What is GERD?
GERD, or gastroesophageal reflux disease, is chronic reflux of stomach contents into the esophagus that causes troublesome symptoms or damage. The main symptoms are heartburn — a burning behind the breastbone — and regurgitation of acid or food into the throat. It is diagnosed largely on symptoms, with testing reserved for alarm features or unclear cases.
Key takeaways
- Occasional reflux is normal; GERD is when it is frequent, troublesome, or causing damage.
- Heartburn and regurgitation are the classic symptoms, but cough, hoarseness, and throat clearing can also occur.
- Alarm features such as difficulty swallowing, weight loss, vomiting blood, or anemia need prompt evaluation.
- Chest pain should never be assumed to be reflux until a cardiac cause has been considered.
- Long-standing GERD can lead to Barrett esophagus, a change in the esophageal lining that warrants monitoring.
Overview
A ring of muscle called the lower esophageal sphincter sits where the esophagus meets the stomach and normally stays closed except when swallowing. In GERD it relaxes inappropriately or is too weak to hold, so acidic stomach contents wash upward. The esophagus, unlike the stomach, has no protective mucus layer, so the result is the burning discomfort most people recognise as heartburn, often with a sour taste and the sensation of food coming back up.
Almost everyone refluxes occasionally, especially after a large meal. What defines GERD is frequency and consequence: symptoms two or more days a week that interfere with daily life, or visible inflammation and complications. Most people are managed successfully on symptoms alone with lifestyle change and acid-suppressing medication. Testing is reserved for those whose symptoms do not fit, do not respond, or come with alarm features.
What GERD is
GERD exists on a spectrum. Non-erosive reflux disease means troublesome symptoms without visible damage on endoscopy, which is the most common form. Erosive esophagitis means visible breaks in the lining. Complications of long-standing acid exposure include peptic strictures that narrow the esophagus and Barrett esophagus, in which the lining changes to an intestinal type, carrying a small but real increase in esophageal cancer risk.
A hiatal hernia — where part of the stomach slides upward through the opening in the diaphragm — is commonly found alongside GERD because it separates the two components that normally reinforce the barrier at the junction. The relationship is not one-to-one, though: plenty of people have a small hiatal hernia and no reflux symptoms at all, and plenty of people with troublesome reflux have no hernia. Its presence and size mainly matter when surgical treatment is being considered.
Common symptoms
Symptoms are typically worse after meals, when lying flat, or when bending forward.
- Heartburn — a burning sensation behind the breastbone, often after eating
- Regurgitation — acid, fluid, or food coming back into the throat or mouth
- A sour or bitter taste in the mouth
- Chest discomfort that worsens lying down or bending over
- Chronic dry cough, especially at night
- Hoarseness or a persistently sore throat in the morning
- The sensation of a lump in the throat
Less common symptoms
- Difficulty or pain on swallowing — an alarm symptom needing evaluation
- Worsening asthma symptoms or wheeze triggered by reflux
- Dental enamel erosion from repeated acid exposure
- Nausea, bloating, or early fullness
- Sleep disruption from nighttime symptoms
Risk factors
- Excess body weight, especially abdominal — raises pressure on the stomach and weakens the barrier
- Hiatal hernia — displaces the sphincter and impairs its function
- Pregnancy — hormonal relaxation of the sphincter plus mechanical pressure
- Smoking — reduces sphincter tone and saliva production
- Large or late meals — lying down with a full stomach is a strong trigger
- Alcohol, and for some people coffee, chocolate, peppermint, and fatty or spicy foods
- Certain medicines including calcium channel blockers, nitrates, some asthma medicines, and NSAIDs
- Delayed stomach emptying, as can occur with long-standing diabetes
- Connective tissue disorders such as scleroderma, which impair esophageal motility
Causes
The central problem is failure of the antireflux barrier at the junction of the esophagus and stomach. Transient inappropriate relaxations of the lower esophageal sphincter account for most reflux episodes; low resting sphincter pressure and hiatal hernia contribute. Once acid enters the esophagus, how long it stays matters — impaired clearance from weak esophageal contractions or reduced saliva prolongs exposure and increases damage.
Raised intra-abdominal pressure from central obesity or pregnancy pushes stomach contents upward, which is why weight change is one of the more effective interventions. Slow stomach emptying keeps the stomach fuller for longer and increases the opportunity for reflux.
How it is diagnosed
Typical GERD is diagnosed clinically; testing is used when symptoms are atypical, refractory, or accompanied by alarm features.
| Test or assessment | What it looks at |
|---|---|
| Clinical assessment and treatment trial | Classic heartburn and regurgitation responding to acid suppression is generally accepted as evidence of GERD without further testing. |
| Upper endoscopy | Direct visualisation of the esophagus and stomach. Indicated for alarm features, poor response to treatment, or to screen for Barrett esophagus in higher-risk people. |
| Ambulatory pH or pH-impedance monitoring | Measures acid and non-acid reflux over 24-96 hours and correlates episodes with symptoms. Considered the reference standard when the diagnosis is in doubt. |
| Esophageal manometry | Assesses muscle function and sphincter pressure, mainly used before antireflux surgery or to exclude motility disorders such as achalasia. |
| Barium swallow | Occasionally used to define anatomy such as a stricture or large hiatal hernia; it is not sensitive for diagnosing reflux itself. |
| Helicobacter pylori testing | Considered in some populations and before long-term acid suppression, since the bacterium is a separate cause of upper gut symptoms and ulcers. |
Treatment overview
Treatment combines behavioural change with acid-suppressing medication, and procedural options for selected people. The categories below describe what is used; any medication choice and dosing is set by your clinician or pharmacist.
