28 Heart Health Secrets Cardiologists Want You to Know

What Is GERD (Gastroesophageal Reflux Disease)?

Gastroesophageal reflux disease (GERD), also known as gastro oesophageal reflux disease, is more than just the occasional heartburn—it's a chronic condition where stomach acid keeps flowing back into the esophagus, sometimes even into the mouth. Chronic acid reflux is a common term for GERD. This backflow, also called acid reflux, can irritate the esophagus lining and cause a range of symptoms that over time can really impact a person's quality of life [5].

Table of ContentsWhat are the Key Symptoms of GERD

When most people think of GERD they think of heartburn—that burning, uncomfortable feeling in the chest, especially after eating or when lying down. But that's only part of the story.

Two main symptoms stand out:

Heartburn – A burning pain or discomfort that often rises behind the breastbone.

Regurgitation – That sour or bitter taste in the throat or mouth when stomach contents come up [4].

Some people also experience atypical symptoms like chronic cough, sore throat or even dental erosion—making it harder to diagnose in some cases [10].

Other symptoms of GERD can include chest pain which can mimic heart disease and requires immediate medical attention. Coughing and nausea can also be present and show how GERD can manifest in different ways. A common misconception is that liver-related diseases such as Cirrhosis, Bile Duct Inflammation, and Alcoholic Hepatitis contribute to GERD, but the jury is still out on that.

How Common is GERD?

GERD isn't rare. In fact:

20% of adults in high income countries have GERD [1].

In Western countries it's even higher—30% are affected [5].

Several risk factors can contribute to the development or worsening of GERD including obesity, pregnancy, smoking and certain medications.

Its not just physical—it's financial too. GERD means frequent doctor visits, medication costs and even hospitalization which puts a heavy burden on the healthcare system.

Certain medications like benzodiazepines, calcium channel blockers and some antidepressants can relax the lower esophageal sphincter (LES) and worsen GERD symptoms.

So what makes stomach acid climb back up where it doesn't belong? It usually comes down to how the lower esophageal sphincter (LES)—a ring-like muscle at the base of the esophagus—works.

The Root Causes of GERD and Hiatal Hernia

Here's a closer look:

Weak or Relaxed LES – When this valve doesn't close properly acid escapes up [3].

Transient LES Relaxations – These are temporary, spontaneous relaxations not triggered by swallowing and are a major contributor to reflux episodes [3].

Impaired Esophageal Motility – If the esophagus isn't pushing acid back into the stomach symptoms get worse [6].

Hiatal Hernia – A hiatal hernia can weaken the LES and increase the likelihood of acid reflux.

Pregnancy Hormones – Hormones associated with pregnancy can affect the muscles in the stomach and esophagus and increase the likelihood of acid reflux.

Fatty Foods – Fatty foods can increase stomach acid and prolong digestion and acid can escape into the esophagus.

Calcium Channel Blockers – These medications can cause or worsen GERD symptoms including heartburn and difficulty swallowing.

Types and Classifications

GERD isn't a one size fits all diagnosis. It manifests in different ways and understanding those differences can determine how it's treated:

Severe GERD – a more intense form of the condition and often requires more aggressive treatment approaches.

Chronic GERD – a long term condition and may require ongoing management strategies.

Main Classifications

Symptom-Based GERD – Individuals feel the typical discomforts of reflux but show no signs of damage on tests. Typical symptoms include heartburn and regurgitation which are key to starting treatment without the need for further diagnostic tests.

Erosive Esophagitis – Acid has caused visible damage or inflammation in the esophagus.

Complex GERD – This includes serious conditions like Barrett's esophagus or even esophageal cancer. Severe symptoms that require medical attention include frequent heartburn, difficulty swallowing and unexplained weight loss as they may indicate more serious complications or conditions.

Subtypes You Should Know

Erosive Reflux Disease (ERD) – There's actual erosion of the esophageal lining often confirmed via endoscopy. Acid indigestion is a common symptom of ERD when stomach acid backs up into the esophagus.

