What is Gastroesophageal Reflux Disease (GERD)?

By Zina Semenovskaya, MD
Medically reviewed checkmarkMedically reviewed
January 18, 2022

Your digestive tract includes a small muscle called the lower esophageal sphincter (LES).

When this muscle inappropriately relaxes after you eat, stomach acid can flow back up into your esophagus.

This is called acid reflux, and it can result in uncomfortable heartburn symptoms.

Heartburn is quite common, and anyone can experience it.

But in some cases, acid reflux can become chronic and severe, and you can develop a condition called gastroesophageal reflux disease, or GERD. 

If you experience heartburn on a regular basis and medication doesn’t help to resolve it, it’s possible you have GERD.

Treating GERD is important because it can help prevent long-term damage to your esophagus.

Fortunately, a combination of medication and lifestyle changes can relieve GERD symptoms.

In severe cases, a doctor might recommend surgery. 

In this article, I’ll explain more about GERD, including its symptoms, causes, and stages.

I’ll tell you how it’s diagnosed, how it’s treated, and how you can prevent GERD.

I’ll also share some risks and warnings about this condition, and tell you when you should see your doctor.

What is GERD? 

Gastroesophageal reflux disease, also called GERD, is a chronic condition that occurs when stomach acid frequently backs up into your esophagus, the tube that connects your mouth and stomach.

This backed-up stomach acid is known as acid reflux. It can cause uncomfortable symptoms, including heartburn. 

It’s common for people to experience heartburn or acid reflux on occasion.

But if you have persistent heartburn due to acid reflux, and it doesn’t go away when you treat it with medication, you may have GERD.

Gastroesophageal reflux disease can range from mild to severe, and the risk of developing complications are higher if you don’t seek treatment. 

Acid reflux vs. GERD vs. heartburn

While some people use these terms interchangeably, acid reflux, GERD, and heartburn are not the same.

Acid reflux is what happens when your lower esophagus sphincter relaxes, allowing stomach acid to back up into your esophagus.

Heartburn, which feels like burning behind your breastbone, is a symptom of acid reflux.

GERD is a chronic condition that occurs when people have frequent acid reflux.

It may require lifestyle changes, medication, or both to manage. 

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GERD Symptoms

The most common symptom of GERD is heartburn.

But because it’s often more persistent and severe than typical acid reflux, GERD can also come with other symptoms: 

  • A burning feeling in your chest, typically after eating
  • Heartburn that’s worse at night
  • Chest pain 
  • Difficulty swallowing
  • A feeling that there’s a lump in your throat 
  • Regurgitating food
  • A sour or bitter taste in your throat 
  • Chronic dry cough 
  • Nausea
  • Belching
  • Disrupted sleep 
  • New or more severe asthma 

If you have GERD, you may have some or all of these symptoms.

Either way, it’s important to talk to your healthcare provider if you suspect you have GERD.

Your clinician can recommend the right path forward to relieve your symptoms and protect your health if you’re diagnosed. 

GERD Causes

In general, GERD results from chronic acid reflux, which occurs when your lower esophageal sphincter inappropriately relaxes, allowing stomach acid to back up into your esophagus.

This can occur due to mechanical and anatomic issues, hormonal changes, or the influence of certain foods, like spicy or fatty meals.

Certain medical conditions and lifestyle choices can increase a person’s risk for experiencing GERD: 

  • Being overweight 
  • Pregnancy 
  • A hiatal hernia (when the top of your stomach bulges into your diaphragm)
  • Connective tissue disorders, including scleroderma
  • Gastroparesis (delayed stomach emptying)
  • Smoking 
  • Drinking alcohol or coffee 
  • Medications, including aspirin 
  • Eating large meals 
  • Eating too close to bedtime
  • Eating heartburn-inducing foods, such as fried food or fatty food

If you have GERD, your doctor may recommend limiting preventable risk factors to help manage your symptoms.

Or if you have a health condition that’s resulting in GERD, the provider might recommend addressing that issue in addition to treating your symptoms. 

GERD Stages

GERD can be classified into four different categories, from mild to severe:

Stage 1: Mild GERD

Mild GERD occurs once or twice a month, and it doesn’t usually impair a person’s daily routines. It can usually be managed by basic lifestyle changes, avoiding foods that cause heartburn, and taking over-the-counter heartburn medications as needed. 

Stage 2: Moderate GERD

Moderate GERD occurs when someone has acid reflux symptoms so frequently that they need a prescription medication to prevent and manage heartburn. People with moderate GERD may have a more difficult time with day-to-day functions like eating and sleeping because they’re so uncomfortable. 

Stage 3: Severe GERD

Severe GERD results in significant discomfort and pain that doesn’t resolve even when a person takes a prescription medication. Severe GERD also heightens the risk of developing more serious medical problems, including esophageal cancer. A healthcare provider may suggest correcting the problem surgically. 