Weight and meal-pattern change
Weight loss where relevant, smaller meals, and avoiding eating within three hours of lying down have the best evidence among lifestyle measures.
Positional measures
Raising the head of the bed by 6-8 inches (15-20 cm) with blocks or a wedge, and sleeping on the left side, both reduce nighttime acid exposure.
Antacids and alginates
Provide rapid, short-lived relief. Alginates form a raft over stomach contents and are particularly useful for postprandial symptoms.
H2 receptor antagonists
Reduce acid production and are useful for milder or intermittent symptoms, and sometimes added at night alongside other therapy.
Proton pump inhibitors
The most effective acid suppression available and the mainstay for erosive disease. Used at the lowest effective intensity for the shortest appropriate period, reviewed periodically.
Antireflux procedures
Fundoplication and magnetic sphincter augmentation are options for people with proven reflux who do not tolerate or do not wish to continue long-term medication.
Barrett esophagus surveillance and therapy
Periodic endoscopy for those diagnosed with Barrett esophagus, with endoscopic ablation or resection if precancerous change is found.
Lifestyle considerations
- Stop eating at least three hours before lying down — this is one of the most effective single changes.
- Eat smaller meals rather than large ones, particularly in the evening.
- Raise the head of the bed by 6-8 inches (15-20 cm); extra pillows alone do not work as well.
- Aim for gradual weight loss if you carry excess weight around the middle.
- Identify your own triggers with a food and symptom diary rather than eliminating foods blindly.
- Stop smoking, which lowers sphincter pressure and reduces protective saliva.
- Limit alcohol, especially in the evening.
- Avoid tight waistbands and heavy lifting or bending soon after meals.
Prevention
- Maintain a healthy weight, particularly around the abdomen.
- Keep the last meal of the day earlier and lighter.
- Avoid tobacco entirely.
- Limit alcohol and identify personal dietary triggers.
- Review with your clinician whether any current medicines could be contributing.
- Treat symptoms early rather than tolerating years of untreated reflux, which raises the risk of Barrett esophagus.
Warning signs and when to get help
Signs that need emergency care
If you believe you are experiencing a medical emergency, call emergency services immediately (911 in the United States).
- Chest pressure or pain with sweating, nausea, breathlessness, or pain spreading to the arm or jaw — call emergency services, since heart attack can mimic reflux
- Vomiting blood, or vomit that looks like coffee grounds
- Black, tarry stools
- Food becoming stuck in the esophagus so that saliva cannot be swallowed
- Sudden severe chest pain with vomiting — rarely, esophageal rupture
Signs that warrant a prompt appointment
These are not emergencies, but they are worth a call to your clinician rather than a wait-and-see.
- New or worsening difficulty swallowing, or pain on swallowing
- Unintentional weight loss
- Persistent vomiting
- Symptoms not controlled after several weeks of treatment
- Signs of anemia such as unusual fatigue or breathlessness on exertion
- Needing over-the-counter acid medicines most days for more than two weeks
Questions to ask a healthcare professional
Take these to your next appointment — or build an agenda with the Appointment Prep tool.
- Do my symptoms need an endoscopy, or is a treatment trial reasonable first?
- Am I at risk for Barrett esophagus, and should I be screened?
- How long should I stay on acid-suppressing medication, and how would we step down?
- Could any of my current medicines be making reflux worse?
- Which lifestyle changes are likely to help most in my case?
- Should I be tested for Helicobacter pylori?
- Would an antireflux procedure be reasonable for me?
- What symptoms should prompt me to come back sooner?
Frequently asked questions
How do I tell heartburn from a heart attack?
You often cannot, reliably. Reflux typically burns, follows meals, and eases with antacids, while cardiac pain is more often pressure with exertion, sweating, or breathlessness — but the overlap is substantial. If there is any doubt, treat it as cardiac and call emergency services.
Are proton pump inhibitors safe long term?
They are effective and generally well tolerated. Observational studies have raised questions about kidney disease, fractures, nutrient absorption, and infections, though causation is not established. The usual approach is the lowest effective intensity for the shortest appropriate time, with periodic review rather than automatic repeat prescriptions.
What foods should I avoid with GERD?
Triggers are individual. Common culprits include fatty and fried foods, chocolate, peppermint, coffee, alcohol, citrus, and tomato-based dishes, but blanket elimination is unnecessary. A short food and symptom diary usually identifies your own pattern more accurately.
Does GERD cause cancer?
GERD itself does not, but long-standing acid exposure can lead to Barrett esophagus, which carries a small increase in esophageal adenocarcinoma risk. The absolute risk for most people with Barrett is low, and surveillance endoscopy is used to catch changes early.
Why is my reflux worse at night?
Lying flat removes gravity's help, swallowing and saliva production fall during sleep, and acid stays in contact with the esophagus for longer. Finishing meals three hours before bed and raising the head of the bed both address this directly.
Sources
- NIDDK — Acid Reflux (GER and GERD) in Adults — NIH overview of symptoms, testing, and treatment
- MedlinePlus — GERD — Consumer summary and related procedures
- Mayo Clinic — GERD — Symptom, trigger, and complication reference
- NHS — Heartburn and Acid Reflux — Practical self-care guidance and red flags
Health Captain links to primary public-health and clinical sources so you can read the original material yourself. See our sources policy.