What Is GERD?

Gastroesophageal reflux disease (GERD) is a chronic and common condition where stomach acid flows back into the mouth through the esophagus. This can cause symptoms such as heartburn or acid indigestion, trouble swallowing, and the feeling of food being trapped or stuck in the esophagus. Certain risk factors and conditions can worsen GERD. Fortunately, GERD is manageable and treatable.

This article details what you need to know about symptoms of GERD, what causes GERD, which specific conditions can worsen GERD, how to go about getting a diagnosis for GERD, and what treatments for GERD are available. You’ll also learn when GERD causes complications, and when to see a healthcare provider for GERD. 

Symptoms of GERD

Main symptoms of GERD include persistent acid reflux or acid regurgitation and heartburn. However, some people can experience GERD without heartburn. Occasional heartburn and acid reflux are normal, but when symptoms are persistent or more frequent, they may be signs of chronic acid reflux (GERD).

Several other symptoms are associated with GERD, including:

• Chest pain
• Trouble swallowing or feeling like something is caught in the throat
• Burning sensation in the back of the throat
• Voice hoarseness upon waking 
• Choking feeling or feeling like your throat is tight
• Dry cough 
• Bad breath

Symptoms for Infants and Children

In infants and children, symptoms of GERD include spitting up or regurgitating food. Other symptoms can include:

• Irritability
• Appetite loss or refusing to eat
• Weight loss or inadequate weight gain
• Vomiting
• Cough or wheezing

GERD is more common in premature infants and infants with certain health conditions.

What Causes GERD?

GERD is generally associated with a weakened esophageal sphincter, the valve-like muscle involved in swallowing. It functions by closing tightly after food passes through. If weakened, it can no longer close as tightly and digestive acid from the stomach starts to backtrack up through the valve, into the esophagus, and into the mouth.

There are many reasons why your esophageal sphincter can weaken, including having risk factors for GERD and being exposed to dietary acid reflux triggers.

Risk Factors for GERD

Risk factors make someone more likely to develop a certain health condition like GERD. In some cases these factors can be reduced with diet or lifestyle changes. 

Factors that can increase your likelihood of experiencing GERD are:

• Having obesity or excess weight, which applies excess pressure on abdomen 
• Taking certain medications in which acid reflux is a side effect (common ones include blood pressure medications and antidepressants) 
• Smoking (and secondhand smoke), which causes irritation of the digestive tract

Dietary Acid Reflux Triggers

Common dietary acid reflux triggers include: 

• Deep-fried foods 
• Fast foods, including pizza
• Processed snack foods, including potato chips and chocolate treats
• Spicy food and herbs and spices like chili powder, pepper (black, red, white, cayenne), peppermint
• Fatty and processed meats such as bacon and sausage
• Cheese

Additionally, some people find tomato-based sauces, citrus fruits or fruit juices and carbonated beverages can also trigger GERD symptoms.

Conditions That May Worsen GERD

Several conditions are associated with worsening GERD symptoms. These include conditions affecting how you digest food and how you breathe.

Conditions that may make GERD worse include:

• Being born prematurely 
• Lung conditions like cystic fibrosis, asthma, or chronic obstructive pulmonary disease (COPD)
• Being pregnant
• Anxiety disorder
• Nervous system disorders such as cerebral palsy
• Hiatal hernia in which the upper part of the stomach pushes through the diaphragm
• Surgery to remedy esophagus differences present at birth 

The link between anxiety and GERD is still being examined, but research does suggest there's a relationship between the two conditions. One study from 2018, in fact, found significantly higher anxiety levels in people living with GERD.

How to Diagnose GERD

If you suspect you have GERD, consult with your healthcare provider for a diagnosis. They will review your symptoms and medical history. They will be able to determine whether or not your acid reflux and heartburn is within the average range or cause for further investigation.

If GERD symptoms are present, your healthcare provider may suggest starting treatment for GERD without further testing. However, your healthcare provider may also suggest testing to rule out other health conditions or complications contributing to GERD symptoms. 

Tests may include:

• Upper gastrointestinal endoscopy to look at the esophagus
• Esophageal pH monitoring to detect stomach acid in esophagus
• Physical exam 

Treatment for GERD

Treatment for GERD can involve medication and in some cases surgery. Oftentimes diet and lifestyle changes for GERD will be suggested first.

Medication

Medications for GERD can be found in over-the-counter (OTC) options or prescription options. If your symptoms do not resolve with OTC options, consult with your healthcare provider. 

Some common medications for GERD include:

• Antacids like Tums, Maalox, Rolaids, or Mylanta to neutralize the acids in the stomach 
• Bismuth subsalicylate like Pepto-Bismol, which slows the flow of digestive fluids and electrolytes into the intestines 
• ​​Baclofen prescription to reduce lower esophageal sphincter relaxation (which permits acid backwash)
• H2-receptor blockers such as Axid AR (nizatidine), Pepcid Complete or Pepcid AC (famotidine), Tagamet (cimetidine), and Zantac (ranitidine) to reduce the amount of stomach acid created by the stomach lining
• Proton pump inhibitors (PPIs) like Nexium (esomeprazole), Prevacid (lansoprazole), and Prilosec (omeprazole) that reduce stomach acid leading to symptoms of GERD
• Prokinetic agents, which are drugs that help improve the activity of muscles in the gastrointestinal tract

Surgery

Surgery or other medical procedures may also be necessary in some cases. Possible surgical options for GERD include:

• Laparoscopic antireflux surgery or fundoplication: The most common procedure for GERD, during which the uppermost part of the stomach lining is folded and sewn around the esophageal sphincter to promote increased functionality and reduce potential for reflux
• Plication: A procedure in which sutures are placed around the lower esophageal sphincter to tighten the muscle
• Radiofrequency: A procedure that uses heat on the lower esophageal sphincter to narrow its opening

Diet and Lifestyle Changes for GERD

The following are diet and lifestyle changes for GERD that you can try:

• Reducing pressure on abdomen by losing weight
• Elevating your head during sleep to prevent backflow of stomach acid into mouth
• Quitting smoking 
• Modifying eating habits (smaller meals, slow down while eating) and reducing or eliminating foods that trigger symptoms of GERD

Long-Term Complications

On its own, GERD isn’t typically cause for concern. However, untreated GERD over time can lead to additional health complications. Long-term complications associated with GERD include:

• Esophagitis or irritation and inflammation from stomach acid in the esophagus, which can lead to ulcers
• Barrett's esophagus, which develops in about 10% of people with GERD due to cell damage caused by chronic acid reflux
• Esophageal cancer, which is rare and is associated with Barrett’s esophagus 
• Respiratory issues, including asthma, pneumonia, and larygitis

Is There a Cure for GERD?

While there is no "cure" for GERD, symptoms are highly manageable. Experts say by adjusting your diet and lifestyle and taking medications when necessary, you could get your symptoms of GERD to a manageable level.

When to Seek Care for GERD

If you have GERD, you should consult with your healthcare provider about next steps regarding the most appropriate lifestyle changes and treatment options. If your symptoms get worse, return to your healthcare provider.

Summary

GERD refers to chronic acid reflux. Symptoms include persistent heartburn, chest pains, and voice hoarseness. Causes are diverse and may include birth differences, diet and lifestyle, side effects from medications, and health conditions contributing to GERD including anxiety, obesity, or pregnancy.

Diagnosis involves getting a medical history and, possibly, conducting more tests. GERD is manageable. Treatments involve medications, diet and lifestyle changes, and in some cases surgery. When in doubt, seek support from your healthcare provider.