What is GERD?

Gastroesophageal reflux disease (GERD) is a common digestive condition that goes beyond the occasional bout of heartburn. When stomach acid flows back into the esophagus too often, it can cause persistent discomfort, irritation and pain. GERD can affect people of all ages, and it may gradually interfere with daily life if it isn’t properly managed.

Understanding GERD is an important first step toward relief. Below, readers can learn what may trigger GERD and the range of symptoms it can cause, as well as treatment and symptom relief management options that may be recommended after a diagnosis.

In this article:

What is GERD?

When someone eats food and swallows, the contents travel down the esophagus and into the stomach. When stomach contents flow back up into the esophagus, it causes gastroesophageal reflux (GER), which is commonly known as acid reflux. Many people experience acid reflux from time to time.

But gastroesophageal reflux disease (GERD) is a more serious, long‑term condition. It occurs when acid reflux happens often, and leads to ongoing symptoms or other health problems.

How common is GERD?

GERD is a common digestive condition that is estimated to affect about 20 percent of adults and an estimated 10 percent of children in the United States.

What can cause GERD?

GERD may develop if someone’s lower esophageal sphincter becomes weak or relaxes when it shouldn’t. Certain factors can increase the risk of this sphincter weakening or relaxing, including:

• Being overweight or having obesity
• Having a hiatal hernia
• Pregnancy
• Smoking or exposure to secondhand smoke

Some medications can also cause GERD or make symptoms worse, such as:

• Calcium channel blockers, which can be used to treat high blood pressure
• Nonsteroidal anti‑inflammatory drugs (NSAIDs)
• Sedatives that cause relaxation or drowsiness
• Tricyclic antidepressants

Symptoms of GERD

GERD can manifest through a range of symptoms, which can vary in intensity and frequency among different individuals. For both children and adults, two common symptoms of GERD include:

• Heartburn: A painful, burning sensation in the center of the chest, just behind the breastbone. It often starts near the lower part of the chest and can move upward toward the throat.
• Regurgitation: Food or stomach acid flowing back up from the stomach into the esophagus and throat. This can leave a sour or bitter taste in the mouth.

Other symptoms may include:

• Chest pain
• Chronic cough or hoarseness
• Nausea
• Problems or pain while swallowing

For babies, who can’t clearly explain how they feel, parents may notice signs that suggest GERD. These include:

• Arching of the back or unusual movements of the neck and chin
• Increased irritability or crying more than usual
• Poor growth, weight loss or gaining less weight than expected
• Reduced appetite or refusing to eat

How is GERD diagnosed?

In most cases, a health care provider starts diagnosing GERD by reviewing a person’s symptoms and going over their medical history. If the symptoms point to GERD, the health care provider may then suggest treatment and symptom relief management options that can include medications and lifestyle changes.

In some cases, when the symptoms are classic and respond to GERD medication, that’s enough and no further testing is needed. However, for patients with certain symptoms, additional testing may be needed.

“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.”

If symptoms suggest a complication of GERD or another condition with similar symptoms, or if symptoms don’t improve after trying medications and lifestyle changes, a health care provider may order one or more of the following tests.

Upper gastrointestinal (GI) endoscopy

An upper GI endoscopy is a procedure that allows a health care provider to look inside the upper digestive tract using a flexible tube with a camera. This includes the esophagus, stomach, and the first part of the small intestine. During the procedure, the provider may also take small tissue samples from the lining of the esophagus. These samples are then examined under a microscope by a pathologist.

Esophageal pH monitoring

There are two main types of esophageal pH monitoring:

• Capsule monitoring. A health care professional uses an endoscope to attach a small, wireless capsule to the lining of the esophagus. The capsule measures acid reflux and sends the information to a monitor.
• Catheter monitoring. A health care professional places a thin, flexible tube through the nose and into the esophagus. The tube measures both acid and non‑acid reflux.

During both types of esophageal pH monitoring, patients wear a small monitor that collects information from the catheter or capsule and records details about diet, sleep and symptoms. A health care provider uses this information to see how eating, sleeping and symptoms are connected to acid reflux in the esophagus.

Upper GI series

For infants and children, a health care provider may also recommend an upper GI series. This test uses X‑rays and a chalky liquid called barium to look at the upper digestive tract. Health care providers may order this test to check for structural problems that could be causing symptoms or making them worse.

Treatment and symptom relief management options for GERD

A health care provider may recommend lifestyle changes and medications to help manage GERD symptoms. In some cases, surgery may also be an option.

