What is GERD?

Gastroesophageal reflux disease (GERD) is a digestive disorder that can cause discomfort if left untreated, and it can affect people of any age. It’s characterized by frequent heartburn, or when stomach acid moves up into the esophagus — or the tube that connects the mouth to the stomach. This can lead to irritation and pain, especially if left untreated.

Understanding GERD is an important first step. Read on to learn more about GERD’s triggers and range of symptoms, as well as treatment and management options typically offered after a formal diagnosis is made.

In this article:

Overview of GERD

When you eat food and swallow, the contents are supposed to travel down your esophagus and into your stomach. If you have acid reflux, however, those contents might not remain inside the stomach after digestion begins. Instead, they might come back up the esophagus, causing discomfort and irritation.

As such, the answer to “What is GERD?” is nuanced. While acid reflux can be normal sometimes, such as it might be in the event you eat spicy food, GERD is diagnosed if symptoms are particularly pronounced or occur over extended periods of time. If left untreated, GERD can lead to further esophagus dysfunction and worsened symptoms.

How common is GERD?

GERD is a common gastrointestinal disorder that affects around 20% of adults in Western cultures. There is also reason to believe that GERD is becoming more common. This might be due to various factors, including changes in diet, increasing levels of obesity, and sedentary lifestyles.

Causes of GERD

Heartburn is one of the most common symptoms of GERD, but one may also experience regurgitation, chest discomfort, pain with swallowing, associated nausea, and sometimes other symptoms such as a chronic cough or hoarseness. Many different risk factors can contribute to the risk of developing GERD. Primary risk factors include:

Pregnancy

There isn’t clear research explaining exactly why up to 80% of pregnant women deal with heartburn and acid reflux. However, hormone fluctuations are one of the top suspects because they can change the function of the muscle that keeps the fluids separated in the stomach from the esophagus. The size of the baby towards the end of pregnancy could also contribute.

Being overweight or obese

Generally speaking, being obese or overweight can contribute to GERD symptoms. Individuals who carry extra weight in the abdomen are at higher risk of GERD symptoms, statistically. This is likely due to the fact that excess weight in the abdomen presses up on the stomach, causing the stomach fluids to move up into the esophagus and resulting in heartburn.

Smoking

Smoking has been scientifically suggested to put a strain on the lower esophageal sphincter (LES), causing reduced pressure of the sphincter and possibly acid reflux.

Hiatal hernia

Hiatal hernia is a condition where the upper portion of the stomach is pushed up into the chest past the diaphragm muscle, which is a thin muscle that separates your chest from your abdomen. Hiatal hernia can be a condition you're born with or can develop with increased age, an injury or previous surgery, or due to lifestyle factors — such as smoking or obesity.

Medications

There are a variety of medications that may contribute to symptoms of GERD. For example, certain drugs can cause irritation or inflammation to the tissue in the esophagus, weaken or relax the LES, or cause an increase in stomach acid. They might also slow down the speed at which food passes through the digestive tract.

Diet

Certain foods and drinks can trigger heartburn and acid reflux. While these GERD symptoms aren't necessarily “caused” by the foods and drinks themselves, they can contribute to and worsen existing symptoms.

Here are some common foods and drinks that can play a role:

Foods:

• Spicy foods
• Fatty or highly-processed foods
• Chocolate
• Citrus fruits
• Tomatoes and tomato-based products
• Onions and garlic
• Peppermint and spearmint

Drinks

• Caffeinated beverages
• Alcohol
• Carbonated drinks
• Citrus juices
• Tomato juice

Avoiding or limiting these foods and drinks may help manage GERD symptoms more effectively.

Other Causes

Beyond what’s listed here, there are several other, less common causes of GERD to consider. Birth defects, connective tissue diseases, or neurological disorders, like Parkinson’s disease or stroke, are some conditions that can lead to GERD or exacerbate related symptoms.

Symptoms of GERD

GERD manifests through a range of symptoms, which can vary in intensity and frequency among different individuals.

Common symptoms

The most common symptom of GERD is heartburn. Other symptoms can also be caused by reflux of acid, including sore throat, a bitter or sour taste in the mouth, or erosion of tooth enamel, resulting in cavities. Those living with GERD might also experience stomach pain (or stomachaches) or nausea.

Symptoms may also worsen in certain situations, like after eating a large meal, lying down, bending over, or after smoking/drinking alcohol.

Less common symptoms of GERD

In addition to the classic signs, GERD can present with less common symptoms — such as chronic cough, hoarseness, sore throat, and a sensation of a lump in the throat.

Some individuals might also experience chest pain that mimics heart issues, while others could have difficulty swallowing, which is known as dysphagia.

Recognizing these less obvious signs is important for a comprehensive diagnosis and treatment plan. It’s important to be careful, however, to avoid self-diagnosis. “Patients should not attempt to diagnose themselves with GERD without talking to a doctor,” says board-certified Internal Medicine Physician Dr. Brennan Kruszewski. “Many of the symptoms of GERD can mimic heart problems, and evaluation by a physician is the only way to differentiate between GERD and heart issues reliably.”

GERD diagnosis

Diagnosing GERD typically involves a combination of clinical evaluation, a medical history assessment, and various diagnostic tests (i.e., endoscopy, pH monitoring) to confirm the presence and severity of the condition.

We’ve summarized each of these steps below:

Clinical evaluation

The initial step in diagnosing GERD, in most cases, is a thorough clinical evaluation by a health care provider. This includes a detailed discussion of symptoms, their frequency and severity, and any triggers that seem to worsen them. A health care provider will also review medical history, including medications, lifestyle factors such as diet and smoking, and any underlying health conditions that might contribute to GERD.

