Gastroesophageal reflux disease (GERD) is a chronic condition in which the contents of the stomach travel up the esophagus. About 20 percent of people United States (US) have GERD. Although anyone can experience gastroesophageal reflux, individuals with GERD experience symptoms at least twice per week and/or suffer from damage to the esophagus over time.^1,2

The most common symptoms of GERD are heartburn (i.e., a burning sensation behind the breastbone) and regurgitation (i.e., the feeling of fluid or fluid from the stomach coming into the chest).^1,3 Other symptoms include nonburning chest pain, difficulty or pain while swallowing, nausea, chronic cough, sore throat, increased salivation, and shortness of breath.^3,4

Gastroesophageal reflux is not uncommon in infants, but if your baby experiences symptoms that prevent them from feeding (e.g., vomiting, gagging, difficulty breathing), is fussy around mealtimes, has an inability to gain weight, has hiccups, or experiences gastroesophageal reflux for 12 to 14 months, they might have GERD.^5,6 

Causes

GERD is typically caused by weakness of the lower esophageal sphincter (LES). The LES is located at the bottom of the esophagus, and it opens to let food into the stomach and closes to prevent food and fluids from escaping the stomach. However, a weak LES might relax too long or too often, thus allowing stomach acid to flow back up the esophagus.⁶ 

Complications of the diaphragm, such as a hiatal hernia, which is a condition that allows the upper part of the stomach to move into the chest through the opening in the diaphragm, can also cause or worsen GERD.³

Risk Factors

Conditions that can increase the risk of developing GERD include pregnancy, obesity, asthma, Down syndrome, neuromuscular disorders (e.g., cerebral palsy, muscular dystrophy), heart defects, neural tube defects, and autoimmune disorders (e.g., scleroderma, rheumatoid arthritis).^3,6–9 

Certain medications can also impact GERD. Asthma medications, especially theophylline,^8,10 calcium channel blockers, benzodiazepines, nonsteroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants, and anticholinergics are examples of medications that can cause or worsen GERD symptoms. Smoking and/or being exposed to secondhand smoke can further increase the risk of GERD.^3,6,9,10

Diet also plays a role in the expression of GERD. Foods high in fat, fried foods, mint, and chocolate can lead to GERD.^6,7,9,11 These foods are thought to affect the muscle tone of the LES, thereby causing it stay open longer than is typical.⁶ Acidic foods, such as citrus and tomatoes, caffeinated food and beverages, and alcohol, have also been associated with GERD.^6,7,9,11

Complications

In addition to the discomfort and pain of heartburn and regurgitation, GERD can lead to the development of several complications, such as esophagitis, Barret’s esophagus, and asthma. 

Esophagitis, or inflammation of the esophagus, can cause ulcers, sores, and bleeding to form in the esophagus.^2,6 Chronic esophagitis can lead to another complication of GERD, esophageal or peptic strictures. This complication occurs when the esophagus narrows, and it can cause difficulty swallowing and a feeling of food sticking to the esophagus.^1,2

Barrett’s esophagus is a condition in which the cells lining the esophagus change to match the lining of the intestines. This condition is especially worrisome, as individuals with Barrett’s esophagus have a 30-fold increased risk of developing esophageal cancer.¹ 

Acid reflux caused by GERD can aggravate the airways and lungs, thereby worsening asthma and potentially triggering allergic reactions and increasing the sensitivity of the airways to environmental conditions.^1,8 GERD can also cause asthma in adults who previously did not have the condition.¹

Treatment

GERD can be treated with a combination of lifestyle changes and medications. Quitting smoking, decreasing alcohol intake, avoiding foods that can trigger reflux or damage the lining of the esophagus, and weight loss can alleviate GERD.^1,7,8,12

Strategies to reduce symptoms of GERD at night include raising the head of the mattress 6 to 10 inches, not lying down for two to three hours after eating, eating a lighter evening meal, and not eating within two hours of bedtime.^1,8

Infants should be burped a few times throughout feeding, as reflux can be more common when burping on a full stomach, and kept upright for 30 minutes after feeding. Additionally, when bottle-feeding, keep the nipple filled with milk to prevent them from swallowing excess air.⁶ 

Over-the-counter (OTC) antacids can be used to treat mild symptoms of GERD, but they are not recommended for severe symptoms or everyday use.¹² H2 receptor antagonists, or H2 blockers, work by reducing stomach acid production. Proton pump inhibitors (PPIs) are more effective at treating severe GERD than antacids and H2 blockers. PPIs reduce stomach acid production and help heal the esophageal lining. Both H2 blockers and PPIs can be prescribed or purchased OTC.^1,7,12

In individuals whose GERD does not improve with lifestyle changes and medications or who cannot take medications due to adverse events, surgery is an option. Fundoplication is the most common surgical procedure for GERD. During this procedure, the surgeon adds pressure to the LES by sewing the top of the stomach around the end of the esophagus. This helps prevent reflux, often leading to long-term symptom improvement. In individuals with obesity, bariatric surgery (i.e., weight-loss surgery) has been shown to be beneficial in reducing symptoms of GERD.¹²

Editor’s note: Please consult with a qualified healthcare professional if you experience symptoms of gastroesophageal reflux. 

Sources

1. American College of Gastroenterology. Acid reflux. https://gi.org/topics/acid-reflux/. Accessed 28 Sep 2022.
2. National Institute of Diabetes and Digestive and Kidney Diseases. Definition and facts for GER and GERD. Reviewed Jul 2020. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/definition-facts. Accessed 28 Sep 2022.
3. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and causes of GER and GERD. Reviewed Jul 2020. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes. Accessed 28 Sep 2022.
4. Johns Hopkins Medicine. Gastroesophageal reflux disease (GERD). https://www.hopkinsmedicine.org/health/conditions-and-diseases/gastroesophageal-reflux-disease-gerd. Accessed 28 Sep 2022.
5. Boston Children’s Hospital. Gastroesophageal reflux disease. https://www.childrenshospital.org/conditions/gerd#symptoms–causes. Accessed 28 Sep 2022.
6. Johns Hopkins Medicine. GERD (gastroesophageal reflux disease) in children.  https://www.hopkinsmedicine.org/health/conditions-and-diseases/gerd-gastroesophageal-reflux-disease-in-children. Accessed 28 Sep 2022.
7. RWJ Barnabas Health. Gastroesophageal reflux disease (GERD). https://www.rwjbh.org/treatment-care/surgery/thoracic-surgery/thoracic-surgery-diseases-and-conditions/gastroesophageal-reflux-disease-gerd-/. Accessed 28 Sep 2022.
8. American Academy of Allergy, Asthma, and Immunology. Gastroesophageal disease. https://www.aaaai.org/Conditions-Treatments/related-conditions/gastroesophageal-reflux-disease. Accessed 28 Sep 2022.
9. Palmyra Surgical LLC. Risk factors for GERD. https://www.palmyrasurgical.com/gastric-reflux-guide/understanding-reflux-disease/risk-factors-for-gerd. Accessed 28 Sep 2022.
10. Picco MF. GERD: can certain medications make it worse? Mayo Clinic. 6 Jan 2022. https://www.mayoclinic.org/diseases-conditions/gerd/expert-answers/heartburn-gerd/faq-20058535. Accessed 28 Sep 2020.
11. National Institute of Diabetes and Digestive and Kidney Diseases. Eating, Diet, and Nutrition for GER and GERD. Reviewed Jul 2020. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/eating-diet-nutrition. Accessed 28 Sep 2022.
12. National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for GER and GERD. Reviewed Jul 2020. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/treatment. Accessed 28 Sep 2022.