Gastroesophageal Reflux Disease (GERD) Guide: Symptoms, Diagnosis, and Treatment

What is GERD?

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).

There’s a tight muscle at the end of your esophagus called a “sphincter.” Normally, that muscle squeezes shut to prevent stomach contents from going back up during digestion. Sometimes, though, that muscle doesn’t close the way it should. And stomach contents can get back into the esophagus and cause irritation and discomfort.

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What causes GERD?

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 and make GERD symptoms worse include:

• Oranges 

• Grapefruit

• Lemons 

• Tomatoes

• Tomato-based sauces 

Other foods, like chocolate or peppermint, can lead to reflux. That’s 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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GERD 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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How is GERD diagnosed?

Diagnosing GERD typically begins with having a conversation about your symptoms with a healthcare professional. Often, your symptoms — along with a physical exam — can be enough to make a diagnosis of GERD. 

You may notice a pattern of symptoms. For example, your symptoms might happen after eating certain foods or at certain times of day. If so, it can be helpful to keep a food diary. Like we mentioned, some foods are much more likely to cause symptoms than others.

Sometimes, a healthcare professional may refer you to a gastroenterologist for further medical evaluation. Gastroenterologists can perform an endoscopy of your upper gastrointestinal (GI) tract, known as an esophagoduodenoscopy (EGD). This is 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 it can 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 moves

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Medication for GERD

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 (OTC) 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 a healthcare professional about your symptoms.

Medications commonly prescribed for GERD include:

• H2 blockers: These 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: These decrease the amount of acid that the stomach produces. Healthcare professionals 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 for GERD

Healthcare professionals will recommend medications as a treatment for GERD. However, 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 may also help relieve GERD. Examples of these are stopping smoking, getting regular exercise, and losing weight. In some cases, people with GERD no longer needed their medications after they lost 10 lbs to 15 lbs.

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 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 just to relieve symptoms. That’s 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, and it’s a risk factor for developing esophageal cancer. But the good news is that treating GERD can reduce the acid in the esophagus. And it can decrease the risk of developing Barrett’s esophagus and esophageal cancer.

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