GERD (Gastroesophageal Reflux Disease)
Chronic acid reflux that irritates the esophagus
Quick Facts
- Type: Digestive (gastrointestinal) condition
- Main symptom: Heartburn and acid regurgitation
- Cause: Weak valve between stomach and esophagus
- Seek care: Trouble swallowing, weight loss, chest pain
Overview
Gastroesophageal reflux disease (GERD) is a long-term condition in which stomach contents, including acid, flow back up into the esophagus, the tube connecting the mouth and stomach. Occasional reflux is common and harmless, but when it happens frequently or causes troublesome symptoms or damage, it is called GERD.
Normally a ring of muscle at the bottom of the esophagus (the lower esophageal sphincter) acts as a valve, opening to let food into the stomach and closing to keep acid in. In GERD, this valve is weak or relaxes at the wrong times, allowing acid to irritate the esophagus. GERD is very common and usually well controlled with lifestyle changes and medication.
Symptoms
The most common symptoms are:
- Heartburn, a burning feeling in the chest, often after meals or when lying down
- Regurgitation of sour or bitter fluid into the throat or mouth
- A sensation of a lump in the throat
- Difficulty or pain when swallowing
GERD can also cause less obvious symptoms, sometimes without classic heartburn, including chronic cough, hoarseness, sore throat, worsening asthma, and disrupted sleep. Chest pain can also come from the heart, so new or severe chest pain, especially with shortness of breath, sweating, or arm or jaw pain, should be treated as a possible emergency.
Causes
GERD develops when the lower esophageal sphincter does not work properly, letting acid reflux into the esophagus. Contributing factors include:
- A weak or frequently relaxing sphincter
- Hiatal hernia, where part of the stomach pushes up through the diaphragm
- Increased pressure on the stomach, as with excess weight or pregnancy
- Delayed stomach emptying
- Certain foods, drinks, and habits that relax the valve or increase acid, such as fatty or spicy foods, caffeine, alcohol, and smoking
Risk Factors
- Overweight or obesity
- Pregnancy
- Hiatal hernia
- Smoking
- Eating large meals or lying down soon after eating
- Certain foods and drinks, and some medications
Diagnosis
GERD is often diagnosed from typical symptoms and a trial of treatment. When the diagnosis is unclear, symptoms are severe, or warning signs are present, tests may include:
- Upper endoscopy: A thin camera examines the esophagus and stomach and can take biopsies.
- Esophageal pH monitoring: Measures how much acid reaches the esophagus over time.
- Esophageal manometry: Assesses the muscle function and valve pressure of the esophagus.
- Barium swallow: X-rays after drinking a contrast liquid to outline the esophagus and stomach.
Treatment
Most people manage GERD well with a combination of lifestyle changes and medication:
- Lifestyle measures: Losing excess weight, eating smaller meals, avoiding trigger foods, not lying down for a few hours after eating, raising the head of the bed, and stopping smoking.
- Antacids for quick, short-term relief.
- H2 blockers that reduce acid production.
- Proton pump inhibitors (PPIs) such as omeprazole, which strongly reduce acid and allow the esophagus to heal; these are commonly used for persistent GERD.
- Surgery or procedures to strengthen the valve in selected cases that do not respond to medication.
Long-standing, poorly controlled GERD can lead to complications such as narrowing of the esophagus or changes in the lining (Barrett's esophagus), so ongoing management matters.
Prevention
- Maintain a healthy weight
- Eat smaller meals and avoid eating within 2 to 3 hours of bedtime
- Identify and limit personal trigger foods and drinks
- Avoid tobacco and limit alcohol and caffeine
- Raise the head of the bed if nighttime reflux is a problem
- Avoid tight clothing around the waist
When to See a Doctor
See a doctor if heartburn occurs more than twice a week, persists despite over-the-counter treatment, or interferes with daily life. Seek prompt care for warning signs:
- Difficulty or pain when swallowing
- Unintended weight loss
- Vomiting blood or passing black, tarry stools
- Persistent vomiting
Call emergency services for chest pain with shortness of breath, sweating, or pain spreading to the arm or jaw, which may be a heart problem rather than reflux.
Frequently Asked Questions
What is the difference between heartburn and GERD?
Heartburn is a symptom, the burning chest feeling from acid reflux. GERD is the chronic condition in which reflux happens frequently and causes troublesome symptoms or damage. Occasional heartburn is common and does not necessarily mean you have GERD.
What foods trigger GERD?
Common triggers include fatty or fried foods, spicy foods, citrus, tomatoes, chocolate, peppermint, caffeine, carbonated drinks, and alcohol. Triggers vary from person to person, so it helps to notice which foods worsen your symptoms and limit those.
Can GERD be dangerous?
GERD itself is usually manageable, but long-standing, untreated reflux can narrow the esophagus or cause Barrett's esophagus, a lining change that slightly raises cancer risk. Warning signs like trouble swallowing, weight loss, or bleeding need evaluation.
How is GERD treated?
Treatment combines lifestyle changes such as weight loss, smaller meals, and avoiding triggers with acid-reducing medicines like antacids, H2 blockers, or proton pump inhibitors. A minority of people benefit from a procedure to strengthen the valve.
Could my chest pain be GERD or a heart problem?
Reflux can cause chest discomfort, but chest pain can also be a heart attack. If chest pain is new, severe, or comes with shortness of breath, sweating, or pain in the arm or jaw, treat it as an emergency and call for help rather than assuming it is reflux.
References
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Acid reflux (GER & GERD).
- Mayo Clinic. Gastroesophageal reflux disease (GERD).
- American College of Gastroenterology.
- MedlinePlus, U.S. National Library of Medicine. GERD.