What Is GERD?

• Acid indigestion
• Acid reflux
• Acid regurgitation
• Heartburn
• Reflux or atypical reflux

Signs and Symptoms of GERD

“GERD has increasingly become a personalized disease,” says Abraham Khan, MD, a gastroenterologist and the director of the Center for Esophageal Health at NYU Langone Health in New York City. Not everyone with GERD has the same underlying causes, symptoms, or amount of injury to the esophagus or aerodigestive tract, he says.

Still, there are some typical telltale signs of GERD.

The most common symptom of GERD is frequent heartburn, which is a painful, burning sensation in the middle of your chest. “Usually, if the heartburn is mild and less than two times a week, it is considered mild GERD,” says Saleem Chowdhry, MD, a gastroenterologist with University Hospitals in Westlake, Ohio. “Symptoms more than two times a week, and where there is concern for inflammation in the esophagus, are considered moderate or severe GERD.”

• Chest pain
• Regurgitating your stomach’s contents
• Cough or hoarseness
• Bad breath
• Nausea and vomiting
• Sore throat or an irritated feeling in your esophagus

Causes and Risk Factors of GERD

• Eating a large meal
• Eating certain foods, including those high in fats and fried foods
• Increased pressure on the abdomen from being overweight, obese, or pregnant
• Side effects from certain medications, such as aspirin
• Smoking
• Having a hiatal hernia, in which the opening of the diaphragm allows the upper part of the stomach to move up into the chest. This lowers the pressure in the esophageal sphincter.

• Consuming alcoholic, caffeinated, or carbonated beverages
• Eating certain foods, such as chocolate, citrus fruits, onions, peppermint, tomatoes, or spicy or fried foods
• Eating large meals
• Eating soon before going to bed
• Lying flat soon after eating
• Taking certain medicines, including non-steroidal anti-inflammatory drugs (NSAIDs) and certain drugs for asthma, high blood pressure, allergies, depression, sleep disorders, and pain

How Is GERD Diagnosed?

Diagnosing GERD is primarily based on the symptoms you have and how often you have them. There’s no hard and fast rule about how frequently they have to occur.

“Some epidemiologic studies would suggest clinically significant symptoms would be at least twice a week, but some studies include patients with GERD as having symptoms only as often as once a month,” Khan says.

• Upper Endoscopy This test involves your doctor inserting a thin tube with an attached light and camera down your throat. This allows examination of your esophagus and stomach to detect inflammation or any other complications.
• Ambulatory Acid (pH) Probe Test This test involves placing a 24-hour probe in the esophagus to determine when (and for how long) stomach acid regurgitates there. The monitor connects to a small computer worn around your waist and might be a thin tube (called a catheter) that’s threaded through the nose into the esophagus that you go home with. Sometimes the monitor is a clip placed in the esophagus during an endoscopy and passes in your stool after two days.
• Esophageal Manometry This procedure measures muscle contractions during swallowing. It can help your doctor determine whether your symptoms are due to a weak sphincter muscle. This is often done when the 24-hour probe is placed.
• Upper Digestive System X-Ray Taken after you drink a chalky liquid, this procedure will allow your doctor to see a silhouette of your esophagus, stomach, and upper intestine. You may also be asked to swallow a barium pill to check for a narrowing of the esophagus or other conditions like hiatal hernias or ulcers.

Treatment and Medication Options for GERD

Medication Options

• Antacids These neutralize stomach acid and offer quick but mild relief. Overuse of antacids can cause side effects, including diarrhea, constipation, and kidney problems.
• H-2-Receptor Blockers These reduce acid production and provide longer relief than antacids, though they may not work as quickly. They may reduce acid production from the stomach for up to 12 hours.
• Proton Pump Inhibitors Called PPIs, also suppress stomach acid and have been most closely associated with healing inflammation of the esophagus caused by reflux.

Surgery Options

• Fundoplication In this minimally invasive procedure, a surgeon sews the top of the stomach around the esophagus. This adds pressure to the lower end of the esophagus to prevent reflux.
• LINX Device Another minimally invasive procedure, this involves a ring of tiny magnetic beads that is wrapped around the area where the stomach and esophagus meet. The magnetic attraction among the beads is strong enough to prevent reflux but weak enough to allow food to pass.
• Transoral Incisionless Fundoplication (TIF) In this newer procedure, the lower esophagus is tightened via a nonsurgical approach. TIF is performed using an endoscope inserted through the mouth and doesn't require a surgical incision.

Lifestyle Changes and Prevention of GERD

• Avoiding foods and beverages that trigger GERD, including alcohol, caffeine, fatty foods, spicy foods, peppermint, citrus fruits, tomatoes, and carbonated beverages
• Sitting upright while eating
• Eating at least three hours before bedtime
• Maintaining a healthy weight
• Eating foods slowly
• Quitting smoking
• Not wearing tight-fitting clothing
• Not lying down after a meal
• Elevating the head of your bed

How Long Does GERD Last?

How long a person lives with GERD is also very dependent on the individual. “Some patients with dietary adjustments can reverse the triggers leading to GERD,” Khan says. “Others, if overweight, will need to lose weight to alter the pressure dynamics of the upper GI tract and reverse the reason for reflux. But others, even with appropriate diet and lifestyle habits for GERD, cannot significantly reverse the reflux they have.”

Complications of GERD

• Esophageal Stricture This is a narrowing of the esophagus that happens when damage from stomach acid causes a buildup of scar tissue. Also known as a peptic stricture, this condition can cause problems with swallowing.
• Esophageal Ulcer This is an open sore in the esophagus, caused by tissue damage from stomach acid. It can lead to pain, bleeding, and problems with swallowing.
• Barrett’s Esophagus This is a precancerous condition in which the lining of the esophagus changes to one that more closely resembles the lining of the intestines. Barrett’s esophagus increases your risk of esophageal cancer by a factor of about 30.
• Esophageal Cancer This cancer can arise from years of untreated GERD.

The Takeaway

• Gastroesophageal reflux disease is a commonly diagnosed chronic condition that occurs when a person's stomach contents flow back up to the esophagus.
• Symptoms can manifest as chest pain, sore throat, bad breath, nausea, and more.
• Getting a diagnosis for GERD may involve an endoscopy, pH testing, digestion X-ray, esophageal muscle testing, or other methods.
• Depending on the severity of the condition, doctors may recommend medications or surgical procedures. Lifestyle changes to diet and eating habits can help mitigate GERD episodes.