Discusses gastroesophageal reflux disease. Covers main symptom of heartburn, caused by stomach acid and juices flowing from the stomach back into the esophagus. Covers treatment with medicines and surgery. Offers tips on lifestyle changes to help manage GERD.
stomach acid and juices flow from the stomach back up
into the tube that leads from the throat to the stomach (esophagus). This causes
heartburn. When you have heartburn that bothers you often, it is called gastroesophageal reflux disease, or GERD.
Eating too much or bending forward after eating sometimes causes
heartburn and a sour taste in the mouth. But having heartburn from time to time
doesn't mean that you have GERD. With GERD, the reflux and heartburn last longer and
come more often. If this happens to you, be sure to get it treated, because
GERD can cause
ulcers and damage to your esophagus.
What causes GERD?
Normally when you swallow your food, it first travels down the food pipe (esophagus). A valve opens to let the
food pass into the stomach, and then the valve closes. With GERD, the valve doesn't
close tightly enough. Stomach acid and juices from the stomach flow back up
(reflux) into the esophagus.
What are the symptoms?
The main symptom of GERD is
heartburn. It may feel like a burning, warmth, or pain just behind the
breastbone. It is common to have symptoms at night when you're trying to
If you have pain behind your breastbone, it is important to
make sure that it isn't caused by a problem with your heart. The burning sensation
caused by GERD usually occurs after you eat. Pain from the heart usually feels
like heaviness, tightness, discomfort, or a dull
ache. It occurs most often after you are active.
How is GERD diagnosed?
First, your doctor will do
a physical exam and ask you questions about your health. You may or may not
need further tests. Your doctor may just treat your symptoms by recommending
medicines that reduce or block stomach acid. These include H2 blockers such as famotidine (Pepcid) and proton pump inhibitors such as omeprazole (Prilosec). If your
heartburn goes away after you take the medicine, your doctor will likely
How is it treated?
For mild symptoms of GERD, you
can try over-the-counter medicines. These include antacids (for example, Tums),
H2 blockers (for example, Pepcid), and proton pump inhibitors (for example,
Prilosec). Changing your diet, losing weight if needed, and making other
lifestyle changes can also help. If you still have symptoms after trying
lifestyle changes and over-the-counter medicines, talk to your doctor.
Your doctor may recommend surgery if medicine doesn't work or if you
can't take medicine because of the side effects. Fundoplication
surgery strengthens the valve between the esophagus and the stomach. But many
people continue to need some medicine even after surgery.
common in pregnant women. Lifestyle changes and antacids are usually tried
first to treat pregnant women who have GERD. Antacids are safe to use for
heartburn symptoms during pregnancy. If lifestyle changes and antacids don't
help control your symptoms, talk to your doctor about using other medicines.
Most of the time, symptoms get better after the baby is born.
How can you manage GERD?
You may need to take medicine for many
years to help control the symptoms. But you can also make changes to your lifestyle
to help relieve your symptoms of GERD. Here are some things to try:
Change your eating habits.
It's best to eat several small meals
instead of two or three large meals.
After you eat, wait 2 to 3
hours before you lie down. Late-night snacks aren't a good
Chocolate, mint, and alcohol can make GERD worse. They relax
the valve between the esophagus and the stomach.
Spicy foods, foods
that have a lot of acid (like tomatoes and oranges), and coffee can make GERD
symptoms worse in some people. If your symptoms are worse after you eat a
certain food, you may want to stop eating that food to see if your symptoms get
Don't smoke or chew tobacco.
you get heartburn at night, raise the head of your bed
6 in. (15 cm) to
8 in. (20 cm) by putting the
frame on blocks or placing a foam wedge under the head of your mattress.
(Adding extra pillows doesn't work.)
Don't wear tight clothing
around your middle.
