Many of us have had heartburn, aka acid reflux, at one point or another, perhaps as a pregnancy side effect or after eating a bowl of spicy chili. But chronic acid reflux can cross the line into a condition called gastroesophageal reflux disease (GERD). So, what is GERD and what are its symptoms?
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Acid reflux — or heartburn — occurs when stomach acid flows backward into the esophagus, says Jennifer Czwornog, MD, gastroenterologist with UCHealth Gastroenterology Clinic at Cherry Creek Medical Center in Denver.
Heartburn most often feels like a burning sensation in the chest and for some people, it may not be that noticeable.
Occasional, temporary heartburn is normal. But if you're having severe heartburn symptoms on a regular basis, it could be a more serious condition called GERD.
Here's everything you need to know about the condition, including what GERD is and its symptoms, causes, treatments and tips to manage it.
What Is GERD, Exactly?
GERD is more than just occasional heartburn — it can cause painful symptoms and long-term complications. The condition happens because the esophagus doesn't work correctly, allowing stomach acid to flow backward, according to the Cleveland Clinic.
This back flow causes the typical "burning" feeling in the throat or chest and can also lead to coughing or feeling like you have to clear your throat.
Just how serious is GERD? If left untreated, Dr. Czwornog says GERD can lead to complications that may include esophagitis (inflammation of the esophagus), a narrowing of the esophagus that can cause difficulty swallowing or Barrett's esophagus, which is a change in the cells lining the esophagus that increases the risk of esophageal cancer.
That's why it's very important to seek medical help if you have any of the following symptoms.
If you're taking an antacid medicine like Tums three times a week, it's a sign you need to see a doctor, says Atif Iqbal, MD, board-certified general surgeon and medical director of the Digestive Care Center at MemorialCare Orange Coast Medical Center in Fountain Valley, California.
Symptoms of GERD
So, what are GERD symptoms, and are they the same as heartburn symptoms?
Well, the signs of GERD in adults differ quite a bit from regular acid reflux symptoms, Dr. Iqbal says. GERD can range in severity, so some people may only experience one or two GERD symptoms in their throat, while others may have more.
Per the Cleveland Clinic, GERD symptoms include:
- Chest pain
- A feeling of food coming backward
- Discomfort in the upper abdomen
- Difficulty swallowing
- Sour taste of acid in the back of the throat
- Sore throat
Less common GERD signs, sometimes called "silent reflux," are:
- Voice hoarseness
- Constant clearing of the throat
- Coughing that gets worse at night
- Post-nasal drip
These less-obvious symptoms of GERD can make a diagnosis tricky, Dr. Iqbal says. Symptoms like your voice changing, feeling like you have a lump in your throat or constantly clearing your throat may lead someone to visit an ENT doctor for other issues when the underlying problem is actually GERD (which is treated by a gastroenterologist).
Acid reflux can also lead to an increased risk for halitosis, or bad breath, according to an October 2017 study in the Journal of Clinical and Experimental Dentistry. The research links the cause of bad breath to the gases and stomach acids that flow back up into the esophagus, giving you not only a bad taste but odor, too.
This acid reflux can also have a negative affect on your teeth. According to the report, tooth erosion affects as many as 44 percent of people with GERD over the course of the disease.
If you are having frequent or severe heartburn or your symptoms accompanied by other issues like chest pain or unintended weight loss, be sure to tell your doctor as soon as possible, per the Mayo Clinic.
What Causes GERD?
GERD is caused by inappropriate relaxation of the lower esophageal sphincter (LES), which is the muscle at the bottom of the esophagus, per the Cleveland Clinic.
Normally, the LES opens to let food into the stomach and closes to keep the food in. With GERD, however, the LES does not function correctly: It's either too weak, too loose or just doesn't work properly, allowing acid to move from the stomach into the esophagus where it doesn't belong.
There isn't one known cause for GERD. There is a genetic link to the condition, which means it does tend to run in families. And per the Cleveland Clinic and Mayo Clinic, the risk of developing GERD also increases if you:
- Have a hiatal hernia
- Have overweight or obesity
- Are pregnant
- Regularly drink alcohol
- Take certain medications, such as those for allergies, high blood pressure, depression and some painkillers
- Eat a diet with a lot of fat
- Have a condition called scleroderma, which can slow down your digestive system
- Have delayed stomach emptying
How Is GERD Diagnosed?
GERD is commonly diagnosed after a physical exam, history and a series of tests that will look at your sphincter for any signs it's not working correctly, check for the physical presence of stomach acid in your esophagus and possibly assess any damage or changes to your esophageal lining, per the Mayo Clinic.
For example, according to the Cleveland Clinic, some common tests given to diagnose GERD include:
- An upper endoscopy or EGD, in which a camera is placed inside the mouth and into the esophagus and stomach to take a better look
- A BRAVO acid test, which measures the level of acid in your esophagus with a small monitoring device that is placed in your esophagus and worn for 48 hours
- X-rays to your upper GI tract
- Esophageal manometry, in which a small, flexible tube with sensors measures your sphincter's strength and spasms
Treatments for GERD
How you fix GERD depends on how severe the condition is, as well as what's causing it. Treatments may include:
To get relief from heartburn fast, there are many over-the-counter (OTC) medications you can try, Hardeep Singh, MD, a gastroenterologist with St. Joseph Hospital in Orange, California, tells LIVESTRONG.com.
"Tums, which is bicarbonate, may temporarily relieve GERD symptoms, and OTC antacids such as Pepcid can provide quick relief," he says.