Non-Erosive Reflux Disease (NERD) – Symptoms are present but no damage is seen during an exam [9]. A burning feeling in the chest often referred to as heartburn is a classic symptom of NERD.

NERD is actually the more common form and can be trickier to treat especially since standard tests may not show anything obvious. [8]

Complications

Untreated GERD can spiral into more serious health problems such as:

Esophagitis – Persistent inflammation can cause pain and ulcers.

Esophageal Strictures – Scar tissue can cause narrowing and make swallowing difficult.

Barrett's Esophagus – Long term acid exposure can cause changes in the esophageal lining which may increase the risk of cancer.

Esophageal Adenocarcinoma – A rare but serious cancer tied to chronic unmanaged GERD.

Esophageal manometry is often used as a diagnostic tool to assess esophageal pressure and motility to rule out conditions that mimic GERD especially when considering surgical options [7].

Why Managing GERD Can Be Complicated

Most people with GERD are prescribed proton pump inhibitors (PPIs) to reduce acid production. But what happens when that doesn't work? Certain medications can worsen GERD symptoms so it's important to consult a healthcare provider before making any changes to medication regimens.That's what doctors call refractory GERD—a form that doesn't respond well to typical treatment [2]. For these patients, further investigation and alternative approaches are often needed. Acid secretion plays a big role in refractory GERD as excess acid can cause persistent symptoms like heartburn and reflux.

Lifestyle Changes: Small Changes, Big Impact

Medication isn't the only answer. Simple changes can make a big difference:

Avoiding spicy, fatty foods or acidic foods

Maintaining a healthy weight

Quitting smoking

Sleeping with the head elevated

Not eating close to bedtime

These lifestyle tweaks including losing weight can help reduce pressure on the stomach and decrease reflux episodes naturally.

GERD is common—but that doesn't mean it should be ignored. Up to 30% of adults are affected in Western regions and serious complications like Barrett's esophagus and esophageal cancer are at stake [1], [5]. If you have severe symptoms you need to see a doctor as they may indicate more serious complications.

The good news? With proper treatment—whether it's medication, lifestyle changes or both—many can find lasting relief. And for those with tougher cases new research is expanding treatment options and improving outcomes. GERD is also linked to digestive and kidney diseases so it's important to recognize and manage symptoms early. Gastrointestinal and liver disease can be related conditions so for persistent symptoms a comprehensive medical evaluation is necessary.

References

[1] Maret-Ouda, J., Markar, S. R., & Lagergren, J. (2020). Gastroesophageal Reflux Disease: A Review. JAMA, 324(24), 2536–2547. Https://doi.Org/10.1001/jama.2020.21360

[2] Fass, R., & Gasiorowska, A. (2008). Refractory GERD: what is it?. Current gastroenterology reports, 10(3), 252–257. Https://doi.Org/10.1007/s11894-008-0052-5

[3] Kahrilas P. J. (2003). GERD pathogenesis, pathophysiology, and clinical manifestations. Cleveland Clinic journal of medicine, 70 Suppl 5, S4–S19. Https://doi.Org/10.3949/ccjm.70.Suppl_5.S4

[4] Kellerman, R., & Kintanar, T. (2017). Gastroesophageal Reflux Disease. Primary care, 44(4), 561–573. Https://doi.Org/10.1016/j.Pop.2017.07.001

[5] Dunbar K. B. (2024). Gastroesophageal Reflux Disease. Annals of internal medicine, 177(8), ITC113–ITC128. Https://doi.Org/10.7326/AITC202408200

[6] Tanvir, F., Nijjar, G. S., Aulakh, S. K., Kaur, Y., Singh, S., Singh, K., Singla, A., Sandhu, A. P. S., Luthra, S., & Antaal, H. (2024). Gastroesophageal Reflux Disease: New Insights and Treatment Approaches. Cureus, 16(8), e67654. Https://doi.Org/10.7759/cureus.67654