Lifestyle changes

Lifestyle changes can help reduce symptoms of GERD. A health care provider may recommend the following for adults:

• Elevating the head during sleep by using a foam wedge or extra pillows under the head and upper back to help raise the head off the bed by about 6 to 8 inches.
• Losing weight if someone is overweight or has obesity.
• Not eating meals for at least three hours before lying down or going to bed.
• Quitting smoking, if someone smokes.
• Identifying and eliminating trigger foods, which may include:
  • Acidic foods, such as citrus fruits and tomatoes
  • Alcoholic drinks
  • Chocolate
  • Coffee and other sources of caffeine
  • High-fat foods
  • Mint
  • Spicy foods

Over-the-counter and prescription medications

Health care providers may prescribe one or more medications to help manage symptoms associated with GER or GERD, including:

• Antacids: These medications can help relieve mild heartburn and other mild GER and GERD symptoms. They are available over the counter.
• H2 blockers: These help lower the amount of acid the stomach produces. They can help heal the esophagus, though not as effectively as proton pump inhibitors. H2 blockers are available both over the counter and by prescription.
• Proton pump inhibitors (PPIs): These medications also help reduce stomach acid and can help heal the lining of the esophagus in most people with GERD. Health care providers may prescribe PPIs for long‑term treatment. They are available over the counter and by prescription.

Always speak with a health care provider before starting or stopping any over-the-counter product or medication.

Surgery and other medical procedures

A health care provider may recommend surgery if GERD symptoms do not improve with lifestyle changes and medications or if a patient wants to stop taking long‑term GERD medications. However, surgery carries a higher risk of complications than medications.

The following surgical options may be used to help treat GERD:

• Endoscopy: In rare cases, a health care provider may recommend an endoscopic procedure to treat GERD. During this procedure, a provider inserts a small, flexible tube with a light and camera into someone’s mouth and down into their esophagus. Endoscopic procedures are usually used to sew the top of the stomach around the lower esophageal sphincter.
• Fundoplication: This is the most common surgery used to treat GERD; it often leads to long‑term symptom improvement. During the procedure, a surgeon sews the top of the stomach around the lower end of the esophagus. This helps add pressure to the lower esophageal sphincter, which can help prevent acid reflux.
• Weight‑loss surgery: Also called metabolic or bariatric surgery, this option may be recommended for people who have GERD and obesity. This surgery can help people lose weight and may reduce GERD symptoms.

What happens if GERD is left untreated?

Untreated GERD symptoms can worsen over time and may lead to serious complications. These may include Barrett’s esophagus, esophagitis, esophageal cancer, esophageal stricture and other problems that occur outside the esophagus.

Barrett’s esophagus

GERD can sometimes lead to Barrett’s esophagus. In this condition, tissue similar to the lining of the intestine replaces the normal lining of the esophagus. A small number of people with Barrett’s esophagus may go on to develop esophageal adenocarcinoma, a type of cancer.

Esophagitis

Esophagitis is inflammation of the esophagus. It can damage the lining and may cause ulcers or bleeding. Over time, ongoing esophagitis can increase the risk of esophageal narrowing (stricture) and Barrett’s esophagus.

Esophageal stricture

An esophageal stricture occurs when the esophagus becomes too narrow. This narrowing can make swallowing difficult.

Complications outside the esophagus

Some people with GERD can develop complications outside the esophagus. These may affect the mouth, throat or lungs and can include:

• Asthma
• Chronic cough
• Hoarseness
• Interstitial lung disease
• Laryngitis (inflammation of the voice box and can cause temporary voice loss)
• Tooth enamel erosion from repeated acid exposure
• Wheezing (a high‑pitched whistling sound when breathing. This complication is specific to children)

When to see a health care provider about GERD

People should talk to a health care provider if they think they have GERD. It’s also important to see a health care provider if symptoms could be a sign of a GERD‑related complication or another serious health problem.

GERD warning signs in adults

The following symptoms may be signs of serious GERD‑related complications or other serious health problems. These need immediate medical attention:

• Chest pain
• Loss of appetite
• Persistent vomiting
• Problems swallowing or pain while swallowing
• Signs of bleeding in the digestive tract:
  • Vomit that contains blood or looks like coffee grounds
  • Stool that contains blood or looks black and tarry
• Unexplained weight loss

GERD warning signs in children

For children, a health care provider should be contacted right away if a child has symptoms that may point to a serious health problem other than GERD or a GERD‑related complication.

These symptoms may include:

• Difficulty or pain with swallowing
• Projectile vomiting
• Repeatedly refusing to eat, leading to weight loss or poor growth
• Trouble breathing
• Signs of dehydration, including not producing tears when crying
• Signs of bleeding in the digestive tract:
  • Vomit that contains blood or looks like coffee grounds
  • Rectal bleeding or blood in the stool 

Key takeaways

GERD is a long-term condition that affects about 20 percent of adults and 10 percent of children in the U.S. It happens when stomach acid regularly flows back into the esophagus. It can cause symptoms like heartburn, chest pain, trouble swallowing or food coming back up. GERD is often managed with lifestyle changes and medications, but without treatment it can lead to more serious problems. Anyone with ongoing symptoms should talk with a health care provider.