Gastroesophageal reflux disease (GERD)

The esophagus is part of the digestive tract, which is the system of hollow organs that carries food through and out of your body. When you eat, food travels down your esophagus (food pipe) and into your stomach. This is where stomach acid (also called gastric juice or gastric acid) and digestive enzymes break down food for digestion.  

The stomach contains a protective coating of thick mucus that helps neutralize this acid and prevent it from damaging the stomach lining. The esophagus does not have this protective coating.  

Ordinarily, a flap-like muscular ring of tissue at the bottom of the esophagus (called the lower esophageal sphincter, or LES) opens to let food and liquid into the stomach and closes to keep it there. In gastroesophageal reflux disease, the LES relaxes and opens too frequently or stays open too long, allowing stomach acid and other contents to flow backward into the esophagus.  

Acid from the stomach can irritate and damage the lining of the esophagus over time and lead to complications such as peptic ulcers and Barrett’s esophagus (more on GERD complications below).   

Non-erosive reflux disease refers to GERD that doesn’t involve damage to the esophagus. If left untreated, non-erosive reflux disease may evolve into the erosive form of GERD.   

What is the difference between acid reflux and GERD?   

Acid reflux occurs when stomach contents travel back up into the esophagus. It’s sometimes called gastroesophageal reflux (GER), acid indigestion, or acid regurgitation.  

Most people experience acid reflux every once in a while, oftentimes without any symptoms. But acid reflux that happens repeatedly or causes severe symptoms is known as gastroesophageal reflux disease (GERD). According to the American College of Gastroenterology (ACG), you may have GERD if:  

• You experience symptoms (such as heartburn) two or more times per week 
• Acid reflux damages your esophagus  

How common is GERD?  

Around 20 percent of people in the U.S. have gastroesophageal reflux disease. In people over age 65, the condition affects roughly 8 percent of men and people assigned male at birth (AMAB) and 15 percent of women and people assigned female at birth (AFAB), according to the ACG.  

GERD is most common in older adults, but it occurs in children, too. Nearly 10 percent of preteens and teenagers have GERD or acid reflux, and many infants experience acid reflux that resolves by the time they reach their first birthday. This is sometimes referred to as pediatric GERD. The condition is uncommon in children between the ages of 3 and 12 years. 

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The main symptoms of gastroesophageal reflux disease are heartburn and backwash.  

• Heartburn is a burning sensation in the chest that occurs when stomach contents rise into the esophagus.  
• Backwash is the flow of stomach contents into the esophagus, which can create a sour, acidic taste in the mouth. This is sometimes referred to as regurgitation.  

Other common symptoms of GERD include:  

• Upper abdominal pain 
• Burning chest pain that worsens when lying down or bending over  
• Trouble swallowing (dysphagia)  
• Nausea  
• A sensation of a lump in the throat 
• Sore throat  
• A persistent cough 
• New or worsening asthma symptoms  
• Laryngitis (inflammation of the vocal cords)   

GERD symptoms tend to occur or worsen when bending over or lying down, such as during sleep. Factors like drinking alcohol or eating large meals or fatty foods can also trigger GERD symptoms.   

Pediatric GERD symptoms  

In infants and toddlers up to 3 years, signs and symptoms of GERD may involve:  

• Spitting up or gagging  
• Coughing  
• Weight loss or poor weight gain 
• Increased fussiness 
• Trouble swallowing  
• Refusal to eat  
• Frequent or forceful vomiting  
• Wheezing   
• Colic  

Signs and symptoms of GERD in older children may include:  

• Heartburn 
• Bad breath  
• Trouble swallowing  
• Upper abdominal or chest pain  
• Nausea or vomiting  
• Worn tooth surfaces  
• Respiratory issues  

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Speak with a healthcare provider (HCP) if you or your child experiences symptoms of gastroesophageal reflux disease. This HCP may include a primary care provider or a pediatrician (an HCP who specializes in children’s health). Don’t delay seeking care; receiving timely treatment for GERD can help prevent severe symptoms and complications. 

