GERD Acid Reflux: What It Is, Why It Happens & How to Treat It

Acid reflux occurs when acid flows up from the stomach into the esophagus (food tube) and the mouth. Although occasional acid reflux is common, gastroesophageal reflux disease (GERD) may be diagnosed when it occurs frequently (a few times a week or more). Acid reflux and GERD, a chronic form, both cause heartburn and other symptoms.

Untreated GERD may cause long-term problems with the esophagus (ulcers or scarring), increase the risk of esophageal cancer, and lead to tooth decay. Effective treatments are available for GERD.

What Is GERD and How Does It Differ from Acid Reflux?

A bundle of muscles called the esophageal sphincter normally prevents stomach acid from entering the esophagus (food tube). It acts as a valve that opens to allow food to pass down through the esophagus and into the stomach and closes to prevent reflux.

Acid backing up into the throat can cause acid reflux, or gastroesophageal reflux (GER), symptoms. Most adultshave acid reflux on occasion.

With GERD, the esophageal sphincter is weakened and does not work as it should to hold acid back. When this happens, stomach acid may flow into the throat and the mouth more often, becoming a chronic problem that can lead to complications.

Causes and Risk Factors

Many different factors can weaken the esophageal sphincter. In acid reflux, which happens only occasionally, the cause may be certain trigger foods or drinks or lying down after eating or drinking. GERD, however, is chronic and can occur for more serious reasons and lead to complications.

Anyone can develop GERD, including infants. However, for babies, it usually resolves by the age of 12 to 14 months.

Risk factors increasing the likelihood of developing GERD include:

• A hiatal hernia, in which the stomach protrudes through the muscular diaphragm that separates the abdominal cavity from the chest cavity
• Overweight or obesity, which increase pressure on the abdomen
• Pregnancy
• Smoking (including secondhand smoke), which is a digestive irritant
• Medications that relax the esophageal sphincter (including antidepressants, antihistamines, asthma medications, calcium channel blockers, painkillers, and sedatives)

Symptoms

The acid reflux associated with GERD usually causes symptoms, although occasionally it can cause mild or only a few symptoms. GERD may commonly cause:

• Acid regurgitation
• Heartburn (pain and burning in the upper chest)
• Persistent acid reflux (more than a few times a week)
  

Other symptoms of GERD may not seem related to acid reflux, making a diagnosis difficult. These can include:

• Bad breath
• Burning sensation in the back of the throat
• Chest pain
• Choking or a feeling of tightness in the throat
• Dry cough
• Feeling like something is caught in the throat (called globus)
• Trouble swallowing
• Voice hoarseness upon waking

GERD Triggers

Lying down within three hours of eating may bring on symptoms of GERD. Avoiding eating before bed or elevating the head when going to bed are both strategies to avoid this potential trigger.

Some medications may also lead to symptoms of GERD. It can help to talk to a healthcare provider to either change medications or try a different treatment approach.

Foods can sometimes cause symptoms of GERD. These include spicy, fatty, acidic, and caffeine-containing food and drink. Causes will vary by individual. Avoiding foods that may cause symptoms can help.

How Is GERD Diagnosed?

The diagnosis of GERD starts with seeing a healthcare provider. They will ask about personal and family medical histories and any symptoms. It is important to note how often acid reflux symptoms occur.

When the symptoms point to GERD, testing may not be necessary. The next step might instead include a trial of medications. In some cases, this can resolve the symptoms and confirm GERD without invasive testing.

Tests such as the following are sometimes used to rule out other conditions:

• Esophageal pH monitoring to detect stomach acid in the esophagus (uncommonly used)
• Upper gastrointestinal endoscopy to look at the esophagus using a flexible scope with a camera and tools, which is inserted through the mouth

Treatment & Management Options

Lifestyle Changes

Making some changes in daily living can help avoid symptoms in some cases. For the most part, changes can be made at home, with the support of a healthcare provider, if needed. These include:

• Avoiding foods that cause symptoms
• Raising the head and upper back 6 to 8 inches (such as with a wedge pillow) when lying down or sleeping
• Seeking treatment for overweight or obesity
• Stopping smoking
  

Diet Modifications

Every person may have slightly different trigger foods. Most people learn over time, with trial and error, which foods are a problem. Some categories of foods that commonly cause symptoms include:

