Gastroesophageal reflux disease (GERD) is a chronic digestive condition where stomach acid frequently flows back into the esophagus, the muscular tube connecting your mouth to your stomach. This backward flow, or reflux, can irritate the lining of the esophagus, causing symptoms like heartburn, regurgitation, and discomfort in the chest. While GERD can be disruptive to daily life, the good news is that it’s manageable with the right treatment and lifestyle adjustments.

Types of GERD

GERD is not a one-size-fits-all condition. It is commonly categorized into three main types based on the degree of damage to the esophageal lining:

Non-Erosive Reflux Disease (NERD)

NERD is the most prevalent form of GERD, accounting for about 60% to 70% of all cases. In this type, symptoms are present, but there is no visible damage to the esophageal lining during an endoscopy. While it may appear less serious than other forms, NERD can still significantly affect quality of life and may worsen over time if left untreated.

Erosive Esophagitis

This form occurs in about 30% of GERD cases and involves visible inflammation and damage to the esophagus. Prolonged exposure to stomach acid leads to erosions in the esophageal lining, potentially resulting in complications like ulcers or bleeding. Without appropriate treatment, erosive esophagitis may progress into a more serious condition.

Barrett’s Esophagus

Found in approximately 6% to 12% of GERD patients, Barrett’s esophagus is a more advanced and serious form of the disease. It involves changes to the cells lining the lower esophagus, replacing normal tissue with tissue similar to the intestinal lining. This cellular change raises the risk of developing esophageal adenocarcinoma, a rare type of cancer.

Common Symptoms

GERD can present a wide range of symptoms, from mild discomfort to severe complications. The most typical signs include:

  • Heartburn (a burning sensation in the chest)

  • Acid regurgitation

  • Chest pain or tightness

  • Trouble swallowing (dysphagia)

  • A persistent cough

  • Hoarseness or sore throat

  • Sensation of a lump in the throat (globus sensation)

  • Unexplained weight loss

It’s also important to note that some individuals with GERD may not experience noticeable symptoms, which can make diagnosis more difficult.

What Causes GERD?

While the exact cause of GERD remains unclear, several contributing factors have been identified:

Weak lower esophageal sphincter (LES): The LES acts as a valve between the stomach and the esophagus. When this muscle becomes weak or relaxes inappropriately, it allows acid to escape upward.

Delayed gastric emptying (gastroparesis): If your stomach takes too long to empty, the pressure can cause reflux.

Esophageal motility disorders: When the esophagus doesn’t function properly, acid clearance is reduced, increasing the likelihood of damage.

Increased abdominal pressure: Obesity, tight clothing, or straining during bowel movements can put pressure on the stomach, pushing acid back into the esophagus.

Risk Factors

Several factors can increase your risk of developing GERD:

  • Hiatal hernia

  • Obesity or high BMI

  • Pregnancy (due to hormonal changes and abdominal pressure)

  • Smoking

  • High-fat or spicy diets

  • Drinking alcohol or caffeinated beverages

  • Certain medications, including NSAIDs, statins, and antibiotics like tetracycline and clindamycin

How GERD Is Diagnosed

Healthcare providers often start with a symptom review and may prescribe a proton pump inhibitor (PPI) to assess response. If symptoms are unusual or do not improve, additional tests may be recommended:

Esophageal pH Monitoring

This test measures the level of acid exposure in your esophagus over a 24-hour period using a thin probe inserted through the nose. It helps determine if your symptoms are truly related to acid reflux.

Upper Endoscopy

An endoscope—a flexible tube with a camera—is used to inspect the esophagus and stomach lining. It helps detect inflammation, ulcers, or Barrett’s esophagus, and tissue samples (biopsies) can be taken if needed.

Esophageal Manometry

This test evaluates the function of the esophageal muscles and LES by measuring pressure and muscle contractions. While not used to diagnose GERD directly, it’s useful in assessing swallowing issues and esophageal motility.

Esophageal Impedance Testing

Used in cases where traditional pH monitoring is inconclusive, this test measures the movement of substances in the esophagus, including acid, bile, and gas.

Esophagogram (Barium Swallow)

A series of X-rays taken after swallowing a barium solution can help detect structural problems such as hiatal hernias and motility issues, although it is not commonly used to diagnose GERD.

Treatment Options

Since GERD is a long-term condition, managing it effectively often requires a combination of approaches:

Lifestyle Modifications

  • Avoid smoking and alcohol

  • Maintain a healthy weight

  • Eat smaller, more frequent meals

  • Avoid lying down after eating

  • Raise the head of your bed by 6–8 inches

  • Wear loose clothing

  • Avoid trigger foods (e.g., spicy, acidic, fatty items)

Medications

Several classes of medications can be prescribed to manage GERD symptoms and promote healing:

  • Antacids: Offer quick symptom relief by neutralizing stomach acid

  • H2 Receptor Antagonists (H2RAs): Reduce acid production (e.g., famotidine)

  • Proton Pump Inhibitors (PPIs): Block acid production more effectively and allow esophageal healing (e.g., omeprazole)

  • Prokinetics: Help improve digestion and stomach emptying

  • TLESR Reducers: Prevent relaxation of the lower esophageal sphincter

PPIs are currently the gold standard for GERD treatment and are effective for both NERD and erosive forms of the disease.

Surgical Options

If medications are ineffective or undesirable for long-term use, surgical intervention may be recommended. One common option is laparoscopic fundoplication, where the top of the stomach is wrapped around the LES to strengthen it. This procedure has a high success rate and may eliminate the need for long-term medications.

How To Prevent GERD

Though not all cases of GERD are preventable, you can reduce your risk by making certain lifestyle changes:

  • Quit smoking

  • Maintain a healthy weight

  • Exercise moderately and regularly

  • Avoid overeating or lying down soon after meals

  • Reduce intake of trigger foods

  • Manage stress effectively

A study in 2016 found that nearly 44% of individuals who quit smoking had fewer GERD episodes after one year.

Conditions Linked to GERD

GERD is associated with several other health conditions. For example, individuals with GERD often report:

  • Sleep disturbances: Insomnia, nighttime awakenings, and poor sleep quality

  • Mental health disorders: Anxiety and depression are common in GERD patients, and these conditions may worsen symptoms or reduce the effectiveness of PPIs

  • Metabolic conditions: People with GERD may also have hypertension, high cholesterol, or type 2 diabetes

Understanding and managing these related conditions is key to improving overall well-being.

Living Well With GERD

If you’ve been diagnosed with GERD, the key to maintaining a good quality of life lies in ongoing management:

  • Follow your healthcare provider’s advice regarding medication and follow-up care

  • Stick to a GERD-friendly diet: favor whole foods, fruits, vegetables, lean proteins, and healthy fats

  • Avoid late-night eating

  • Practice good posture, especially after meals

  • Chew sugar-free gum to increase saliva and help neutralize acid

  • Monitor your symptoms and adjust your lifestyle as needed

Although GERD can be chronic, many people manage their symptoms effectively and live comfortably by following a consistent treatment and prevention plan.