Lose weight if you need to. Losing just 5 to 10 pounds can
Frequently Asked Questions
Learning about gastroesophageal reflux disease (GERD):
Most of the time, GERD happens when the valve relaxes at the wrong time and stays open too long. Normally, the valve is only open for a few seconds when you swallow. Some foods, like peppermint and chocolate, may relax the valve so it doesn't close tightly. Alcohol, tobacco, and some medicines can also relax the valve.
Some foods can make GERD worse. Avoiding them can help reduce heartburn. These include citrus fruits, fatty and fried foods, garlic and onions, spicy foods, and tomato-based foods like spaghetti sauce and pizza.
Other things can make stomach juices back up,
Hormonal changes during pregnancy. Heartburn is common during pregnancy, because hormones cause
the digestive system to slow down.
A weak lower esophageal sphincter. If this valve is
weak, it won't close normally, and reflux will occur more often.
Hiatal hernia. GERD is common among people who have
Slow digestion. If food stays in your stomach too
long before it goes to the small intestine,
the stomach contents are more likely to get pushed up into the esophagus and
Overfull stomach. Having a very full stomach increases the chance that the valve will relax and let stomach juices back up into your esophagus.
The main symptoms of
gastroesophageal reflux disease (GERD) include:
Persistent heartburn. Heartburn is an
uncomfortable feeling or burning pain behind the breastbone. It may occur after
you eat, soon after you lie down, or when you bend forward. Some people
have GERD without heartburn.
A sour or bitter taste in the mouth. The backflow
stomach acid and juices into the esophagus may cause this sour or bitter taste.
Heartburn caused by GERD is
usually felt within 2 hours after you eat. If your heartburn lasts for several
hours—for example, all night—you may have severe GERD.
Other symptoms of GERD may include:
Chest pain. This may be a dull, heavy
discomfort that spreads across the chest. This chest pain may occur with
heartburn and may be confused with the pain of a heart attack.
Trouble swallowing. This is
more common with advanced GERD.
A feeling that you have something
stuck in your throat.
Having extra saliva.
Gastroesophageal reflux disease (GERD) may cause
inflammation in the esophagus, the tube that connects the throat to the stomach. This condition is
called esophagitis. GERD without esophagitis is sometimes called nonerosive
If you have mild GERD symptoms—an uncomfortable
feeling of burning, warmth, heat, or pain just behind the breastbone—you may be able to treat
yourself with nonprescription medicines that reduce or block acid.
Barrett's esophagus, in which the cells that line the
inside of the esophagus are replaced by cells similar to those that line the
inside of the stomach and intestine. Barrett's esophagus is not common, but it can
lead to cancer of the esophagus.
Respiratory problems, such as a
asthma, pneumonia, and laryngitis.
speeding up of
tooth decay, because stomach acid gets into the mouth
and wears away tooth enamel.
Some people who have GERD may be at increased risk for
cancer of the esophagus.
What Increases Your Risk
Things that increase your
risk for symptoms of
gastroesophageal reflux disease (GERD) include your lifestyle and certain health conditions.
certain foods, such as chocolate or peppermint, that may relax the valve
between the stomach and esophagus.
Taking certain medicines. If you
think that a medicine you take may be causing your GERD symptoms, talk to your
When To Call a Doctor
The main symptom of
gastroesophageal reflux disease (GERD) is an
uncomfortable feeling of burning, warmth, heat, or pain just behind the
breastbone, a feeling commonly referred to as heartburn. Sometimes heartburn
can feel like the chest pain of a heart attack.
Call 911 or other emergency services immediately if:
You have symptoms of a heart attack. These may include:
Chest pain or pressure, or a strange feeling in the chest.
Nausea or vomiting.
Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
Lightheadedness or sudden weakness.
A fast or irregular heartbeat.
After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.
Call your doctor immediately if
Have bloody, black, or
Call your doctor if your GERD symptoms:
Do not improve after 2 weeks of home
treatment, are different or are getting worse, or are interfering with normal
Occur with choking or difficulty
Occur with a lot of weight loss when you are not trying to lose weight.
