Gastroesophageal Reflux Disease (GERD), also known as acid reflux disease, occurs when stomach acid flows up (refluxes) to the esophagus. The most common GERD symptoms are heartburn, regurgitation, chest pain, throat pain, and trouble swallowing. The easiest way to stop symptoms is by making lifestyle changes, including modifying what you eat. Some people with GERD also take medication to lower the amount of stomach acid.
Spotting the signs of GERD
The most common sign of GERD is experiencing symptoms of heartburn, regurgitation, chest pain, throat pain, or trouble swallowing more than twice a week. Prolonged exposure to damaging stomach acid can also cause a sour taste in your mouth along with a constant cough, sore throat, or hoarse voice. Symptoms that are often called indigestion are all related to acid reflux.
Other health issues can seem similar to acid reflux, including stomach ulcers, heart disease, inflammation of the stomach lining, and cancer of the esophagus. Symptoms that may be a sign that you have a more serious health condition include difficulty swallowing, shortness of breath, feeling lightheaded or dizzy, black tarry stool, persistent or bloody vomiting, and unexplained weight loss. In particular, it is recommended that older people with reflux symptoms have heart disease ruled out first because GERD and heart disease can cause similar complaints. These are all serious diseases, so if you are experiencing these symptoms see your primary care doctor—even if you think it is GERD.
Main Symptoms of GERD
- Heartburn feels like a burning sensation in the middle of the chest or upper abdomen. It usually happens after eating or when lying down.
- Regurgitation of acidic material leading to an acidic or sour taste in the mouth
Other symptoms you may have with GERD
- Bad breath
- Chest pain. Usually, in the center of your chest.
- Nausea and vomiting
- Constant cough. It usually lasts more than four weeks.
- Sore throat
- Hoarse voice
- Trouble swallowing. It might feel like something is in your throat.
- Teeth erosion. Stomach acid that comes back up toward your throat and mouth can cause teeth to wear away, causing tooth pain or tooth decay.
- Trouble sleeping. Pain may interfere with sleep.
- Breathing issues. If you have a respiratory disease like asthma, acid reflux can cause flare-ups.
Understanding the causes of GERD
Acid reflux disease is usually caused by two things: your body making food stay in your stomach and your eating habits.
When you eat, food travels down your food pipe (the esophagus) into your stomach. Typically, a muscle between the esophagus and stomach—the lower esophageal sphincter (LES)—prevents food from coming back up through the esophagus.
When the LES is too relaxed or you're lying down, food can travel in the wrong direction (up, instead of down) into the esophagus, causing symptoms of acid reflux.
Certain foods and even drinks can trigger GERD. Spicy, high-fat foods, along with drinks like alcohol, carbonated drinks like soda, tea and coffee, should be limited. These can weaken the LES and also slow down digestion, causing the food to sit in the stomach longer than usual.
Lifestyle habits that can make acid reflux symptoms worse:
- Smoking cigarettes
- Eating spicy and fatty foods
- Eating large meals
- Eating right before lying down or going to sleep
- Drinking alcohol, soda, coffee, and tea
- NSAID (nonsteroidal anti-inflammatory drugs, such as ibuprofen)
GERD risk factors
Pressure on your stomach, from being pregnant or overweight, can also push food and acid back up into the esophagus.
Even a few pounds overweight can lead to acid reflux. Often, as patients who are overweight and have GERD lose weight, they find they can re-introduce previously cut out foods (red wine, spicy foods) into their diet. —Dr. Shria Kumar
Conditions that increase the risk of GERD:
- Being overweight
- Hiatal hernias (part of your stomach pushes up toward your chest)
- Connective tissue disorders (like scleroderma)
- Gastroparesis (your stomach has trouble emptying)
If you often have heartburn or symptoms are severe, talk to your primary care doctor. Other reasons to get in touch with your doctor:
- Losing weight
- Pain when you swallow or after you eat. Your doctor may want to rule out other diseases.
- Have a parent, sibling, or another close relative who had cancer of the esophagus, stomach, or intestines
- Symptoms that do not improve despite lifestyle modifications and OTC medications
Go to the ER or call 911 if:
- Having chest pain
- Food gets stuck in your throat
- Blood in stool or vomit
How GERD is treated
For many people, changing some habits (especially related to eating) and taking over-the-counter (OTC) antacids, like Tums, relieve symptoms.
