What Is GERD? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Gastroesophageal reflux disease (GERD) is a chronic condition in which the stomach's contents sometimes flow backward, up into the esophagus (the tube that carries food from your throat into your stomach).

Your doctor may also use these names for GERD:

• Acid indigestion
• Acid reflux
• Acid regurgitation
• Heartburn
• Reflux

GERD can interfere with daily living, but most people can get relief from it through lifestyle changes, home remedies, and medical treatment. (1)

“GERD has increasingly become a personalized disease,” says Abraham Khan, MD, gastroenterologist and medical director of the Center for Esophageal Health at NYU Langone Health in New York City. Not everyone with GERD has the same underlying causes, symptoms, or amount of injury to the esophagus or aerodigestive tract, he says.

Still, there are some typical telltale signs of GERD.

The most common symptom of GERD is frequent heartburn, felt by a painful, burning sensation in the middle of your chest. “Usually, if the heartburn is mild and less than two times a week, it is considered mild GERD,” says Saleem Chowdhry, MD, a gastroenterologist at the Cleveland Clinic. “Symptoms more than two times a week and where there is concern for inflammation in the esophagus is considered moderate or severe GERD."

Other common symptoms of GERD:

• Chest pain
• Regurgitating your stomach’s contents
• Difficulty swallowing
• Bad breath
• Nausea and vomiting
• Sore throat or an irritated feeling in your esophagus (2)

Stomach acid helps digest food. When that acid flows up into the esophagus, it causes irritation that leads to the symptoms of GERD. (2)

A ring of muscle called the lower esophageal sphincter (LES) normally keeps the top of your stomach closed. It relaxes and opens when you're swallowing to allow food through.

GERD happens when the LES relaxes and opens up when you aren't swallowing. This allows your stomach contents to flow back up the esophagus. (3)

“The lower esophageal sphincter’s role is to keep the acid restricted to the stomach,” Dr. Chowdhry says. “However, there are various conditions that can cause it to relax.” These include the following:

• Belching or eating a large meal
• Eating certain foods, including those high in fats, chocolate, and peppermint
• Increased pressure on the abdomen from being overweight, obese, or pregnant
• Side effects from certain medications, including antihistamines, calcium channel blockers, painkillers, sedatives, antidepressants, and asthma medication
• Smoking or inhaling secondhand smoke
• Having a hiatal hernia, in which the opening of the diaphragm allows the upper part of the stomach to move up into the chest. This lowers the pressure in the esophageal sphincter.

Being pregnant is a major risk factor for GERD due to increased pressure on the abdomen and hormonal changes.

Some pregnant women experience heartburn as often as every day, according to the Cleveland Clinic. (4)

Other causes and risk factors:

• Consuming alcoholic, caffeinated, or carbonated beverages
• Eating certain foods, such as chocolate, citrus fruits, onions, peppermint, tomatoes, or spicy or fried foods
• Eating large meals
• Eating soon before going to bed
• Lying flat soon after eating
• Taking certain medicines, including aspirin and certain drugs for asthma, high blood pressure, allergies, depression, sleep disorders, and pain (1,2,4)

A diagnosis of GERD is based primarily on the symptoms you have and how often you have them, though there is not a hard and fast rule about how frequently they have to occur.

"Some epidemiologic studies would suggest clinically significant symptoms would be at least twice a week, but some studies include patients with GERD as having symptoms only as often as once a month,” Dr. Khan says.

Your doctor will work with you to determine if you have GERD. Diagnostic tests for GERD include the following:

• Upper Endoscopy This is a test in which your doctor inserts a thin tube with an attached light and camera down your throat. This allows for an examination of your esophagus and stomach to detect inflammation or any other complications.
• Esophageal pH and Impedance Monitoring This test measures the amount of acid in your esophagus while you carry out your normal daily activities like eating and sleeping. Your doctor will perform the procedure, which involves inserting a thin tube through your nose or mouth into your stomach, at a hospital or outpatient center. The tube is pulled back into your esophagus and taped to the outside of your cheek. The monitor is worn for 24 hours and your doctor will ask you to keep a diary of when, what, and how much you eat to see if there are any patterns connected to your symptoms.
• Bravo Wireless Esophageal pH Monitoring This test also measures the pH in your esophagus during your everyday life to determine if you have GERD. The monitor is a small capsule that's placed in your esophagus during an endoscopy and transmits information to a receiver worn on your belt or waistband. The test usually lasts 48 hours, and the capsule will pass through your digestive tract in a few days.
• Esophageal Manometry This procedure measures the muscle contractions in your esophagus when you swallow. It can show your doctor if your symptoms are due to a weak sphincter muscle.
• Upper Digestive System X-Ray Taken after you drink a chalky liquid, this procedure will allow your doctor to see a silhouette of your esophagus, stomach, and upper intestine. You may also be asked to swallow a barium pill to check for a narrowing of the esophagus or other conditions like hiatal hernias or ulcers. (5,6)

