Most people have experienced heartburn at some point — that uncomfortable burning sensation rising from the stomach into the chest. Occasional heartburn isn’t usually a concern, but frequent acid reflux may point to gastroesophageal reflux disease (GERD), a chronic condition that requires attention.

Acid reflux occurs when the lower esophageal sphincter (LES), the valve between the stomach and esophagus, doesn’t close properly. This allows acidic contents to move upward, irritating the lining of the esophagus. Over time, repeated episodes can damage tissue, disrupt daily life, and increase the risk of complications such as Barrett’s esophagus.

Understanding what triggers reflux is the first step in managing it. Here are nine common causes of acid reflux and GERD, along with practical strategies to minimize symptoms.

Certain Foods and Drinks

What you eat and drink can directly influence reflux symptoms. Foods that are high in fat, spicy, or acidic often trigger heartburn. Common culprits include:

  • Alcohol

  • Coffee and caffeinated beverages

  • Chocolate

  • Tomatoes, citrus fruits, and juices

  • Peppermint and spearmint

  • Fried or greasy foods

  • Chili peppers and spicy sauces

These items can either increase stomach acid production or relax the LES, making reflux more likely. Identifying and avoiding your personal trigger foods is a simple but powerful way to reduce symptoms.

Hiatal Hernia

A hiatal hernia occurs when the upper part of the stomach bulges into the chest cavity through the diaphragm. This shift weakens the LES and makes reflux more common. Hiatal hernias are more likely to appear in people over age 50 and those with obesity.

Mild cases may be managed with weight control, dietary changes, and over-the-counter medications. Severe hernias sometimes require surgery.

Lying Down After Large Meals

Eating a heavy meal and then lying down is a recipe for reflux. When the stomach is overly full, pressure builds and forces acid toward the esophagus. The effect is magnified if you recline too soon after eating.

Experts recommend:

  • Eating smaller, more frequent meals

  • Avoiding food for at least 3 hours before bedtime

  • Elevating the head of your bed to keep acid down with the help of gravity

Medications

Certain prescription and over-the-counter drugs can worsen reflux symptoms. These include:

  • Calcium channel blockers (used for high blood pressure)

  • Some antibiotics, such as tetracycline

  • NSAIDs (ibuprofen, aspirin, naproxen)

  • Asthma medications

  • Sedatives, including benzodiazepines

  • Tricyclic antidepressants

If you suspect a medication is contributing to your reflux, do not stop it suddenly. Instead, talk with your healthcare provider about alternatives or ways to reduce side effects.

Obesity

Excess weight, especially around the midsection, increases pressure on the stomach and pushes acid into the esophagus. Obesity is one of the strongest risk factors for GERD and its complications.

Even modest weight loss can significantly reduce reflux symptoms. Research suggests that abdominal fat and hormone changes (like higher estrogen levels) play a role in how obesity affects reflux.

Pregnancy

Pregnancy is a common time for reflux to flare. Elevated estrogen and progesterone levels relax the LES, and the growing uterus places added pressure on the stomach. Together, these changes make heartburn especially frequent in the second and third trimesters.

Most women find relief after delivery, but during pregnancy, lifestyle measures such as eating smaller meals, avoiding spicy foods, and remaining upright after eating can help. Certain antacids may be safe, but always check with a healthcare provider before using medications.

Scleroderma

Scleroderma is an autoimmune disease that scars connective tissue and slows digestion. It can prevent the LES from closing fully, allowing stomach contents to escape into the esophagus.

People with scleroderma often experience digestive issues beyond reflux, including constipation or diarrhea. Management strategies include avoiding alcohol, steering clear of trigger foods, and using medications under medical supervision.

Smoking

Smoking harms nearly every part of the digestive system and is a well-established risk factor for acid reflux. Nicotine relaxes the LES, reduces saliva production (which normally helps neutralize acid), and impairs the esophagus’s ability to clear refluxed contents.

Even secondhand smoke and smokeless tobacco can worsen symptoms. Quitting smoking not only reduces reflux but also benefits overall health.

Stress and Anxiety

Stress doesn’t directly cause acid reflux, but it can make symptoms worse. Anxiety and depression may increase stomach acid production, while stress often leads to behaviors — such as smoking, drinking alcohol, or overeating — that trigger reflux.

Reflux itself can heighten stress, creating a vicious cycle. Relaxation techniques like meditation, yoga, or regular exercise can help break the loop.

Key Takeaway

Acid reflux has many potential causes, from dietary habits and lifestyle choices to medical conditions and stress. Occasional heartburn is common, but if you experience frequent or severe reflux, you may have GERD, which requires medical attention.

Managing reflux usually starts with lifestyle changes: avoiding trigger foods, eating smaller meals, quitting smoking, losing weight, and practicing stress management. For persistent symptoms, medications or further medical evaluation may be needed.