There are also over-the-counter and/or prescription H2 blockers and proton-pump inhibitors (PPIs), which both work to reduce the amount of acid produced by the stomach, Dr. Czwornog says.
In some cases, if there is a discernible cause, some people with GERD may undergo surgery. For instance, if the GERD is caused by a hiatal hernia, fixing the hernia can resolve the symptoms.
If it's not a hiatal hernia but symptoms are severe enough, you might undergo a laparoscopic procedure called Nissen fundoplication, which wraps the top of the stomach around the bottom of the esophagus in order to stop the back flow of acid, according to the International Foundation for Gastrointestinal Disorders (IFFGD).
There are also a few emerging surgical therapies for GERD, including the LINX System — a kind of expandable "bracelet" that goes around the bottom of the esophagus to help it close — and transoral incisionless fundoplication (TIF), which is similar to the Nissen procedure but done without an incision, per the Cleveland Clinic.
What About Probiotics for GERD?
Cara Marrs, RD, a registered dietitian nutritionist at UCHealth Yampa Valley Medical Center in Steamboat Springs, Colorado, recommends talking with your doctor about a board-spectrum probiotic supplement to promote overall gut health and help with digestion.
A 2020 review in Nutrients found that taking regular probiotics was associated with a decrease in GERD symptoms, especially the strains Lactobacillus and Bifidobacterium.
Foods to Avoid With GERD
While there's no proven "GERD diet," it may help to make changes to your eating habits and avoid certain foods with GERD, Marrs says.
To help tame GERD symptoms, try limiting or avoiding:
1. Acidic Foods
High-acid foods including citrus, tomatoes, eggplant, coffee and spicy foods can aggravate GERD and bring on the burn.
To take it one step further, Marrs also suggesting cutting out high-histamine foods, including processed meats like salami, aged cheeses like blue cheese, red wine, beer, aged liquors such as Scotch, nuts such as walnuts and peanuts, chocolate, tea (black and green) and energy drinks.
2. Bubbly Beverages
Avoiding alcohol and decreasing your intake of carbonated beverages (think: seltzer, soda) can help manage GERD symptoms.
Caffeinated beverages like coffee and tea may trigger GERD symptoms for some people, per the IFFGD.
If you swap out your daily cup of joe for an herbal tea, just be careful to avoid mint teas, as a June 2017 paper in Primary Care notes that mint can actually make reflux worse because it lowers esophageal sphincter pressure.
4. Dairy Products (for Some People)
Milk is an interesting food with GERD, because for some people, milk creates a "buffer" in the stomach, temporarily relieving heartburn, Marrs says. But milk may make things worse for other people, especially if they have lactose intolerance or a food sensitivity to dairy.
It may be helpful to keep a food diary to better understand how certain foods affect your acid reflux symptoms and avoid any triggers.
July 2017 research in the Journal of Neurogastroenterology and Motility found that people with GERD often say that foods taste and smell differently than they did before they had the condition, which may affect what you do and don't want to eat.
How to Manage GERD
In addition to changing your diet, there are also lifestyle changes you can make that will help manage symptoms of acid reflux, per the Cleveland Clinic. These include:
- Not eating two hours before bedtime
- Not lying down after meals
- Sleeping with your head elevated
- Losing weight if you have overweight
- Quitting smoking
- Deceasing gum chewing
- Eating smaller portions
Quitting smoking has been found to both reduce GERD symptoms and improve other health factors, according to February 2016 research in PLOS One.
Weight loss alone can also have a significant affect on GERD symptoms. A 2014 study in Obesity found that losing weight even completely resolved GERD in some people.
Remember: It may be perfectly normal to experience a bit of heartburn after that slice of pepperoni pizza, but acid reflux that occurs more than two to three times per week is not normal and does warrant a visit to your health care provider for evaluation.
Can GERD or Acid Reflux Happen on an Empty Stomach?
While GERD symptoms often occur after eating too much or too fast, you can actually experience symptoms like heartburn or acid reflux on an empty stomach. That's because there's always acid in the stomach, even when it's empty, Dr. Singh says.
While an empty stomach doesn't make heartburn worse per se, if you notice that your acid reflux symptoms worsen when your stomach is empty, it may be helpful to eat small meals comprised of non-triggering foods throughout the day.
Because remember, eating too much at once may also aggravate GERD, even if you were experiencing acid reflux from an empty stomach.
- Primary Care: “Integrative Medicine for Gastrointestinal Disease”
- Nutrients: “Gastroesophageal Reflux Disease and Probiotics: A Systematic Review”
- The International Foundation for Gastrointestinal Disorders: "About GERD"
- Obesity: "Weight Loss Can Lead to Resolution of Gastroesophageal Reflux Disease Symptoms: A Prospective Intervention Trial"
- PLOS One: "Long-Term Benefits of Smoking Cessation on Gastroesophageal Reflux Disease and Health-Related Quality of Life"
- International Foundation for Gastrointestinal Disorders: "Surgical Treatments: About GERD"
- Cleveland Clinic: "GERD (Chronic Acid Reflux)"
- Mayo Clinic: "Gastroesophageal reflux disease (GERD)"
- Journal of Clinical and Experimental Dentistry: "Oral manifestations of gastrointestinal disorders"
- Journal of Neurogastroenterology and Motility: "Taste and Smell Disturbances in Patients with Gastroparesis and Gastroesophageal Reflux Disease"
- Johnson & Johnson: "LINX® Reflux Management System"
- Johns Hopkins Medicine: "Transoral Incisionless Fundoplication (TIF)"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.