[7] Jones, R., & Galmiche, J. P. (2005). Review: what do we mean by GERD?--definition and diagnosis. Alimentary pharmacology & therapeutics, 22 Suppl 1, 2–10. Https://doi.Org/10.1111/j.1365-2036.2005.02610.X

[8] Sontag S. J. (1999). Defining GERD. The Yale journal of biology and medicine, 72(2-3), 69–80. Https://pubmed.Ncbi.Nlm.Nih.Gov/10780568/

[9] Savarino, E., de Bortoli, N., De Cassan, C., Della Coletta, M., Bartolo, O., Furnari, M., Ottonello, A., Marabotto, E., Bodini, G., & Savarino, V. (2017). The natural history of gastro-esophageal reflux disease: a comprehensive review. Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, 30(2), 1–9. Https://doi.Org/10.1111/dote.12511

[10] Mahajan, R., Kulkarni, R., & Stoopler, E. T. (2022). Gastroesophageal reflux disease and oral health: A narrative review. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry, 42(6), 555–564. Https://doi.Org/10.1111/scd.12726

MORE DOCTORS & SCIENTISTS

IBS, GERD, And IBD: What Is The Difference And Why It Matters To Know

The digestive system is extremely complex and vast and does not include the stomach alone. It has several main components, like the gastrointestinal tract, which runs from the mouth, pharynx, and oesophagus to the stomach, small intestine, large intestine, rectum, and anus, and also accessory organs like the liver, gallbladder, and pancreas. With such intricacy, it is no surprise that digestive diseases are as varied and, sometimes, easily confused. IBS (Irritable Bowel Syndrome), GERD (Gastroesophageal Reflux Disease), and IBD (Inflammatory Bowel Disease) may share common symptoms, but they are distinct and separate medical conditions.

Also Read: Can Tea And Coffee Trigger Irritable Bowel Syndrome (IBS)? Find Out From The Expert

IBS, GERD, And IBD: What Are The Differences?

Discussing each condition in detail – IBS, GERD, and IBD – Dr Mahadevan, Senior Consultant – Gastroenterology, Gleneagles Hospital, Chennai, explains:

IBS (Irritable Bowel Syndrome) is a functional disorder, meaning the structure of the bowel is normal but its function is disturbed. It affects the colon and presents with symptoms of bloating, gas, abdominal cramps, diarrhoea, or constipation without any apparent damage to the intestines.

GERD (Gastroesophageal Reflux Disease) is of the oesophagus, whereby stomach acid frequently flows back, causing heartburn, chest discomfort, and regurgitation.

IBD (Inflammatory Bowel Disease) is an autoimmune, inflammatory condition that primarily includes Crohn's disease and ulcerative colitis. It causes chronic inflammation and evident damage to the intestinal lining, potentially anywhere from the mouth to the rectum, and may result in bleeding, weight loss, or heavy diarrhoea.

To differentiate between the conditions, it is crucial to identify each disorder's specific symptoms and characteristics.

While IBS leads to alternating diarrhoea and constipation, relieved by defecation, GERD is characterised by a burning sensation behind the chest (heartburn), which worsens after meals or when lying down. On the other hand, persistent diarrhoea, abdominal pain, blood in stools, weight loss, and fatigue are key indicators of IBD.

To accurately diagnose the conditions, a combination of history, lab tests, endoscopy/colonoscopy, and imaging is required.

Understanding Overlapping Triggers For IBS, GERD, And IBD

Stress, irregular eating habits, poor sleep, processed foods, and certain medications (like NSAIDs) can aggravate symptoms across IBS, GERD, and IBD. Therefore, stress management, dietary modifications, and lifestyle balance are crucial for all three.

Also Read: Should People With IBS Have Fermented Foods? A Gastroenterologist's Insight

How To Manage IBS, GERD, And IBD

It is easy to confuse IBS, GERD, and IBD with each other. According to Dr Mahadevan, misdiagnosis occurs because symptoms like abdominal pain and altered bowel habits can be common to all three.

