Gastroesophageal Reflux Disease Overview



Heartburn is a burning feeling behind the breastbone. Stomach acid and food back up from the stomach into the esophagus. It irritates the lining of the esophagus. The pain is often worse after eating, in the evening, or when lying down or bending over.

Heartburn that occurs often and gets in the way of day-to-day life may be gastroesophageal reflux disease (GERD). It can damage your esophagus. GERD can also cause Barretts esophagus, a change in the cells that can lead to cancer.

Gastroesophageal Reflux Disease
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A muscular ring controls the opening between the esophagus and the stomach. It relaxes to let food pass into the stomach. Then it closes shut to keep stomach acid and food in the stomach. If the ring does not close completely, stomach acids can escape up into the esophagus. The acid irritates the esophagus and causes heartburn. There are a number of reasons that the ring may not close tightly including:

  • Problems with the nerves that control the muscles of the ring
  • Problems with muscle tone of the ring
  • Muscles that move food down into the stomach are weak
  • Abnormal pressure on the area
  • Increased relaxation of the muscles
  • Increased pressure within the abdomen—pushes up against the stomach
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Risk Factors

Factors that may increase your chance of heartburn or GERD include:

  • Obesity
  • Smoking
  • Alcohol use
  • Exercising or strenuous activity immediately after eating
  • Lying down, bending over, or straining after eating
  • Pregnancy
  • Prior surgery for heartburn
  • Diabetes
  • Scleroderma
  • Certain nervous system disorders
  • In-dwelling nasogastric tube

Foods and drinks that are more likely to cause symptoms include:

  • Caffeinated products
  • Carbonated drinks
  • Citrus fruits
  • Chocolate
  • Fried foods
  • Spicy foods
  • Foods made with tomatoes, such as pizza, chili, or spaghetti sauce
  • Large or fatty meals

Medications and supplements that cause symptoms may include:

  • Anticholinergics
  • Calcium channel blockers
  • Theophylline, bronchial inhalers, and other asthma medications
  • Nitrates
  • Sildenafil
  • Bisphosphonates



Heartburn often occurs after overeating or lying down after a big meal. The symptoms may last for a few minutes or a few hours.

Common symptoms may include:

  • Burning feeling that starts in the lower chest and moves up the throat—most common symptom
  • Regurgitation—a feeling that food is coming back up
  • Sour or bitter taste in the throat
  • Burping
  • Bloating

The repeated, regular episodes can lead to other symptoms such as:

  • Sore throat
  • Hoarseness
  • Chronic laryngitis
  • Chronic cough
  • Feeling of a lump in the throat
  • Waking up with a sensation of choking
  • Difficulty swallowing

Long-term complications of GERD may include:

  • Inflammation and scarring of the esophagus—esophagitis
  • Bleeding and ulcers in the esophagus
  • Narrowing of the esophagus— esophageal stricture
  • Dental problems, which may occur because of the effect of stomach acid on tooth enamel
  • Asthma attacks
  • Vomiting blood
  • Black or tarry stools
  • Precancerous condition that can lead to esophageal cancer— Barrett esophagus
  • Esophageal cancer

When Should I Call My Doctor?

Make an appointment to see your doctor if you have heartburn 2 or more times a week, every week.


The doctor will ask about your symptoms and past health. Heartburn or GERD will be suspected based on your symptoms. Your doctor may do a trial with medicine. If your symptoms are managed with medicine it will confirm GERD.

Further testing is not always needed. Your doctor may order the following to look for complications:

  • Upper GI series
  • 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the acid in the lower esophagus
  • Manometry to test muscle strength in the lower esophagus



Treatment will depend the cause of the heartburn. The goal is to prevent further symptoms and heal any damage.

Lifestyle Changes

To help decrease chronic heartburn symptoms:

  • Keep a food diary. Note what you eat and how you feel after.
  • Make gradual changes to your diet. Record the results.
    • Avoid foods and drinks that trigger heartburn.
    • Eat smaller portions.
    • Allow at least 2-3 hours after a meal before lying down or exercise.
    • Avoid alcohol or drink in moderation. Moderation is 1-2 drinks per day for men and one drink per day for women.
  • If you are overweight, talk to your doctor about a plan to lose weight .
  • If you smoke, look for ways to help you quit .
  • Avoid belts and clothing that are too tight. They can increases pressure on the abdomen.
  • Elevate head of your bed 6-8 inches. It may relieve heartburn at night.


Medicine may help relieve symptoms. Some can also help to repair damage. Many heartburn medicines are available over-the-counter. Options include:

  • Proton-pump inhibitors
  • H2 blockers
  • Antacids

Talk to your doctor about which ones may be best for you.


Surgery may be an option if:

  • Symptoms are severe
  • Other treatment methods fail
  • Medicine cannot be tolerated

Surgical treatments include:


The most common surgery for GERD is fundoplication . The doctor wraps the stomach around the esophagus. This creates extra pressure on the opening to the stomach and helps keep it closed.

Endoscopic Antireflux Procedures

There are a number of procedures that can be done with an endoscope. These procedures use a long thin tube called a scope. It is passed through the mouth and down the throat and has a camera that will help the doctor see inside. Small tools can also be passed through the scope to do a number of procedures. One example is transoral incisionless fundoplication (TIF). With TIF, fasteners are used to reshape the upper part of the stomach. It will help tighten the ring muscles.

LINX Reflux Management System

LINX is a small band with magnetic beads. A surgeon places the band around the end of the esophagus where it meets the stomach. The magnets pull together to help close the opening. Swallowed food or drink push apart the beads so that it can move into the stomach.

Some people will be able to stop or reduce medicine after surgery.

Some people will be able to stop or reduce medicine after surgery.


There are no current guidelines to prevent GERD.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (Chronic Heartburn; Gastro-oesophageal Reflux Disease [GORD]; GERD; Reflux)

See also:

  • Gastroesophageal Reflux Disease—Adolescent
  • Gastroesophageal Reflux Disease—Child
  • Gastroesophageal Reflux Disease—Infant
  • Gastroesophageal Reflux Disease—Children with disabilities


American Gastroenterological Association 

National Institute of Diabetes and Digestive and Kidney Diseases 


Canadian Association of Gastroenterology 

Canadian Digestive Health Foundation 


Acid reflux (GER & GERD) in adults. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: Accessed January 26, 2021.

Gastroesophageal reflux disease (GERD). EBSCO DynaMed Plus website. Available at: Accessed January 26, 2021.

Heartburn. Family Doctor—American Academy of Family Physicians website. Available at: Accessed January 26, 2021.

Warning signs of a heart attack. American Heart Association website. Available at: Accessed January 26, 2021.

4/25/2014 DynaMed Plus Systematic Literature Surveillance Shimamoto T, Yamamichi N. No association of coffee consumption with gastric ulcer, duodenal ulcer, reflux esophagitis, and non-erosive reflux disease: A cross-sectional study of 8,013 healthy subjects in Japan. PLoS One. 2013;8(6):e65996.