But you still may need prescription medication to get GERD under control. Medications can lower the amount of acid your stomach produces. Depending on the severity of your symptoms or disease, your doctor may prescribe a lower or higher dose and on follow-up, may step up or step down your therapy depending on how you respond to these medications.
Most people with acid reflux get it under control. And may even stop taking acid suppression medication. Lifestyle changes—not eating within 3 hours of bedtime, modifying diet, and weight loss—can address the majority of symptoms. Use a diary to identify if particular foods trigger your symptoms. —Dr. Kumar
- Eat smaller meals.
- Avoid spicy, fatty, and fried foods.
- Don't lie down or go to sleep soon after eating (wait a minimum of three hours).
- Lose weight if overweight.
- No smoking cigarettes.
- Wear loose clothing to avoid pressure on your stomach.
- If you are taking antacid medications, let your doctor know so they can make sure you are taking them correctly.
- OTC antacids
- Proton pump inhibitors (PPI) and Histamine H2-receptor antagonists (H2 blockers) —available over the counter and by prescription (certain formulations or strengths are only available by prescription)—help decrease the amount of acid in the stomach. PPIs are a step-up from H2RA and are the most potent medications that decrease acid secretion in the stomach.
- Famotidine 20 mg twice daily
- Cimetidine 400 mg twice daily
- Nizatidine 150 mg twice daily
- Pantoprazole 40 mg daily
- Lansoprazole 30 mg daily
- Omeprazole 20 mg daily
- Esomeprazole 20 mg daily
- Rabeprazole 20 mg daily
- Dexlansoprazole 30mg daily
While GERD itself is not usually serious, when the esophagus is repeatedly exposed to acid it can eventually lead to other serious problems like narrowing of the esophagus, inflammation or ulcers, Barrett’s esophagus (when the cell lining of the esophagus changes due to acid exposure), and esophageal cancer
If GERD does not go away with medication and lifestyle changes, you might need surgery. Most likely, a Nissen Fundoplication, which tightens the sphincter muscle.
It is often recommended to people who have large hiatal hernias—where the upper part of the stomach bulges through an opening in the diaphragm.
Surgery is no longer the only option after lifestyle changes and medical therapy fail. A new endoscopic procedure—transoral incision-less fundoplication (or TIF)—offers a non-surgical approach. It’s currently best for a very select group of individuals. And only certain advanced endoscopists perform it. But it may become more prominent in the future. —Dr. Kumar
Statistics on GERD
GERD is a fairly common condition found in both children and adults. According to a 2018 study published in the Journal of Neurogastroenterology and Motility, 18% to 27% of people in North America live with GERD.
60% of GERD patients had less than 6 doctor visits: 22% had 1 doctor’s visit, 16% had 2 doctor’s visit, 11% had 3 doctor’s visits
Your doctor may ask about your symptoms and lifestyle; examine your abdomen, chest, and lungs; run diagnostic and lab tests; and recommend OTC or prescription drugs. Your doctor may schedule a follow-up to monitor your symptoms. If your symptoms improve, they may try to taper you off your medication. Or, if your symptoms do not improve, you may need further testing like an endoscopy and more follow-up visits.
11% of patients with GERD were treated at the ER
While mild GERD usually does not require going to the ER, when you have pain in the chest area, feel like you’re choking, notice blood in your stool, or are forcefully vomiting, you should get immediate medical attention.
45% of GERD patients had an imaging procedure performed
Doctors may order imaging to check for anatomical abnormalities in the esophagus or stomach or to see if there is food in your lungs (due to aspiration). Of the patients that had imaging procedures performed, 58% needed only one imaging procedure.
Dr. Dasani is a resident physician at Penn and Brigham and Women's Hospitals. She graduated from Columbia University in 2013 with a BA in Neuroscience and Behavior. Upon graduation, she served as a Fulbright scholar on the island, Bangka, Indonesia. After her Fulbright, she pursued a MD/MBA at Penn during which she worked on various health care consulting projects solving problems across multiple sectors of the health care system. She is currently a medicine resident physician at Penn and is planning to continue her anesthesia training at Harvard starting in July 2020. She is primarily interested in increasing the efficiency of health systems delivery with attention to patient safety, specifically within the perioperative realm.