• Acidic foods, including citrus fruits
• Alcoholic drinks (wine, beer, spirits)
• Carbonated beverages
• Cheese
• Chocolate
• Citrus fruits or fruit juices
• Coffee
• Deep-fried foods
• Fast food, including pizza
• Fatty and processed meats such as bacon and sausage
• High-fat foods
• Peppermint
• Processed snack foods, including potato chips and chocolate treats
• Spicy food and spices
• Tea
• Tomato-based foods

Home Remedies 

Some methods can be tried at home when symptoms start. There is varying evidence as to whether or not they work for most people. For the most part, trying them may not cause harm, except that they may not be helpful. Remember that home remedies shouldn't replace treatments prescribed by a healthcare provider.

Some home remedies for GERD include:

• Aloe vera
• American ginseng (Panex quinquefolium)
• Apple cider vinegar
• Baking soda (sodium bicarbonate)
• D-limonene (a flavoring agent made from citrus oils)
• Deglycyrrhizinated (DGL) licorice root
• Ginger
• Honey
• Marshmallow root (Althea officinalis)
• Papaya
• Ripe bananas
• Slippery elm (Ulmus rubra)
• Turmeric/curcumin
  

Medications

There are both prescription and over-the-counter medications for GERD. Some options are available both over-the-counter and as a prescription. Medications include:

• Antacids (Tums, Maalox, Rolaids, or Mylanta)
• ​​Baclofen (a prescription muscle relaxant)
• Bismuth subsalicylate (Pepto-Bismol)​​
• H2-receptor blockers such as nizatidine (prescription), Zantac 360 or Pepcid AC (famotidine), Tagamet (cimetidine)
• Proton pump inhibitors (PPIs), such as Nexium (esomeprazole), Prevacid (lansoprazole), and Prilosec (omeprazole)
• Prokinetic agents (prescriptions that stimulate the movement of food through the digestive tract)

Surgical Treatment for Severe GERD

Surgery may be the best option for some people with GERD. They may be unable to take medications, or medications do not work for them.

Surgical options for GERD include:

• Bard EndoCinch System procedure (endoluminal gastroplication), which puts two stitches in the esophageal sphincter to strengthen it
• LINX Reflux Management System surgery, which is the placement of magnetized rings to augment the esophageal sphincter
• Nissen fundoplication, which strengthens the lower esophageal sphincter with other muscle tissue
• Stretta procedure, which uses heat to affect the esophageal tissue and strengthen it
• Transoral incisionless fundoplication (TIF), which is done by folding the esophageal sphincter tissue on itself to strengthen it
  

Long-Term Effects of Untreated GERD

GERD is chronic, and the long-term effects of acid and inflammation could lead to complications. Anyone who has questions about their risks should speak to a healthcare provider.

Complications include:

• Asthma (chronic inflammation and narrowing of the airways)
• Barrett’s esophagus (intestinal tissue replaces esophageal tissue and may be connected to a risk of cancer)
• Chronic cough
• Chronic hoarse voice
• Esophagitis (inflammation in the esophagus that may lead to bleeding or ulcers)
• Esophageal stricture (a narrowing of the esophagus)
• Laryngitis (inflammation of the voice box)
• Pneumonia (inflammation of the lungs)
• Tooth decay
  

When to See a Provider

If you have acid reflux symptoms, such as heartburn, a few times a week, see a healthcare provider. This includes people already diagnosed with GERD who have symptoms that do not improve with changes to lifestyle or diet and/or prescription medication.

It's also important to be aware of symptoms that seem unconnected to the esophagus but could be from GERD or another condition that should be diagnosed and treated. These include:

• Blood in or on the stool or having tarry stools
• Chest pain
• Lack of appetite
• Losing weight without trying
• Trouble swallowing
• Vomiting when food won't go down (especially if it contains blood or looks like coffee grounds)
  

Summary

GERD and acid reflux have some of the same symptoms, but GERD is a chronic condition. GERD can be diagnosed by a healthcare provider with little or no testing. Treatments include changing lifestyle habits, modifying diet, and taking medications. Some supplements and home remedies may be helpful, but not enough evidence supports their use. Surgery is sometimes needed when GERD is not treatable or controllable in other ways.