The burning sensation in your chest that comes with GERD can last anywhere from a few minutes to a few hours. (7)

While occasional episodes of heartburn are normal, the heartburn that comes with GERD is regular or severe. Generally, GERD-related heartburn may occur two or more times a week, or it may happen once or twice a month but recur for several years, Khan explains. But again, severity and frequency will vary by individual. (8)

How long a person lives with GERD is also very dependent on the individual. “Some patients with dietary adjustments can reverse the triggers leading to GERD,” Khan says. “Others, if overweight, will need to lose weight to alter the pressure dynamics of the upper GI tract and reverse the reason to reflux. But others, even with appropriate diet and lifestyle habits for GERD, cannot significantly reverse the reflux they have.”

Your doctor may recommend a number of different treatments for GERD.

The first recommendation is often lifestyle changes, which may include eliminating or avoiding certain foods, eating smaller meals, or staying upright for a couple of hours after eating.

Medication Options

A number of over-the-counter (OTC) drugs are available to treat GERD and its symptoms:

• Antacids These neutralize stomach acid and offer quick but mild relief. Overuse of antacids can cause side effects, including diarrhea and kidney problems.
• H-2-Receptor Blockers While they also reduce acid production, they don't work as quickly as antacids, but they do provide longer relief. These drugs may reduce acid production from the stomach for up to 12 hours.
• Proton Pump Inhibitors Called PPIs, they effectively suppress stomach acid and help heal your esophagus.

If you don’t see much improvement on an OTC drug, your doctor may prescribe a prescription-strength version of an H-2-receptor blocker or PPI. There’s also a medication called baclofen, which strengthens the lower esophageal sphincter. (6)

Surgery Options

If lifestyle changes and drugs aren’t enough to manage your GERD, you may be a candidate for surgery. Surgical procedures to treat GERD include these options:

• Fundoplication In this minimally invasive procedure, a surgeon sews the top of the stomach around the esophagus. This adds pressure to the lower end of the esophagus to prevent reflux.
• LINX Device Another minimally invasive procedure, this one involves a ring of tiny magnetic beads that are wrapped around the area where the stomach and esophagus meet. The magnetic attraction among the beads is strong enough to prevent reflux but weak enough to allow food to pass.
• Transoral Incisionless Fundoplication (TIF) In this newer procedure, polypropylene fasteners tighten the lower esophagus. TIF is performed using an endoscope inserted through the mouth and doesn’t require a surgical incision. (6)

Learn More About Treatments for GERD

Prevention of GERD

Certain lifestyle changes may help reduce the frequency of episodes of GERD:

• Avoiding foods and beverages that trigger GERD, including alcohol, caffeine, fatty foods, spicy foods, peppermint, citrus fruits, tomatoes, and carbonated beverages
• Eating small meals throughout the day, rather than large amounts of food a few times a day
• Sitting upright while eating
• Eating at least three hours before bedtime
• Maintaining a healthy weight
• Eating foods slowly
• Quitting smoking
• Not wearing tight-fitting clothing
• Not lying down after a meal
• Elevating the head of your bed

It may also be helpful to keep a journal of foods that trigger episodes of GERD and detail your symptoms to discuss with a healthcare provider. They will discuss a personalized approach with you to prevent future episodes. (6,9,10)

GERD isn’t usually life-threatening, but it can result in complications:

Esophageal Stricture This is a narrowing of the esophagus that happens when damage from stomach acid causes a buildup of scar tissue.

Also known as a peptic stricture, this condition can cause problems with swallowing — even though it can also reduce the frequency and severity of heartburn. (2,3)

Esophageal Ulcer This is an open sore in the esophagus, caused by tissue damage from stomach acid. It can lead to pain, bleeding, and problems with swallowing. (2)

Barrett’s Esophagus This is a precancerous condition in which the lining of the esophagus changes to one that more closely resembles the lining of the intestines.

While Barrett’s esophagus can reduce symptoms of heartburn, it increases your risk of esophageal cancer by a factor of about 30. (2,3)

Esophageal Cancer This lethal cancer, which current treatments can’t do much to slow, can result from years of untreated GERD. (3)

About 20 percent of the U.S. population experiences GERD, according to the National Institute of Diabetes and Digestive and Kidney Diseases. (1)

Many more people experience acid reflux on a regular basis but not frequently enough for it to qualify as GERD.