"Treating IBS when the patient actually has IBD can delay proper care and lead to complications like intestinal damage. Similarly, GERD treated as a cardiac issue or vice versa can pose health risks. Hence, thorough evaluation is essential," notes Dr Mahadevan.

Depending on the condition you're diagnosed with, here are some management tips:

IBS: Primarily managed through diet (low FODMAP), stress reduction, and symptom-specific medications.

GERD: Treated with acid suppression (PPIs) and lifestyle changes like weight loss and dietary adjustments.

IBD: Requires immunosuppressants, biologics, dietary support, and regular monitoring due to its chronic inflammatory nature.

Conclusion

While IBS, GERD, and IBD share some of the same symptoms, they are different diseases and must be treated separately. Misdiagnosis with one for another might lead to ineffective therapy and possible complications. This is why knowing the specific signs, causes, and triggers of each is crucial for early intervention. With appropriate medical evaluation, life-style modification, and certain therapies, individuals can effectively control their gastrointestinal condition and improve their quality of life.

GERD: Facts, Statistics, And You

Anyone can develop GERD. It occurs across every age group and ethnicity. However, you're more likely to have GERD if:

You're overweight or obese.

You're pregnant.

You take certain medications, including antihistamines, painkillers, and antidepressants

You smoke or are regularly exposed to secondhand smoke.

One of the biggest challenges in determining the number of people living with GERD is identifying who actually has the disease. Many people with GERD symptoms don't consult a healthcare provider. A 2014 systematic review estimates from 15.1 to 30 percent[DS1] of the U.S. Population has GERD.

According to the Healthcare Cost and Utilization Project (HCUP), there were 995,402 hospitalizations for GERD in 1998. In 2005, there were 3.14 million, an increase of 216 percent. In both years, approximately 62 percent of all GERD hospital discharges involved women.

The same study showed that the number of adults hospitalized for GERD decreased by 2.4 percent between 1998 and 2005. During the same period, the rate increased by 42 percent for babies. It increased by 84 percent for children aged two to 17.

In 2010, 4.7 million hospitalizations and 1,653 deaths were a result of GERD, reports the National Institute of Diabetes and Digestive and Kidney Diseases.

GERD is a result of a weak lower esophageal sphincter. That weakness allows the contents of your stomach to flow back up into your esophagus.

There are a variety of factors that can weaken your esophageal sphincter, including:

overeating

being overweight

pregnancy

smoking or regular exposure to secondhand smoke

hiatal hernia (part of the stomach protrudes into the diaphragm muscle)

Certain foods and beverages can trigger GERD. Some of the more common food triggers include:

fried or fatty foods

citrus

chocolate

coffee

carbonated beverages

drinks containing alcohol

Some medications can cause GERD, too. Among them are:

alpha blockers

anti-inflammatories

sedatives

nitrates

If you take medication and have symptoms of GERD, speak to your doctor or pharmacist. They can discuss switching or stopping the medication with you. Don't stop taking a prescribed medication without consulting your doctor first, though.

The most common symptoms of GERD are acid indigestion and heartburn. You may frequently burp and feel bloated.

Acid in your esophagus can make it spasm. That causes pain and a feeling of tightness in the chest.

Other symptoms of GERD include:

nausea and vomiting

belching

difficulty swallowing

tooth erosion and bad breath

problems swallowing (dysphagia)

respiratory problems

abdominal pain

Some cases of heartburn may be a sign of a more serious condition. See your doctor if your heartburn:

occurs more frequently than once a week

becomes more severe

occurs at night and wakes you from sleep

Seek immediate medical attention if you have difficulty swallowing or breathing.

Consider it an emergency if:

you're vomiting large amounts

you have projectile vomiting

your vomit contains green or yellow fluid

your vomit looks like coffee grounds

In most cases, doctors diagnose acid reflux by reviewing symptoms and medical history. If you often have heartburn or acid indigestion that won't go away, testing for GERD may be recommended.

