Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease (GERD) is a chronic digestive condition in which stomach acid or, occasionally, stomach content flows back into the esophagus. This backwash (acid reflux) can irritate the lining of the esophagus and cause the burning sensation known as heartburn.

Occasional acid reflux is common. GERD is diagnosed when reflux symptoms occur more than twice a week or when the esophagus shows signs of inflammation or injury. Untreated GERD can lead to complications such as esophagitis, esophageal stricture, Barrett’s esophagus, and, rarely, esophageal adenocarcinoma.

Most people can manage GERD with lifestyle changes and over-the-counter medicines. Stronger prescription medicines or procedures are available when symptoms persist or complications develop.

Common signs and symptoms of GERD include:

• A burning sensation in the chest (heartburn), usually after eating, which may be worse at night or when lying down
• Regurgitation of food or sour liquid
• Upper abdominal or chest pain
• Difficulty swallowing (dysphagia)
• Sensation of a lump in the throat
• Chronic cough, laryngitis, new or worsening asthma, or disrupted sleep

Nighttime reflux can be particularly bothersome and is associated with a higher risk of complications. Some people experience “silent” reflux with minimal heartburn but prominent throat or respiratory symptoms.

GERD is caused by frequent acid reflux. At the lower end of the esophagus, a circular band of muscle (the lower esophageal sphincter) relaxes to allow food and liquid to enter the stomach, then tightens again. If this sphincter weakens or relaxes abnormally, stomach acid can flow back up into the esophagus.

Factors that can contribute include:

• Hiatal hernia
• Obesity and increased abdominal pressure
• Pregnancy
• Connective-tissue disorders such as scleroderma
• Delayed stomach emptying
• Certain foods, medicines, and habits that relax the sphincter or increase acid production

Risk factors for GERD include:

• Obesity
• Hiatal hernia
• Pregnancy
• Connective-tissue disorders (e.g., scleroderma)
• Delayed gastric emptying
• Smoking
• Eating large meals or lying down soon after eating
• Certain foods (spicy, fatty, chocolate, mint, citrus, tomato-based, caffeine, alcohol)
• Medications that can worsen reflux (some calcium-channel blockers, anticholinergics, bisphosphonates, NSAIDs, and others)

Chronic acid exposure can lead to:

• Esophagitis — inflammation that may cause bleeding, ulcers, or pain
• Esophageal stricture — scarring that narrows the esophagus and causes swallowing difficulty
• Barrett’s esophagus — precancerous changes in the esophageal lining that increase the risk of esophageal adenocarcinoma
• Respiratory problems, including chronic cough, laryngitis, and worsening of asthma
• Dental erosion from repeated acid exposure

People with long-standing GERD, especially white males over 50 with central obesity or a history of smoking, may be candidates for screening endoscopy for Barrett’s esophagus.

Lifestyle measures that reduce reflux include:

• Maintain a healthy weight
• Stop smoking
• Elevate the head of the bed 6–8 inches (use blocks or a wedge, not just extra pillows)
• Avoid lying down within 2–3 hours after meals
• Eat smaller, more frequent meals
• Identify and limit personal trigger foods
• Loosen tight clothing around the waist
• Limit alcohol and caffeine if they provoke symptoms

Diagnosis is often based on symptoms and response to treatment. When further evaluation is needed, tests may include:

• Upper endoscopy — to look for esophagitis, stricture, Barrett’s esophagus, or other findings; biopsies can be taken
• Ambulatory acid (pH) probe test — measures acid in the esophagus over 24–48 hours
• Esophageal manometry — assesses muscle function and sphincter pressure
• Barium swallow X-ray — sometimes used to evaluate swallowing difficulty or structural abnormalities

Empiric therapy with a proton-pump inhibitor is often both diagnostic and therapeutic in typical cases.

See a healthcare professional if you have frequent heartburn or other GERD symptoms that do not improve with lifestyle measures or occasional over-the-counter antacids. Seek prompt care for:

• Difficulty or pain when swallowing
• Unexplained weight loss
• Persistent vomiting or vomiting blood
• Black or bloody stools
• Chest pain that could be cardiac in origin (especially with shortness of breath, jaw or arm pain, or sweating)

Chest pain should always be evaluated carefully to rule out heart disease before attributing it to GERD.

Treatment is stepwise:

Lifestyle and dietary changes form the foundation for everyone.

Medicines

• Antacids for occasional mild symptoms
• H2-receptor blockers (famotidine and others) for less frequent symptoms
• Proton-pump inhibitors (omeprazole, esomeprazole, pantoprazole, etc.) — the most effective acid-suppressing medicines for frequent or erosive disease
• Alginate-based agents and, in selected cases, baclofen or prokinetics

Procedures and surgery for refractory GERD or preference to avoid long-term medication:

• Laparoscopic fundoplication (Nissen or partial)
• Magnetic sphincter augmentation (LINX)
• Transoral incisionless fundoplication (TIF) and other endoscopic options in selected patients

Treatment is individualized according to symptom severity, presence of erosive disease or Barrett’s, and patient preference.

Daily habits that help control GERD:

• Take prescribed acid-reducing medicine as directed (usually before the first meal of the day for PPIs)
• Keep a food-and-symptom diary to identify triggers
• Elevate the head of the bed and avoid late-night meals
• Maintain a healthy weight and stay active
• Do not smoke
• Review all medicines with a clinician or pharmacist for possible reflux-promoting effects

Bring:

• A description of symptoms, timing (after meals, nighttime), and severity
• List of medicines and supplements
• Notes about diet, weight changes, and smoking or alcohol use
• Previous endoscopy or test results if available
• Questions about long-term medication safety, Barrett’s screening, and surgical options if relevant