux in the test group better than PPIs, with results that lasted longer. More large studies are needed to confirm this, but early results are promising.

You can make changes in your lifestyle and habits to help with your GERD and its symptoms. Some ideas include:

Avoid food and beverage triggers. Stay away from foods that can relax the LES, including chocolate, peppermint, fatty foods, caffeine, and alcoholic beverages. You should also avoid foods and beverages that can irritate a damaged esophageal lining if they cause symptoms, such as citrus fruits and juices, tomato products, and pepper.

Eat smaller servings. Eating smaller portions at mealtime may also help control symptoms. Also, eating meals at least 2 to 3 hours before bedtime allows the acid in your stomach to go down and your stomach to partially empty.

Eat slowly. Take your time at every meal.

Chew your food thoroughly. It may help you remember to do this if you set your fork down after you take a bite. Pick it up again only when you’ve completely chewed and swallowed that bite.

Stop smoking. Cigarette smoking weakens the LES. Stopping smoking is important to reduce GERD symptoms.

Elevate your head. Raising the head of your bed on 6-inch blocks or sleeping on a specially designed wedge lets gravity lessen the reflux of stomach contents into your esophagus. Don’t use pillows to prop yourself up. That only puts more pressure on the stomach.

Stay at a healthy weight . Being overweight often worsens symptoms. Many overweight people find relief when they lose weight.

Wear loose clothes. Clothes that squeeze your waist put pressure on your belly and the lower part of your esophagus.

 

If you have severe, lasting esophageal reflux, or if your symptoms don’t get better with treatment, you may need tests for a better diagnosis. Your doctor may use one or more procedures to do this:

Endoscopy.Your doctor will put a small lighted tube with a tiny video camera on the end (endoscope) into your esophagus to look for inflammation or irritation of the tissue (esophagitis). If the results are abnormal or questionable, they may remove a small tissue sample for more testing (biopsy).

Upper gastrointestinal (GI) series. This may be one of the first tests your doctor does. It’s a special X-ray that shows your esophagus, stomach, and the upper part of your small intestine (duodenum). It gives limited information about possible reflux, but it can help rule out other conditions, such as peptic ulcers.

Esophageal manometry and impedance study. This test checks for low pressure in your esophagus. It can also show defects in how your esophageal muscles contract.

pH testing. If it’s hard to make a definite diagnosis, your doctor may measure the acid levels inside your esophagus through this test. It tracks how much acid is in your esophagus during meals, activity, and sleep. Newer techniques of long-term pH tracking have made this a more effective tool.

If you need regular high doses of PPIs to control your symptoms, have damage to your esophagus even with medication, or a hiatal hernia, you may need surgery for GERD. But you should try all the other treatments you can first.

Fundoplication. This is a procedure that raises the pressure in your lower esophagus. The doctor will wind the top of your stomach around the LES. This tightens the muscle and raises pressure in your lower esophagus to stop reflux. They’ll do this either through a laparoscope (small holes through the belly) or through open surgery.

Transoral incisionless fundoplication (TIF). A newer form of this surgery uses an endoscope (a small tube with a camera) to wrap the stomach around the LES with plastic fasteners. It’s less invasive than standard fundoplication.

Stretta procedure. Your doctor puts a small tube down the esophagus that uses low-radiofrequency heat to reshape your LES.

LINX surgery. Your doctor wraps a band of magnetic titanium beads around the place where your stomach and esophagus meet. The magnetic attraction of the beads keeps it loose enough to let food pass through into the stomach but tight enough to stop reflux.

Sometimes, GERD can lead to serious complications:

Esophageal ulcer. Stomach acid eats away at your esophagus until an open sore forms. These sores are often painful and may bleed, making it hard for you to swallow food.

Esophageal stricture. Stomach acid damages the lower part of your esophagus and causes scar tissue to form. This scar tissue builds up until it narrows the inside of the esophagus, making it hard to swallow food.

Barrett’s esophagus. Acid reflux changes the cells in the tissue that lines your esophagus. The lining gets thicker and turns red. This condition is linked to a higher chance of esophageal cancer.

Lung problems.If reflux reaches the back of your throat, it can cause irritation and pain. From there, it can get into the lungs (aspiration). If this happens, your voice may get hoarse. You could also have chest congestion and a lingering cough. If your lungs get inflamed, you can develop asthma, bronchitis, and even pneumonia.

Although GERD can limit your daily activities, it’s rarely life-threatening. If you understand the causes and get proper treatment, you should feel better.

Having heartburn now and again doesn't mean you have GERD. But if you're having it often or it's causing you great discomfort, you may have a condition that's making acid from your stomach back up into your esophagus. If you think you have GERD, see a doctor for treatment. But there's also a lot you can do to help with your symptoms, including eating more slowly and losing weight.

Is GERD a lifetime disease?

Not necessarily. It may depend on the reason for your GERD. For example, if GERD is related to pregnancy, it may go away after childbirth. But for some people, it can be a condition that starts in childhood and continues.

What is the most common symptom of GERD?

The classic and most common symptom is a burning feeling in your chest, also called heartburn. But GERD can come with many other symptoms, including a sour taste in your mouth, chest pain, and a feeling of being full or the sensation of a lump in your throat.

What foods should you avoid if you have GERD?

Foods that are fatty, salty, spicy, and/or fried can make your heartburn worse. You may also want to avoid acidic foods, chocolate, peppermint, and soda or other carbonated drinks.