It’s especially important to visit an HCP if you take over-the-counter (OTC) medication to control heartburn more than twice a week, or if your symptoms include:  

• Unintended weight loss  
• Vomiting   
• Small amounts of blood in vomit 
• Pain when swallowing  
• Shortness of breath  
• New or worsening GERD symptoms    

When to call 911  

Call 911 immediately or go to the nearest hospital emergency department if you or someone around you experiences any of the following:  

• Difficulty breathing  
• Chest pain, pressure, or tightness, which may be accompanied by lightheadedness, a cold sweat, or jaw or arm pain (these are possible signs of a heart attack)  
• Large amounts of blood in stool or vomit 
• Faintness or weakness 
• Loss of consciousness  

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Gastroesophageal reflux disease occurs when stomach contents flow upwards into the esophagus. This happens when the structures that work to keep stomach contents in the stomach—including the LES and the diaphragm (a large muscle below the lungs that helps with breathing)—don’t function as they should and allow stomach acid to bubble up.  

Acid reflux is a common byproduct of gravity. For example, simple actions like lying down or bending over too soon after eating a big meal push stomach contents upward. Having GERD, however, means your LES is relaxing and staying open when it should be closed.  

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Several factors can affect the LES and diaphragm and increase a person’s risk of GERD. These include:  

Smoking: Smoking tobacco raises GERD risk in several ways. Tobacco relaxes the LES and other muscles. Both smoking and secondhand smoke can trigger coughing, which opens the LES and can weaken the diaphragm over time. For some people, smoking produces excess stomach acid.  

Pregnancy: Pressure placed on a person’s abdominal area during pregnancy can push up stomach contents and cause acid reflux. Rising hormone levels during pregnancy may also cause muscles, including the LES, to relax. GERD often resolves on its own after pregnancy.  

Overweight or obesity: Similar to pregnancy, having overweight or obesity places added pressure on the abdomen and pushes stomach contents upward, increasing the risk of GERD. Fat tissues also produce estrogen, a hormone that may cause the LES to relax more often.  

Hiatal hernia: Smoking and obesity increase the risk of hiatal hernia. This happens when pressure forces the top of the stomach upward through the opening in the diaphragm where the esophagus passes through. The esophagus and upper stomach are squeezed together, which shifts and weakens the LES. 

Certain medicines: Taking certain medicines may increase your risk of GERD. These include:  

• Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) 
• Benzodiazepines, which are sedatives that ease anxiety  
• Hormone therapy drugs, which are used to manage side effects of menopause  
• Theophylline, which is used to control asthma    
• Tricyclic antidepressants, which are used to treat pain and depression symptoms 
• Calcium channel blockers, which are used to treat hypertension (high blood pressure)   

Esophageal scleroderma: Scleroderma is an inflammatory disease that causes thickening and scarring in connective tissues. Esophageal scleroderma (scleroderma of the esophagus) can weaken the LES and cause painful, difficult swallowing.   

Esophageal atresia: GERD is a possible complication of esophageal atresia. This is a congenital difference in which a baby’s esophagus isn’t fully developed. Esophageal atresia affects around one in every 3,500 babies.  

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If your HCP suspects you may have gastroesophageal reflux disease, they’ll likely:  

• Ask questions about your symptoms  
• Review your personal and family medical histories  
• Perform a physical exam 
• Discuss what medications or supplements you may be taking  

These steps may be enough for an HCP to rule out or diagnose GERD and provide appropriate treatment. In other cases, additional tests may be performed to view the inside of the esophagus and check for complications.   