Diagnostic Tests

A health care provider may order several tests for GERD. These tests provide valuable insights into the mechanisms and impact of GERD on an individual basis, guiding effective management and treatment strategies. Some tests may include:

Endoscopy

This is a test where a small camera is passed into the esophagus while you are under anesthesia. It can help identify areas of inflammation that happen with GERD, as well as any concerning issues from long-term GERD, like inflammation or any precancerous lesions.

pH monitoring

pH monitoring is another way to measure acid levels in the esophagus. This can be done as part of an endoscopy or by inserting a small tube through the nose down into the esophagus to measure acid levels.

Manometry

Esophageal manometry is a test that helps measure the strength of the esophageal muscles. During the procedure, numbing medication is received inside the nose. Then, a tube is inserted through the nose, down the esophagus and into your stomach. You are asked to swallow as the tube is withdrawn. This allows a doctor to measure the tightness of your esophageal muscles, which can help make a diagnosis of lower esophageal sphincter dysfunction.

Complications of GERD

If GERD goes untreated, it may result in worsening symptoms or may lead to the development of other diseases — like esophagitis, Barrett’s esophagus, strictures or laryngopharyngeal reflux.

Esophagitis

Esophagitis occurs when the esophagus is inflamed. Symptoms may include pain or issues with swallowing. 

While esophagitis can be brought on by many different diseases, GERD is the most common cause. Persistent inflammation of the esophagitis can lead to esophageal ulcers or strictures (abnormal narrowing of the esophagus), which can cause swallowing difficulties.

Barrett’s esophagus

Over time, chronic irritation of the esophagitis can result in Barrett's esophagus, a condition that changes the esophageal lining and increases the risk of esophageal cancer. The damage to the esophagus lining causes the normal cells to convert into column-shaped cells that resemble the cells found in the intestines. At first, these new cells are not cancerous, but over time, they may become abnormal. As such, it’s important to quickly manage and treat cases of esophagitis and GERD to prevent these severe complications.

Strictures

Strictures occur when the esophageal passageway is unusually narrow, making it hard to swallow. Strictures can be discovered during a barium swallow study and/or upper endoscopy (EGD).

Laryngopharyngeal reflux

Also referred to as "silent reflux," laryngopharyngeal reflux causes postnasal drip, a feeling of a lump in the throat, hoarseness, a sensation of needing to clear the throat often, a dry cough, or mucous in the throat.

Treatment options for GERD

Many find relief from GERD-related symptoms via lifestyle modifications and over-the-counter medications. For those living with more severe or persistent GERD, prescription medications and further medical interventions may be necessary. Recommended treatment options for individuals who are pregnant differ from those who are not pregnant. Pregnant individuals should be evaluated by a health care provider to help determine the best course of action.

Over-the-counter medications

If someone is dealing with occasional heartburn or mild GERD symptoms, over-the-counter (OTC) options (like antacids, proton pump inhibitors) may provide heartburn relief support.

Antacids work by neutralizing stomach acid, helping to reduce heartburn symptoms quickly. They’re great for on-the-spot relief support, but they don't typically last very long, so many find that they're best used for occasional symptoms rather than long-term management

Many proton-pump inhibitors are available over-the-counter, and others are available only by prescription and are often the first line of treatment for GERD because of their effectiveness to reduce the amount of stomach acid produced. It may take a few days for PPIs to become fully effective. They are best taken on an empty stomach, either before breakfast or about 30 minutes before dinner.

Histamine H-2 receptor antagonists, including cimetidine and famotidine, are over-the-counter products that can also be helpful in patients with GERD by suppressing acid, helping with symptoms.

Prescription medications

If over-the-counter options aren't quite addressing GERD symptoms, prescription medications might be the next course of treatment to discuss with a health care provider.

Surgical treatments

When medications and lifestyle changes aren't enough to control GERD symptoms, surgical options may be a consideration for some. Two common options include:

• Nissen fundoplication — This surgical procedure wraps the top part of the stomach around the lower esophagus to repair the valve at the end of the esophagus that isn’t working correctly for those living with GERD.
• LINX Reflux Management System implementation — This surgery is newer than Nissen fundoplication. Instead of using part of the stomach, a small flexible band with metal beads is placed on the lower esophageal sphincter to help it compress.

When to see a health care provider

For heartburn or mild GERD symptoms, lifestyle changes and over-the-counter medications might be enough to manage the condition. However, there are certain situations where it’s important to see a doctor. Situations that may require 1:1 provider support include:

• Heartburn or acid reflux that occurs more than twice a week
• Persistent symptoms that occur despite using over-the-counter treatments and making lifestyle adjustments
• Instances of intense chest pain
• Difficulty swallowing, whether acute or chronic
• Nausea and/or vomiting, whether acute or chronic
• Presence of black stool
• Blood present in vomit or stool
• Instances of sleep disturbances from GERD symptoms, whether acute or chronic

Frequently Asked Questions

Can GERD be cured?

GERD cannot be cured. However, in many cases, it can be managed effectively with a combination of lifestyle changes, medications, and, if necessary, surgical interventions.

What is the most common cause of GERD?

The most common cause of GERD is the dysfunction of the lower esophageal sphincter (LES). Other common causes include pregnancy, being overweight or obese, smoking, and certain medications.

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements and prior to beginning or changing any health care practices.