Stage 4: GERD-induced lesions or cancer

Over time, stomach acid from severe GERD can cause long-term damage to the esophagus, including ulcers and narrowing of the esophagus. Another serious condition caused by untreated GERD symptoms is called Barrett’s esophagus. If this issue is not addressed, it’s possible that the lesions on the esophagus can result in esophageal cancer. 

GERD Diagnosis

Because GERD symptoms can be uncomfortable and even lead to long-term damage of the esophagus, it’s important to seek a proper diagnosis from a healthcare provider or talk to a K doctor.

Your doctor will likely ask questions about your symptoms, lifestyle, and health history to determine if you have GERD.

To formally diagnose you or determine if your GERD symptoms have resulted in damage, your provider may also want to conduct a test. 

Tests for diagnosing GERD 

  • An upper endoscopy: During an upper endoscopy, a doctor puts a thin tube with a light and a camera down your throat to look closely at your esophagus and stomach. This is done under sedation. The endoscope may reveal reflux, but a GERD diagnosis is more likely if you have inflammation in your esophagus area. An upper endoscopy can also help your doctor take a tissue sample if they’re concerned about Barrett’s esophagus.
  • Esophageal manometry: During this test, your doctor measures the muscle contractions in your esophagus when you swallow, as well as the strength and coordination of your esophageal muscles.
  • X-ray: With an X-ray of your upper digestive tract, your doctor can see the silhouette of your esophagus, stomach, and upper intestine to determine if there’s any damage to them, or see any other issues that may be contributing to GERD. An X-ray can also help your doctor diagnose esophageal narrowing that can cause problems with swallowing.
  • Ambulatory acid (pH) probe test: This test helps your doctor understand when and for how long stomach acid backs up into your esophagus. In this test, the doctor puts a thin catheter into the nose and down the esophagus. This catheter is connected to a small computer worn around the patient’s waist. An ambulatory acid (pH) probe test can also be conducted with a small clip inserted into your esophagus through an endoscopy. The clip passes through your stool, usually in about 48 hours. 

GERD Treatment

If you’re diagnosed with GERD, your healthcare provider will determine the best way to manage your acid reflux symptoms to minimize your discomfort and prevent long-term damage to your esophagus.

Depending on how severe your reflux is, your provider may recommend over-the-counter or prescription medication, diet and lifestyle changes, a surgical procedure, or a combination of those treatments. 

GERD Medications 

Both over-the-counter and prescription medications can help manage acid reflux symptoms caused by GERD.

Some of the most common drugs for GERD include: 

  • Antacids: Tums, Maalox, and Rolaids help neutralize stomach acid and relieve heartburn symptoms. 
  • H-2 receptor antagonists (H2RAs): The medications, including famotidine (Pepcid AC, Pepcid Oral, and Zantac 360), can reduce the amount of stomach acid your body produces. H2RAs don’t work as fast as antacids, but are more likely to help in the long term. 
  • Proton pump inhibitors (PPIs): PPIs also work to reduce stomach acid. They can be especially effective when antacids or H2 blockers haven’t worked. Recently, some PPIs have become available OTC, including esomeprazole (Nexium) and omeprazole (Prilosec). Other PPIs, like rabeprazole (AcipHex), are only available with a prescription. Research shows that long-term use of PPIs can lead to kidney problems, including kidney failure. Experts recommend using PPIs only when necessary and not as a regular medication.

Each of these medications are available over-the-counter, but if your GERD is severe enough, your provider may recommend these types of drugs as prescriptions, which are often given in higher doses. 

In the event you have severe GERD, your doctor may prescribe Baclofen, a drug that helps to reduce the relaxations of the lower esophageal sphincter that result in stomach acid entering the esophagus.

Diet and lifestyle changes for GERD

Along with medication, your doctor might recommend simple lifestyle changes to relieve GERD symptoms and prevent long-term damage. These may include: 

  • Maintaining a healthy weight 
  • Avoiding alcohol 
  • Quitting smoking 
  • Avoiding large meals
  • Sitting upright while you eat, and remaining that way for 60 minutes after 
  • Eating food more slowly 
  • Chewing food thoroughly 
  • Not eating too close to bedtime 
  • Avoiding tight-fitting clothing that causes pressure on your abdomen or chest 
  • Avoiding foods that cause you to get heartburn 
  • Elevating your head in bed to prevent reflux

Home remedies for GERD—such as eating ginger, sipping herbal tea, or sucking on a peppermint candy—may also soothe symptoms. Keep in mind that peppermint can also make heartburn worse in some people. 

Surgery for GERD

Most of the time, medication and lifestyle changes are enough to control GERD.

But if your doctor is concerned about the health implications of your GERD, or it’s not advisable for you to be on medication long-term, they may talk to you about a surgical procedure.