Have occurred frequently over several years and are only partially
relieved with lifestyle changes and nonprescription medicines that reduce or
Watchful waiting is a wait-and-see approach. Occasional mild heartburn can often be relieved
by making lifestyle changes and taking nonprescription medicines that reduce or
block acid. Contact a doctor if
you have any of the symptoms listed above.
Who to see
The following health professionals can evaluate
symptoms of GERD:
You may be referred to a doctor who specializes in
diseases of the digestive tract (gastroenterologist) to check severe
GERD symptoms or to get an opinion on whether surgery is needed. If you are
thinking about having surgery, you may also be referred to a general surgeon
who has experience treating stomach and esophagus problems.
To find out if you have gastroesophageal reflux disease (GERD), your doctor may
first ask you questions about your symptoms, such as whether you have a
frequent uncomfortable feeling of burning, warmth, heat, or pain just behind
the breastbone (heartburn). If you have heartburn often, your doctor may prescribe medicines
to treat GERD without doing any other tests.
If medicines don't help, you may have other tests. These may include:
Preventing damage to the lining of the esophagus, or helping to heal the lining if damage has occurred.
Keeping GERD from coming back.
Preventing health problems that can occur because of GERD.
Treatment starts with changing habits, avoiding things that trigger your symptoms, and taking nonprescription medicines that reduce or block acids. If you still have symptoms after taking medicines for a few weeks, you may need prescription medicines. You may need to keep up with treatment over the long term to prevent GERD symptoms from coming back. If GERD keeps coming back or gets worse, you may need to think about surgery.
Making lifestyle changes is an important part of treating symptoms of GERD. Quitting smoking, losing weight if you need to, and changing your eating habits can all help you feel better.
If you have been
using nonprescription medicines to treat your symptoms for longer than 2 weeks,
talk to your doctor. Stomach acid could be causing damage
to your esophagus. If you
have GERD symptoms often, or if they are very bad, your doctor may recommend that you use
Be sure to continue to take
medicines as instructed by your doctor, because stopping treatment will often
bring symptoms back.
Avoid your triggers
An important part of treating GERD is avoiding triggers. These things can include:
Drinks that contain caffeine or alcohol.
If you think that your symptoms are
worse after you eat a certain food, you can stop eating that food to see if it
If you think a medicine is making your
symptoms worse, talk to your doctor.
Watch for changes
symptoms don't get better with treatment, or if they get worse, your doctor may suggest that you
take your medicine more often. Or you may be switched to a higher dose or a
Your doctor may also refer you to a
specialist for an
upper gastrointestinal endoscopy. Sometimes, GERD leads to other health problems, such as Barrett's esophagus. Part of your treatment may involve more endoscopies and other tests to monitor your health.
Sometimes surgery is needed, such as when medicines don't relieve symptoms or if you're unable to take medicines over a long period of time. Surgery can have benefits but can also cause problems with swallowing and burping. Some people still need to take medicines after surgery. And some people need to have surgery again.
may cause gastroesophageal reflux disease (GERD) as a side effect. If any medicines you take
seem to be the cause of your heartburn, talk with your doctor. Don't stop
taking a prescription medicine until you talk with your doctor.
If you have been using nonprescription medicines to treat your symptoms for
longer than 2 weeks, talk to your doctor. If you have gastroesophageal reflux disease (GERD), the stomach acid
could be causing damage to your esophagus. Your doctor can help you find the
right treatment. Making lifestyle changes is still an important part of the
treatment of GERD when you are using medicine.
blockers, and proton pump inhibitors—either prescription or nonprescription—are usually tried first. Medicines can:
Relieve symptoms (heartburn, sour taste, or pain).
esophagus to heal.
Prevent complications of GERD.
Antacids, such as Mylanta and Tums. Antacids
neutralize stomach acid and relieve heartburn. If you want to take medicine
only when your symptoms bother you, antacids are a good choice.
