Gastroesophageal reflux disease (GERD) is a long-term condition in which acid from the stomach comes up into the esophagus. It can lead to heartburn and other symptoms.

The American College of Gastroenterology says that 1 in 5 people living in the United States experiences heartburn every day. GERD has an estimated prevalence of 18.1–27.8% in the U.S., but its prevalence may be higher.

This article covers information about the symptoms, causes, diagnosis, and treatment of GERD.

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Many people occasionally experience acid reflux or gastroesophageal reflux (GER).

In GER, stomach acid flows back up into the esophagus. If an individual experiences persistent acid reflux that occurs more than twice a week, a doctor may diagnose GERD.

GERD is the regular, persistent, and long-term occurrence of GER.

The esophagus is a tube that transports food from the mouth to the stomach. Acids in the esophagus cause heartburn and other symptoms, as well as possible tissue damage.

Here are some key points about GERD:

  • GERD may result from a weak or damaged valve between the stomach and the esophagus.
  • Stomach acid that washes up into the esophagus can cause dangerous tissue damage.
  • Maintaining a moderate weight, quitting smoking, and avoiding certain foods can help reduce the risk of GERD.
  • Treating GERD may involve the use of proton pump inhibitors (PPIs), antacids, and other medications, as well as lifestyle changes.

The most common symptoms of GER and GERD are heartburn and regurgitation. Other possible symptoms include:

  • nausea
  • chest pain
  • difficulty swallowing
  • chronic cough
  • water brash (excess saliva mixed with stomach acid)
  • globus sensation (the sensation of a lump in one’s throat)

Occasional acid reflux is quite common, often occurring as a result of eating a large meal, lying down after eating, or eating particular foods. However, recurrent acid reflux, or GERD, typically has other causes and risk factors and can have more serious complications.

GERD occurs in people of all ages and sometimes for unknown reasons. It happens when the valve that prevents stomach contents from going back up to the esophagus becomes weak or opens when it should not.

GERD occurs more commonly in people:

  • with obesity or people who are overweight because of increased pressure on the abdomen
  • who are pregnant, affecting around 40–85% of people during pregnancy
  • who are taking certain medications, including some asthma medications, calcium channel blockers, antihistamines, sedatives, and antidepressants
  • who smoke and those with exposure to secondhand smoke

In addition, hiatal hernia is a condition in which an opening in the diaphragm lets the top of the stomach move up into the chest. This lowers the pressure in the esophageal sphincter and increases the risk of GERD.

Anyone experiencing frequent acid reflux symptoms should talk with their doctor, who may refer them to a specialist in gut medicine known as a gastroenterologist for further investigation.

There are several possible tests to diagnose GERD, including:

  • Esophageal pH and impedance monitoring: This measures the amount of acid in the esophagus while the body is in different states, such as while eating or sleeping.
  • Upper GI endoscope: This is a tube with a camera attached that is used to inspect the esophagus. A small sample of tissue may also be taken at the same time for a biopsy.
  • Upper GI series: This is a type of X-ray that shows certain physical abnormalities that might cause GERD.
  • Esophageal manometry: This measures muscle contractions in the esophagus during swallowing. It can measure the strength of the sphincter.
  • Bravo wireless esophageal pH monitoring: In this test, a small temporary capsule is attached to the esophagus. This measures the acidity continuously for approximately 48 hours.

GERD is a chronic disease that requires long-term management. Doctors often treat GERD with medications and by suggesting lifestyle changes. If symptoms do not improve, doctors may suggest surgery.

Lifestyle changes

Lifestyle modifications are the cornerstone of GERD treatment because they can help improve symptoms. These modifications may include:

  • losing weight for people who are overweight or had a recent weight gain
  • sleeping in an inclined position
  • modifying diet and avoiding food triggers
  • avoiding eating meals at least 3 hours before going to bed

Diet

Certain foods may trigger GERD symptoms in some people. These include:

  • greasy foods
  • spicy foods
  • chocolate
  • peppermint
  • caffeine
  • foods containing tomato products
  • alcoholic drinks

If a person avoids these types of foods and still experiences regular heartburn, it is important to visit a doctor, as there may be other underlying issues causing the symptoms.

Medications

Medications used to treat GERD suppress acid production. Of the available options, PPIs are considered the most effective in treating both erosive and nonerosive GERD. They can help heal the lining of the esophagus.

Other options include:

  • H2 blockers: These also reduce the amount of acid in the stomach but are not as good at healing the lining of the esophagus.
  • Antacids: These counteract the acid in the stomach because they are alkaline (bases). People can buy them over the counter to help relieve mild symptoms. Side effects can include diarrhea and constipation.
  • Prokinetics: These help the stomach empty faster. Side effects include diarrhea, nausea, and anxiety. A 2021 study found that using prokinetics with PPIs is more effective than using PPIs alone.

Surgical options

If lifestyle changes and medications do not significantly improve the symptoms of GERD, a gastroenterologist may recommend surgery.

Surgical treatments include:

  • Fundoplication: The surgeon sews the top of the stomach around the esophagus. This adds pressure to the lower end of the esophagus and is generally successful at reducing acid reflux.
  • Endoscopic procedures: There are a range of endoscopic procedures available to treat GERD. These include endoscopic sewing, which uses stitches to tighten the sphincter muscle, and radiofrequency, which uses heat to produce small burns that help tighten the sphincter muscle.

GERD can worsen and result in other conditions if left untreated. These may include:

  • Esophagitis: This is inflammation of the esophagus. It can also lead to gastrointestinal (GI) bleeding.
  • Esophageal stricture: Repeated irritation can cause scarring in the esophagus, making it narrow. This can cause difficulty swallowing.
  • Barrett’s esophagus: The cells lining the esophagus can change into cells similar to the lining of the intestine. This can develop into esophageal cancer.
  • Respiratory problems: It is possible to breathe stomach acid into the lungs, which can cause a range of problems, such as chest congestion, hoarseness, asthma, laryngitis, and pneumonia.

A 2021 study found that GERD can contribute to the development of idiopathic pulmonary fibrosis. Another 2021 study found that GERD is common in people with asthma and may cause lung transplant complications.

Aside from the lifestyle changes mentioned above, adopting the following changes may help prevent the onset of GERD:

  • eat small meals frequently
  • avoid eating very large meals
  • stay upright after eating
  • finish eating 2–3 hours before going to bed
  • quit or avoid smoking
  • avoid strenuous activities after eating
  • lose weight if overweight
  • minimize wearing tight clothing around the abdomen
  • sleep at a slight angle with the head slightly elevated

Acid reflux is not a cause for concern unless it happens often and becomes persistent. In this case, a person’s heartburn may be a symptom of GERD.

GERD is a treatable condition. A combination of lifestyle changes and medications is often enough to treat it. However, it may cause severe complications if left untreated and could require surgery.