Diagnostic testing may include:

Endoscopy. A fiber-optic tube is passed down your throat so your doctor can view your esophagus and stomach. Tissue samples can be taken for biopsy.

Upper GI series X-rays. These are taken after you drink a barium solution. This procedure can find ulcers, hiatal hernias, and other abnormalities.

Esophageal monitoring. This is a way to measure acid levels in your lower esophagus for 24 hours.

Manometry. A manometry measures the rhythmic muscle contractions that occur in your esophagus when you swallow.

Antacids can neutralize stomach acid.

An H2 receptor blocker, like cimetidine, treats excess stomach acid.

Proton pump inhibitors reduce the amount of acid your stomach produces.

If OTC drugs aren't working well, your doctor can prescribe alternative medications:

Sucralfate forms a protective film on the surface of your esophagus and stomach.

Metoclopramide helps your esophagus contract efficiently and your stomach to empty faster.

Avoid smoking and being around secondhand smoke.

Maintain a healthy weight, and avoid tight clothing around your middle.

Eat smaller meals. Keep a food diary so you can pinpoint and avoid the foods that trigger your symptoms.

Try to move around a little after you eat, staying upright for three hours after meals. A short walk may go a long way.

If you don't find relief from medication and lifestyle changes, surgery may be an option. The most common surgical treatment options include:

Fundoplication. This is the most common surgery for GERD. Your surgeon wraps the top of your stomach around the lower esophageal sphincter to tighten the muscle and prevent reflux. Fundoplication is usually done with a minimally invasive (laparoscopic) procedure.

LINX reflux management system. A ring of tiny magnetic beads is wrapped around the junction of the stomach and esophagus. The magnetic attraction between the beads is strong enough to keep the junction closed to refluxing acid, but weak enough to allow food to pass through. The LINX system can be implanted using minimally invasive surgery. The U.S. Food and Drug Administration approved the LINX system in 2012 for people with GERD who haven't been helped by other treatments.

For most people, GERD is a manageable condition. If left untreated, though, GERD can lead to serious complications.

Scar tissue can cause the esophagus to become too narrow (esophageal stricture). This can make swallowing difficult and painful.

Stomach acid entering into your lungs can cause serious harm. Lung damage can make you more likely to have chest congestion and wheezing. This puts you at increased risk for recurrent pneumonia or asthma.

Long-term inflammation of the esophagus (esophagitis) increases the risk of precancerous cells in the esophagus. Severe cases of GERD can lead to a condition called Barrett's esophagus. That's when your esophagus grows tissue resembling the tissue found in the lining of your intestine. Barrett's esophagus increases your risk of esophageal adenocarcinoma, a rare type of cancer.

According to the HCUP, 4.2 percent of GERD hospitalizations involved an esophageal disorder in 2005. Cases of dysphagia grew by 264 percent between 1998 and 2005. Esophageal adenocarcinoma rose by 195 percent. Esophagitis increased by 94 percent.

If you need to be hospitalized, GERD can be costly. In 1998, a hospital stay for GERD averaged $5,616 in the United States, reports HCUP. By 2005, it had risen to $6,545.

Nationally, total hospital costs for GERD were $509 million in 1998. By 2005, costs rose to $622 million, an increase of 22 percent.

In the United States alone, overall spending on all gastrointestinal diseases was estimated to be $142 billion per year in direct and indirect costs in 2009, notes a 2015 review. Researchers note GERD accounts for approximately $15 to $20 billion of these direct and indirect costs.

Jen Thomas is a journalist and media strategist based in San Francisco. When she's not dreaming of new places to visit and photograph, she can be found around the Bay Area struggling to wrangle her blind Jack Russell Terrier or looking lost because she insists on walking everywhere. Jen is also a competitive Ultimate Frisbee player, a decent rock climber, a lapsed runner, and an aspiring aerial performer.

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