H2 blockers, such as cimetidine (Tagamet) and famotidine (Pepcid). H2 blockers reduce the amount of
acid in the stomach. Most are available in both nonprescription and
prescription strength. If nonprescription H2 blockers don't relieve
your symptoms, talk to your doctor about trying prescription-strength medicine.
Proton pump inhibitors, such as lansoprazole (Prevacid) and omeprazole (Prilosec). Proton pump inhibitors (PPIs) reduce the amount of
acid in the stomach. Some are available without a prescription.
Medicine may not prevent all of your GERD symptoms all the time. Even if you're taking an acid reducer every day, you may still have heartburn from time to time. It's okay to take antacids when you have heartburn like this. But if you feel like your daily medicine isn't working to control your GERD symptoms, talk with your doctor. You may need to try a different medicine.
Be sure to keep taking
medicines as instructed by your doctor, because stopping treatment will often
bring symptoms back.
Doctors usually try to choose a
treatment that uses enough medicine to control your symptoms but not so much
that side effects become a serious problem.
Besides medicines, surgery is the
only other effective option to prevent GERD symptoms from coming back.
Surgery may be used to treat
gastroesophageal reflux disease (GERD) symptoms that
have not been well controlled by medicines.
be an option when:
Medicines don't completely
relieve symptoms, and the remaining symptoms are caused
by reflux of stomach juices.
A person doesn't want or, because of
side effects, is not able to take medicines over an extended period of
time to control GERD symptoms.
Along with reflux, a person has symptoms such as asthma,
hoarseness, or cough that do not adequately improve when treated with
The benefits of surgery need to be compared to the possible complications and new symptoms you may have after surgery. Surgery for GERD can cause problems with swallowing and burping. It can also cause extra gas in the digestive tract, which leads to bloating and passing gas (flatulence).
After surgery, you may need to have other procedures to fix these problems. Some people still have to take medicine to control their symptoms, even after surgery. And some people need to have surgery again.
Fundoplication surgery is the most
common surgery used to treat GERD. This surgery strengthens the valve between
the esophagus and stomach (lower esophageal sphincter) to keep acid from
backing up into the esophagus as easily. It relieves GERD symptoms and inflammation of the esophagus (esophagitis).
Other types of surgery
for gastroesophageal reflux disease may include:
Partial fundoplication. Partial fundoplication
involves wrapping the stomach only partway around the
esophagus. Full fundoplication involves wrapping the stomach around the
esophagus so that it completely encircles it. Most fundoplication surgery uses
the full fundoplication method.
Gastropexy. A gastropexy attaches the stomach to
the diaphragm so that the stomach cannot move through the opening in the
diaphragm into the chest. Gastropexy is done less often than
Other Places To Get Help
American College of
6400 Goldsboro Road
Bethesda, MD 20817
The American College of Gastroenterology is an organization of digestive disease specialists. The website contains information about common gastrointestinal problems.
4930 Del Ray Avenue
Bethesda, MD 20814
The American Gastroenterological Association is a
society of doctors who specialize in the digestive system
(gastroenterologists). This Web site can help you find a gastroenterologist in
your area. They also have patient information on many gastrointestinal diseases
National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
Agency for Healthcare Research and Quality (2011). Comparative Effectiveness of Management Strategies
for Gastroesophageal Reflux Disease: Update
(AHRQ Publication No. 11-EHC049-EF). Rockville, MD: Agency for Healthcare Research and Quality. Also available online: http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=781.
American Gastroenterological Association (2008). American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology, 135(4): 1383–1391.
Saltzman JR, Poneros JM (2009). Gastroesophageal reflux disease. In NJ Greenberger et al., eds., Current Diagnosis and Treatment: Gastroenterology, Hepatology, and Endoscopy, pp. 139–147. New
How this information was developed to help you make better health decisions.