Tests for GERD  

There are several tests that an HCP may use to examine the esophagus and other parts of the digestive tract. These include:  

Upper endoscopy: During an upper endoscopy, an HCP uses a long, thin tube with a camera on the end (endoscope) to view the lining of the esophagus and stomach. The endoscope is gently inserted into the mouth and down the throat. An endoscope may also be used to remove a small tissue sample for additional testing (a procedure called a biopsy). An upper endoscopy is performed using sedation, so you shouldn’t feel any discomfort.  

Upper gastrointestinal (GI) series: An upper GI series uses X-ray imaging to capture pictures of the esophagus and stomach. Before X-rays are taken, you’ll drink a chalky liquid (barium) that helps digestive organs appear more clearly in images.  

Esophageal manometry: An esophageal manometry evaluates the pressure inside the esophagus and how well throat muscles contract when swallowing. This test involves inserting a thin tube into the nostril and gently feeding it down into the esophagus.  

Ambulatory acid (pH) test: An ambulatory acid (pH) test assesses the level of stomach acid in your esophagus. This test involves inserting a long, thin tube with a small sensor on the end through the nostril and into the esophagus. This sensor measures acid levels for 24 to 48 hours and relays information to a wearable monitor. You’ll go home and perform routine activities during the test, during which you’ll be asked to take note of your symptoms and how certain foods or activities affect them.  

An HCP may also perform an ambulatory acid test by attaching a small sensor capsule to the esophagus using an endoscope. This sensor sends information to a wearable monitor. The capsule detaches from the esophagus after a few days and is passed in stool.  

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Gastroesophageal reflux disease is generally divided into four stages: 

Stage 1 (mild GERD): 

Most people with the condition have stage 1 GERD, which is mild. It’s marked by backwash and heartburn that occurs a few times a month. It can typically be managed with self-care measures such as taking OTC medication, avoiding certain types of food, and not eating too close to bedtime.   

Stage 2 (moderate GERD):  

Around one third of people with GERD have stage 2 or moderate GERD. Symptoms in this stage may interfere with daily activities and include a sensation of a lump in the throat, in addition to backwash and heartburn. Prescription medication is usually necessary to control symptoms in this stage.  

Stage 3 (severe GERD):  

Roughly 15 percent of people with GERD have stage 3 or severe GERD. In this stage, symptoms can be quite painful and affect quality of life. Symptoms might include backwash, sore throat, voice hoarseness, and a persistent cough. Surgical treatment may be considered, as self-care measures and medication may not be enough to manage severe GERD.   

Stage 4 (reflux-induced precancerous lesions or esophageal cancer):

If left untreated or poorly managed for several years, GERD can advance to stage 4. This stage is characterized by difficulty swallowing and complications that may involve precancerous changes in esophageal tissue (Barrett’s esophagus). Surgery is usually necessary to treat stage 4 GERD, which occurs in around 10 percent of people with the condition. Esophageal cancer may occur without treatment.  

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Gastroesophageal reflux disease is a common but complex condition. Having questions about GERD is perfectly normal and expected. Sharing your questions with your HCP can help you better understand the condition and make educated treatment decisions.  

Some basic questions about GERD that you may want to ask your HCP include:  

• What stage of GERD do I have?  
• What do you think is causing GERD?    
• What are my GERD treatment options? Are there risks involved in treatment?  
• How can I manage acid reflux and heartburn at home?  
• What foods should I avoid with GERD? Should I eat more of certain foods?  
• How can I manage GERD with other conditions I have?   
• If my symptoms change or worsen, should I contact you? When should I seek emergency care?  
• What is my risk of GERD complications?  

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Gastroesophageal reflux disease may be treated by a primary care provider, pediatrician, or gastroenterologist (a medical doctor who specializes in diagnosing and treating digestive tract conditions).   

GERD treatment focuses on reducing acid reflux and easing symptoms like heartburn. Most treatment plans for adults and children include a combination of self-care measures and medication. Surgery to prevent acid reflux may be an option for people with severe GERD.  