There’s evidence to suggest that people the United States and Europe are at a higher risk for GERD than people in other parts of the world.

According to a study published in the journal Gut, between 10 and 20 percent of participants in North America and Europe experienced heartburn or acid regurgitation at least weekly, compared with less than 5 percent of people in Asia. A number of factors may explain this, the researchers say, including higher prevalence of obesity and co-occurring conditions like respiratory diseases.

Frequent heartburn appears to be more common in North America than in Europe, with differences across countries and regions.

Men and women seem to be about equally likely to experience GERD. (11)

Symptoms of GERD can overlap with some more serious health conditions, including major heart events. GERD may also trigger respiratory problems like asthma. GERD may be confused with eosinophilic esophagitis (EoE), a chronic disease of the esophagus.

GERD vs. Heart Attacks

The chest pain that comes with both heartburn and a heart attack can sometimes feel similar, and it may be difficult to distinguish between the two.

If you have persistent chest pain and are unsure if it is heartburn, seek emergency medical help right away. If you experienced a period of unexplained chest pain that dissipated within a few hours and you did not seek care, call your doctor to discuss your symptoms. Both heartburn and a developing heart attack can cause chest pain that goes away after a while. Your doctor will help you decide if you should come in for further evaluation. (12)

GERD and Asthma

Not only can GERD trigger asthma-like symptoms but the reverse is also true. Researchers aren’t exactly sure why, but they theorize that the aspiration of stomach acid into the airways caused by GERD can lead to breathing difficulties. And if you already have asthma, the pressure changes that occur inside the chest and abdomen during an asthma attack can aggravate acid reflux.

Getting control over one of these conditions can help alleviate the other. Proper identification and diagnosis of these conditions is essential for treatment. (13)

Favorite Organizations for Essential GERD Information

About GERD

The official website for the International Foundation for Gastrointestinal Disorders, About GERD is a nonprofit patient support organization that offers a wealth of resources for people living with functional gastrointestinal (GI) and motility disorders. The website has information on symptoms of GERD and other GI conditions and treatment options. Plus, there are monthly Twitter chats. Find out information about each month’s chat on the foundation’s blog.

American Gastroenterological Association

This organization provides information for doctors, researchers, patient educators, and patients on GI disorders, including GERD. The site also includes a patient center, with information prepared by specialists and reviewed by a patient adviser to ensure it’s understandable by a general audience. Don’t miss the animated video on YouTube on preventing GERD during the holidays. (It’s actually useful for anytime you might not be in control of your menu.)

American College of Gastroenterology

The American College of Gastroenterology is a professional association of gastroenterologists and GI professionals. The site is a main resource for doctors and professionals, but it also has a patient section with facts and information for various GI conditions, including a search option for finding a gastroenterologist in your area.

Favorite Online Resources on GERD

Mayo Clinic

This great resource lets you know what tests to expect for a GERD diagnosis, what treatments your doctor might suggest, and even a couple of herbs to try — in addition to your doctor’s treatment regimen — to help relieve your symptoms. You can also look for a doctor in your area in the "Find a Doctor" section on the main page.

National Institute of Diabetes and Digestive and Kidney Diseases

This institute is a division of the National Institutes of Health and is funded by the federal government to research treatments for many diseases, including GERD. In addition to vetted basic information on the condition and treatment, the site offers information on how to participate in clinical trials, which you may want to discuss with your doctor.

Lifestyle Guidelines for the Treatment of GERD

Cleveland Clinic

This resource indicates foods to avoid as well as choices from certain categories less likely to produce symptoms. Example: Nonfat or fat-free sour cream and cream cheese get a thumbs-up; the full-fat versions get a thumbs-down.

Academy of Nutrition and Dietetics

The Academy of Nutrition and Dietetics has a great page illustrating how GERD occurs to help you better understand the condition. The site also provides dietary tips on foods to avoid and other ways to reduce triggers.

Favorite Blogs About GERD

Gastroenterology Associates

This blog, hosted by a gastroenterology practice, has basic information on GERD diagnosis and treatment. Topics include lifestyle changes, medication, and procedures to treat the condition.

Gabby

Motivational speaker, life coach, and author Gabrielle Bernstein’s website is packed with information about how to lead a healthy life. Her blog covers topics from meditation to healthy eating, including her personal experience with GERD and gut inflammation.

Additional reporting by Mark Henricks.