These three surgeries are the most common procedures for GERD patients: 

  • Fundoplication: In this procedure, a surgeon tightens your lower esophageal sphincter (LES) by wrapping the top of your stomach around it. This is often done via laparoscopy, a thin, lighted tube with a camera that is put into the body via a tiny cut or incision. For this reason, fundoplication is considered a minimally invasive procedure. Sometimes, fundoplication is done with an incision. 
  • Transoral incisionless fundoplication (TIF): A newer type of surgical procedure, TIF tightens the LES with polypropylene fasteners. It’s performed via a tube inserted through your mouth, so there’s no surgical incision.
  • LINX device: This ring of small, magnetic beads is wrapped around the area where your stomach and esophagus meet by a surgeon. With the LINX device in place, stomach acid can’t pass through as easily, but it’s still possible to eat. Like fundoplication, LINX implantation is considered a minimally-invasive procedure. 

Each surgical procedure for GERD comes with its own benefits and risks. Your doctor can help determine if you’re a candidate for surgery and, if so, which surgery is most likely to help you. 

GERD Prevention

Along with reducing your personal risk for developing GERD, it’s also possible to prevent bothersome GERD symptoms by scaling back on the foods and drinks you know contribute to your heartburn.

You may not always be able to control what you eat, but decreasing these foods in your routine may help you feel better and protect your overall health: 

Foods to avoid 

  • Citrus fruit and juice, including orange, grapefruit, lemon, and lime
  • Tomato products such as tomato sauce, salsa, and ketchup 
  • Carbonated drinks
  • Alcoholic beverages, especially red wine
  • Coffee and other caffeinated beverages
  • Chocolate
  • Peppermint 
  • Full-fat dairy products, such as milk, cheese, and butter
  • Dairy desserts, such as ice cream 
  • Garlic 
  • Onion
  • Black pepper
  • Fatty foods, including dairy and fatty meats like bacon and sausage
  • Deep-fried foods, such as french fries 
  • Spicy foods
  • Foods high in salt
  • Fast food

Because many of these foods—particularly greasy, fried foods and those high in salt—can negatively impact your health in other ways, you may also indirectly reduce your risk for GERD by changing your diet.

It’s possible that other foods can trigger acid reflux.

To better identify what contributes to your heartburn symptoms, keep a daily log of what you eat and drink and whether or not you experience pain or discomfort from acid reflux.

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GERD Risks and Warnings

Ongoing exposure to stomach acid can cause irritation and inflammation in the esophagus.

This is known as esophagitis. If GERD is not treated, people can develop other medical conditions due to this inflammation, such as: 

  • Esophageal stricture: When the lower esophagus is damaged due to stomach acid, scar tissue can form on it. This narrows the food pathway and can cause problems with swallowing and moving food down into your stomach.
  • Esophageal ulcer: Stomach acid can damage tissue on the esophagus, causing an open sore called an ulcer. Esophageal ulcers can cause severe pain, bleeding, and difficulty swallowing.
  • Barrett’s esophagus: Stomach acid damage can cause changes in the lower esophageal tissue lining, including the formation of precancerous cells called Barrett’s esophagus. These changes increase a person’s likelihood of developing esophageal cancer. 

If you have acid reflux on a regular basis and think it may be GERD, talk to a healthcare provider so they can diagnose you and recommend treatment.

How K Health Can Help 

Manage acid reflux online using K Health for just $29 per month.

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  2. Meet your provider.
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Frequently Asked Questions

Can GERD worsen or cause asthma?
Yes. Gastroesophageal reflux disease (GERD) can worsen existing asthma or even cause new asthma in a person who’s never had it. Experts aren’t totally clear on why this happens, but difficulty breathing or other asthma symptoms are typically more common in people with severe GERD.
How do I differentiate between GERD and a heart attack?
GERD can cause significant discomfort in your chest, where your esophagus is, so it’s important to differentiate between acid reflux and a cardiac event like a heart attack. If you’re having a heart attack, you may also experience other symptoms, such as crushing chest pain, difficulty breathing, pressure in your neck, jaw, or back, nausea, fatigue, shortness of breath, cold sweat, or dizziness. If you think you may be having a heart attack, call 9-1-1 or go to an emergency room right away.
Can GERD be life-threatening?
Not usually. But untreated, severe GERD can cause long-term damage to the esophagus, including ulcers and a narrowing of the esophagus that can make it difficult to swallow. GERD that’s not treated can even heighten your risk of developing esophageal cancer. If you have GERD, talk to your doctor about how to manage it.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Zina Semenovskaya, MD

Dr. Semenovskaya specializes in emergency medicine, and received her medical degree from Weill Cornell Medical College. She is currently the medical director at Remote Emergency Medicine Consulting, LLC and splits her time working clinically as an emergency medicine attending in California and Alaska. She is the first of our doctors to be fluent in Russian.

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