Lifestyle changes for GERD 

Managing gastroesophageal reflux disease often starts with relatively simple lifestyle changes. These self-care measures can reduce the frequency and severity of acid reflux and help prevent GERD symptoms:  

• Reach and maintain a healthy body weight. 
• Quit smoking and vaping. Try to avoid secondhand smoke, if possible.  
• Eat small amounts throughout the day instead of large meals. Take your time when eating and chew slowly.  
• Wait a minimum of three hours after eating before lying down.  
• Use large pillows or a foam wedge to prop up your head and upper back during sleep (your head should be elevated 6 to 8 inches above your bed). Alternatively, you can elevate the head of your bed 6 to 9 inches by placing cement or wood blocks under the feet of the top end of the bed.  
• When you go to bed, start by lying on your left side. This helps ensure that the lower esophageal sphincter (LES) is positioned above stomach contents.  
• Drink alcohol in moderation or avoid it altogether.  

Drinking alcohol in moderation means limiting your consumption to two drinks per day if you’re a man or person AMAB, or one drink per day if you’re a woman or person AFAB. The Centers for Disease Control and Prevention (CDC) defines “one” drink as:  

• 12 ounces of beer  
• 8 ounces of malt liquor, including malt-based seltzers  
• 5 ounces of wine  
• 1.5 ounces of distilled spirits, such as rum, vodka, whisky, and gin   

What foods should I avoid with GERD?  

For some people, certain foods and beverages can cause or worsen gastroesophageal reflux symptoms. These GERD triggers vary from person to person, but often include:  

• Spicy foods 
• Chocolate  
• Mint 
• Garlic  
• Raw onions 
• Citrus fruits and juices 
• Tomatoes and tomato sauce   
• Fatty or fried foods, such as fatty red meats, butter, full-fat cheese and dairy, French fries, potato chips, and most fast foods  
• Coffee and other caffeinated drinks, such as soda and energy drinks  
• Carbonated beverages  
• Red wine and other alcoholic beverages  

What should I do when I have GERD symptoms?  

When experiencing GERD symptoms like heartburn and backwash, stand up (if you aren’t already) and allow gravity to help keep stomach contents down. Slowly sip some water and change into loose, comfortable clothes if you’re able. Taking acid reflux medication such as an antacid can also help.    

Medication for GERD 

Using medication that reduces or blocks the effects of stomach acid is helpful for many people with gastroesophageal reflux disease.  

OTC medications  

OTC medications can be purchased without your HCP’s authorization. Common OTC medications for GERD include:  

Antacids: Antacids that contain calcium carbonate provide fast (but temporary) relief from mild GERD symptoms by neutralizing stomach acid. Antacids aren’t a long-term solution for GERD, however, and using them too often may cause side effects like constipation and diarrhea. Examples of antacids include Tums, Mylanta, and Rolaids.  

Alginates: Alginates are natural sugars harvested from a brown seaweed called kelp. They help prevent GERD symptoms by “floating” on top of stomach acid, creating a gel-like barrier between the acid and the lining of the esophagus. Alginates are found in some antacids and can be purchased as a supplement.  

Histamine receptor antagonists (H2 blockers): An acid blocker, H2 blockers reduce the amount of acid in the stomach and promote healing in the esophagus. They don’t work as quickly as antacids, but H2 blockers provide longer-lasting relief from symptoms. Some are effective for up to 12 hours. Examples of OTC H2 blockers include cimetidine (Tagamet HB) and famotidine (Pepcid AC and Zantac).  

Proton pump inhibitors (PPIs): PPIs are a stronger and more widely used acid blocker than H2 blockers. They also help heal the esophagus and ease GERD symptoms like heartburn. Examples of OTC PPIs include omeprazole (Prilosec OTC), lansoprazole (Prevacid), and esomeprazole (Nexium).   

Inform your HCP if you start taking OTC medications or supplements for heartburn or GERD. Make sure to use all medications and supplements according to package directions.  

