Gastroesophageal Reflux Disease (GERD): Your GoodRx Guide

Definition

Gastroesophageal reflux disease (GERD) is a very common medical condition that affects about 20% of people. Sometimes people simply refer to it as “acid reflux” or “heartburn.” GERD happens when acid from the stomach travels back up — or “refluxes” — into the food pipe (esophagus).

Normally, there’s a tight muscle (a “sphincter”) at the end of the esophagus that squeezes shut to prevent stomach contents from going backward during digestion. Sometimes that muscle doesn’t close the way it should — and stomach contents can get back into the esophagus and cause irritation and discomfort. 

Many people with symptoms of GERD may think they have a stomach ulcer, but these are actually two different conditions with different causes. Stomach ulcers are small sores that develop from erosion of the stomach lining, and they don’t typically cause chest discomfort.

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Causes

Anyone, at any age — even children and babies — can have GERD. And it can happen for many different reasons. 

In many cases, reflux is related to diet. Well-known foods that can cause reflux include heavy, spicy, or greasy foods —  but others can cause it, too. Foods that might increase the acidity in your stomach — like oranges, grapefruit, lemons, or tomatoes and tomato-based sauces — can make reflux worse. Other foods, like chocolate or peppermint, can lead to reflux because they tend to relax the muscle that separates the esophagus from the stomach. Alcohol use, and in some cases carbonated drinks, can also lead to symptoms for some people.

Besides food, other factors and medical conditions may increase the risk of GERD:

• Obesity

• Pregnancy

• Smoking or exposure to smoke

• Hiatal hernia, a condition where the upper part of the stomach bulges up into the chest

• Asthma

• Meals or snacks too close to bedtime 

Certain medications can also lead to GERD symptoms, including: 

• Benzodiazepines

• Nonsteroidal anti-inflammatory drugs (NSAIDs)

• Calcium channel blockers

• Tricyclic antidepressants

• Asthma medications

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Symptoms

Common symptoms of GERD include:

• A burning sensation or pain in the middle of the chest

• Nausea

• Difficulty or pain with swallowing

• Belching

• Food coming back up or tasting acid

• Chronic cough

• Laryngitis or hoarseness

Symptoms of GERD can be a bit different for different people. Some experience more pain or burning. Others don’t have pain but instead develop a cough or experience belching.

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Diagnosis

A good place to start is having a conversation about your symptoms with your primary care provider. Often, your symptoms — along with a physical exam — can be enough to make a diagnosis of GERD. If you notice a pattern of symptoms, like if they happen after eating certain foods or at certain times of day, it can be helpful to keep a food diary so you can show your provider. Like we mentioned, some foods are much more likely to cause symptoms than others.

Sometimes, your primary care provider may refer you to a gastroenterologist for further medical evaluation. Gastroenterologists can perform an esophagoduodenoscopy (EGD), a procedure in which they use a small camera to look inside your esophagus, stomach, and the first part of your intestine. Seeing the inside of the stomach and esophagus can help confirm the diagnosis of GERD or determine if there are other causes for your symptoms.

Occasionally, you may need to undergo other diagnostic tests. Examples of these include:

• X-rays of the upper GI tract to show what happens to food when you swallow

• Esophageal pH testing to see how much acid there is in your esophagus

• Esophageal motility tests to look at how the esophagus move

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Medications

There are different types of medications that can help with GERD symptoms. Medications commonly used to treat GERD are antacids, H2 blockers, and proton pump inhibitors.

Over-the-counter medications like antacids can temporarily relieve your symptoms. Examples of these medications include calcium carbonate (Tums) and Maalox. These medications work well for mild symptoms or rare episodes of acid reflux. If you find that you need to use these medications daily, or even 2 to 3 times a week, you should talk with your healthcare provider about your symptoms.

Medications that providers commonly prescribe for GERD include:

• H2 blockers prevent histamine from stimulating the stomach to produce acid. These medications are common in the early treatment of acid reflux or for mild cases. Examples of H2 blockers include famotidine (Pepcid AC) and cimetidine (Tagamet HB).

• Proton pump inhibitors decrease the amount of acid that the stomach produces. Providers often prescribe these medications if H2 blockers don’t work, or in more severe cases of acid reflux. Examples include omeprazole (Prilosec) and Protonix (pantoprazole). 

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Treatments

Although providers often recommend medications as a treatment for GERD, diet can also help improve symptoms. Common recommendations for diet changes include:

• Avoiding or minimizing trigger foods

• Eating less greasy or spicy foods

• Not eating within 2 hours of bedtime

Lifestyle changes — like stopping smoking, getting regular exercise, and losing weight — may also help relieve GERD. In some cases, people with GERD no longer needed their medications after they lost 10 to 15 pounds.

Other recommended lifestyle changes include:

• Raising the head of the bed by 6 to 10 inches with a wedge under the mattress

• Avoiding tight clothing

• Avoiding lying down within 2 hours of eating

• Avoiding or lowering alcohol use

Sometimes, if symptoms don’t improve with lifestyle changes or treatment, people elect to have surgical treatment. Surgery for GERD involves making the connection between the stomach and esophagus stronger, so that stomach contents can’t go back up. Talking about your symptoms and concerns with your primary healthcare provider, a gastroenterologist, and a surgeon can help you decide if surgery may be right for you. 

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Risks

If you have GERD, it’s important to get treatment not only to relieve symptoms, but because untreated GERD can have long-term consequences. Over time, when the lining of the esophagus is repeatedly exposed to stomach acid, it can change the tissue that makes up the lining. This is known as “Barrett’s esophagus,” which is a risk factor for developing esophageal cancer. But the good news is that treating GERD can reduce the acid in the esophagus and decrease the risk of developing Barrett’s esophagus and esophageal cancer.

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