GERD (Acid Reflux)

What It Is

At the bottom of the esophagus is a ring of muscle called the lower esophageal sphincter (LES). It normally opens to let food into the stomach and then closes to keep stomach contents from moving back up. In GERD, this muscle relaxes at the wrong times or is weak, allowing acid and other stomach contents to flow back into the esophagus.

The lining of the esophagus is not built to handle stomach acid. Repeated exposure can cause a burning sensation and, over time, inflammation (esophagitis). Some people have reflux symptoms in the throat or voice box, sometimes called laryngopharyngeal reflux.

Gastroesophageal reflux (GER) without lasting problems is common, including in infants. GERD is the term used when reflux happens often, interferes with daily life, or causes damage.

Common Terminology

Heartburn

A burning feeling in the chest, often behind the breastbone, caused by stomach acid irritating the esophagus. It is not related to the heart.

Lower esophageal sphincter (LES)

A ring of muscle at the bottom of the esophagus that helps keep stomach contents from flowing backward.

Regurgitation

The backflow of food or sour liquid into the throat or mouth.

Esophagitis

Inflammation of the esophagus lining, which can be caused by repeated acid exposure.

Hiatal hernia

A condition in which part of the stomach pushes up through the diaphragm into the chest, which can contribute to reflux.

Barrett's esophagus

A change in the cells lining the lower esophagus that can develop after long-term reflux and slightly raises the risk of esophageal cancer.

Upper endoscopy (EGD)

A procedure that uses a thin, flexible camera to look at the esophagus, stomach, and first part of the small intestine.

Common Causes and Associations

GERD often results from a combination of factors that affect the LES or increase pressure on the stomach.

• Excess body weight, especially around the abdomen, increases pressure on the stomach.
• A hiatal hernia can weaken the barrier between the stomach and esophagus.
• Pregnancy is commonly associated with heartburn due to hormonal changes and pressure on the stomach.
• Smoking is linked with weaker LES function.
• Large meals, eating close to bedtime, and lying down after eating can make reflux more likely.
• Certain foods and drinks, such as fatty or fried foods, chocolate, peppermint, coffee, alcohol, citrus, and tomato products, are common triggers for some people.
• Some medicines, including certain pain relievers, sedatives, calcium channel blockers, and some asthma medicines, can worsen reflux.

Symptoms and Features

This is a general description, not a diagnostic checklist. Reflux symptoms can overlap with other conditions, including heart problems.

• A burning feeling in the chest (heartburn), often after eating and sometimes worse at night or when lying down.
• Regurgitation of food or sour or bitter liquid into the throat or mouth.
• Upper abdominal or chest discomfort.
• Difficulty swallowing or a feeling of food sticking.
• Chronic cough, hoarseness, sore throat, or a sensation of a lump in the throat.
• Worsening of asthma symptoms or disrupted sleep in some people.

Tests and Evaluation

GERD is often diagnosed based on typical symptoms. Testing is generally used when symptoms are unclear, persistent, or accompanied by warning signs.

• A clinician may consider the diagnosis based on symptom history and whether symptoms improve with acid-reducing treatment.
• Upper endoscopy allows direct viewing of the esophagus and can detect esophagitis, narrowing, or Barrett's esophagus, with biopsies if needed.
• Ambulatory pH or pH-impedance monitoring measures how often acid or other stomach contents reach the esophagus over 24 to 96 hours.
• Esophageal manometry measures the muscle contractions of the esophagus and is often done before reflux surgery.
• A barium swallow X-ray can show the shape of the esophagus and stomach and may reveal a hiatal hernia or narrowing.

Treatment Overview

Treatment is usually stepped, starting with lifestyle measures and adding medicines or procedures as needed, under a clinician's guidance.

• Lifestyle measures often discussed include eating smaller meals, avoiding meals two to three hours before lying down, and raising the head of the bed.
• Weight loss, when appropriate, and stopping smoking can reduce symptoms.
• Identifying and limiting personal food and drink triggers helps some people.
• Antacids can neutralize stomach acid for short-term relief.
• H2 blockers (such as famotidine) and proton pump inhibitors (such as omeprazole) reduce how much acid the stomach makes.
• Surgery, such as fundoplication, or other procedures that strengthen the barrier at the LES may be considered when medicines are not effective or not suitable.
• People with Barrett's esophagus are often monitored with periodic endoscopy.

When Professional Care May Be Discussed

Chest pain, especially with shortness of breath, sweating, or pain spreading to the arm, jaw, or back, can be a sign of a heart attack and is generally treated as a medical emergency; in the US, people are advised to call 911. Vomiting blood or material that looks like coffee grounds, or black tarry stools, is also generally treated as urgent.

• Heartburn that happens more than twice a week or keeps returning is commonly discussed with a healthcare professional.
• Difficulty or pain with swallowing is generally evaluated by a clinician.
• Unintended weight loss, persistent vomiting, or signs of anemia are considered warning signs that often lead to further testing.
• Symptoms that continue despite over-the-counter treatment are typically reviewed with a clinician.
• Long-term use of acid-reducing medicines is often reviewed periodically with a clinician or pharmacist.

Questions to Ask a Healthcare Professional

General questions people often find useful to bring to an appointment:

• What is the difference between occasional heartburn and GERD?
• When is an upper endoscopy generally recommended for reflux?
• How do antacids, H2 blockers, and proton pump inhibitors differ?
• Which lifestyle changes are most often helpful for reflux?
• What is Barrett's esophagus, and how is it usually monitored?
• Could a hiatal hernia be involved, and how does it relate to reflux?
• How can reflux-related chest discomfort be distinguished from heart-related chest pain?

Sources

This guide was written in plain language from the following authoritative references.

1. GERD — MedlinePlus (U.S. National Library of Medicine)
2. Acid Reflux (GER & GERD) in Adults — National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
3. Heartburn and acid reflux — NHS

Related Guides

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