Prescription medications  

Common prescription medications for GERD, which must be authorized by an HCP, include:  

Prescription-strength H2 blockers: Stronger forms of select H2 blockers are available by prescription. Many people take prescription H2 blockers without experiencing notable side effects.  

Prescription-strength PPIs: Prescription PPIs are often recommended for people with moderate to severe GERD symptoms. They include pantoprazole (Protonix), dexlansoprazole (Dexilant), rabeprazole (Aciphex), omeprazole, esomeprazole, and lansoprazole. Possible side effects of prescription PPIs include diarrhea, headache, and upset stomach.  

Baclofen: Baclofen, which is typically prescribed to ease muscle spasms, can help reduce the frequency of LES relaxation and subsequent acid reflux. It may be combined with other GERD treatment approaches. Drowsiness and dizziness are common side effects of Baclofen.   

Contact your HCP right away if you experience unexpected or severe side effects from a medication. They may adjust your dosage or recommend a different type of GERD medication. Don’t hesitate to speak with your HCP if you have any questions or concerns.  

Surgery for GERD 

Surgery may be an option for some people with severe gastroesophageal reflux disease that cannot be managed with lifestyle changes and medication. Others may explore surgical treatment if they wish to avoid long-term medication use. Your HCP can determine if you’re a candidate for GERD surgery and help you weigh the risks and benefits.  

Types of surgery for GERD include:  

Fundoplication: The most commonly performed GERD surgery, fundoplication involves wrapping and sewing the top of the stomach around the LES. This tightens the sphincter and prevents stomach contents from rising into the esophagus. Fundoplication is also used to treat hiatal hernias.  

When possible, fundoplication may be performed using minimally invasive laparoscopic surgery. This involves a few small incisions in the abdomen and less recovery time than open surgery, which requires one large incision.  

Transoral incisionless fundoplication: A more recently developed procedure, transoral incisionless fundoplication is performed through the mouth using an endoscope. It wraps the stomach partially around the LES and requires no incisions. (Someone with a hiatal hernia will likely require traditional fundoplication, however.) 

LINX device surgery: The LINX device is a flexible ring of small magnetic beads that’s implanted around the LES during minimally invasive surgery. This device strengthens the sphincter, helping it keep acid in the stomach while allowing foods and liquids to travel through. The magnetic beads won’t disrupt MRI scans or screening technology used in airport security.  

Weight loss surgery: Because excess weight can play a role in GERD, people with obesity and GERD may benefit from weight loss surgery (bariatric surgery). Weight loss surgery refers to several procedures that alter the size of the stomach. This type of surgery can help someone achieve significant weight loss, improve GERD symptoms, and enjoy the many other health benefits of achieving a healthy weight.  

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Acid reflux and inflammation related to gastroesophageal reflux disease may result in health complications if the condition is poorly managed or left untreated. Possible GERD complications include:  

Esophagitis  

Prolonged exposure to stomach acid can cause esophagitis, which is inflammation of the tissue that lines the esophagus. Symptoms of esophagitis may include painful or difficult swallowing, bleeding, and a type of open sore called a peptic ulcer. Treatment for esophagitis involves medication and lifestyle changes, such as avoiding foods that can trigger acid reflux.  

Esophageal stricture  

An esophageal stricture occurs when the esophagus becomes narrowed. In someone with gastroesophageal reflux disease, a stricture can develop at the base of the esophagus due to scar tissue formation caused by stomach acid. Narrowing of the esophagus can make it difficult to swallow comfortably. 

Esophageal stricture treatment usually involves a series of dilation procedures to gradually open the esophagus with special instruments. Dilation is performed on an outpatient basis, meaning it may be done in your HCP’s office and you can go home after treatment.  

Laryngopharyngeal reflux 

Laryngopharyngeal reflux is a type of acid reflux. While acid reflux typically occurs in the lower part of the esophagus, laryngopharyngeal reflux happens when stomach acid rises even higher in the digestive tract and affects the voice box (larynx) and throat (pharynx). This can also cause tiny particles of stomach acid to enter your airways (trachea and bronchi) and cause irritation.  

Symptoms of laryngopharyngeal reflux may include voice hoarseness or deepening, nagging cough, sore throat, wheezing, or trouble swallowing. Treatment for the condition usually involves a combination of medication and lifestyle changes to reduce acid reflux.  

Worsening asthma symptoms  

Gastroesophageal reflux disease can worsen pre-existing asthma or trigger symptoms that may resemble asthma—such as wheezing and coughing—in someone without respiratory illness. This occurs when particles of acid aggravate your bronchi, which are the airways that connect the trachea (windpipe) to your lungs. Managing asthma and GERD can ease these symptoms and help you breathe easier.  

Barrett’s esophagus  

Prolonged exposure to stomach acid and inflammation can result in Barrett’s esophagus. This is a form of intestinal metaplasia, which is characterized by precancerous changes in digestive tract tissues. You can’t feel these precancerous changes taking place. Promptly seeking treatment for persistent acid reflux can help prevent Barrett’s esophagus and esophageal cancer. 

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Research suggests that certain controllable lifestyle factors may influence a person’s chances of developing gastroesophageal reflux disease. One 2024 study, published in BMC Gastroenterology, evaluated more than 9,600 people between the ages of 35 and 65 years. The study found that GERD was most common among people who:  

• Smoked 
• Drank alcohol  
• Were physically inactive  
• Ate too little fiber 
• Ate large amounts of sugar 
• Had visceral fat (belly fat that surrounds organs in the abdomen)   
• Had obesity   
• Had depression  

Notably, the study found smoking increased GERD risk by 23 percent, and depression was associated with a 46 percent increased risk. While the link between GERD and mental health isn’t fully understood, many experts theorize that the brain-gut axis may play a role. This refers to the two-way neurological connection between the brain and the digestive system.  

Another study, published in 2021 in JAMA Internal Medicine, analyzed a group of nearly 43,000 women and people AFAB who did not have GERD. More than 9,200 participants developed GERD by the end of the study, which spanned 10 years.  

Five key factors were common among the participants who did not develop GERD. These included:  

• A healthy weight  
• A healthy diet that included plenty of vegetables, fruits, legumes, whole grains, fish, and poultry 
• No history of smoking  
• At least 30 minutes of moderate to vigorous physical activity daily  
• No more than two daily cups of coffee, tea, or soda 

Participants who had all five of these factors were roughly half as likely to develop GERD than those who didn’t have any. The lifestyle factor associated with the largest decrease in GERD risk was a healthy body weight. 

Speak to your HCP to learn more about GERD risk factors and how you may be able to prevent the condition.  

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Gastroesophageal reflux disease is a chronic condition that won’t go away on its own. In some cases, the tissue that lines the esophagus may become accustomed to acid reflux and develop changes (such as Barrett’s esophagus) that make symptoms less noticeable. But acid reflux—and damage to the esophagus—is still occurring.  

The good news is that GERD treatment is typically successful. Most people can significantly improve their symptoms and avoid complications with self-care measures and medication. For some people, surgery to address the underlying cause of GERD (such as a hiatal hernia) may be necessary to alleviate symptoms.   

Overall, the outcome for people with GERD is positive. Speak with your HCP to learn more about your diagnosis, prognosis (expected outcome), and what you can expect during treatment.   

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Living with gastroesophageal reflux disease can sometimes be inconvenient, frustrating, or downright uncomfortable. But relief from symptoms like heartburn and backwash is possible with treatment. Most people with GERD can effectively manage their symptoms with self-care measures and medication. Living a healthy lifestyle may help prevent the condition.  

To learn more about GERD and its causes, symptoms, and treatment options, visit an HCP.  

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• Got heartburn? Here’s why, plus what to do about it 
• 7 simple ways to ease gastroesophageal reflux  
• Health risks of untreated GERD