What is GERD?

Many people experience occasional acid reflux — when stomach acid flows back into your esophagus, the tube that carries food from your mouth to your stomach. But reflux two or more times a week for a few weeks could signal a more serious condition called gastroesophageal reflux disease, or GERD. If left untreated, severe GERD can damage the lining of the esophagus, which can raise the risk of serious complications.

GERD stands for gastroesophageal reflux disease. Gastroesophageal refers to the stomach and esophagus, and reflux means to flow backward, and disease refers to a chronic function — so GERD reflects the recurrence of stomach acid back into the esophagus.

The most common symptom of GERD is frequent heartburn.

Other symptoms of GERD can include:

• Chest or upper abdominal pain
• Trouble or painful swallowing
• Regurgitation of food or acid
• Sensation of a lump in your throat
• Nausea

GERD is often caused by something that affects the lower esophageal sphincter (LES). The LES is a strong muscular ring at the lower end of the esophagus where it joins the stomach. When you swallow, the LES opens to allow food to pass into the stomach and then closes to prevent food and liquids from flowing back up. When the LES is weak or relaxes inappropriately, stomach contents can flow back up into the esophagus.

Some foods and drinks appear to affect the muscle tone of the LES. They let the LES stay open longer than normal, which may worsen your GERD symptoms. These include:

• Alcohol
• Coffee and other beverages that contain caffeine
• Chocolate
• Peppermint
• Fatty, fried, greasy or spicy foods

Certain foods can cause the stomach to make more acid and aggravate your symptoms. These include:

• Citrus fruits
• Tomatoes and tomato products

Other things that may increase your risk of GERD include:

• Having increased pressure on your abdomen from being overweight, obese or pregnant. Eating large meals can also increase stomach pressure.
• Taking certain medications, including some antihistamines, antidepressants and pain medicines
• Smoking or inhaling secondhand smoke

Yes, symptoms of GERD can be worse at night. At nighttime, when you are lying down, you lose gravity’s help in keeping stomach acid from coming back up into the esophagus, so you may experience increased heartburn. Waiting three hours after eating a meal before lying down or going to bed may help reduce symptoms. Nighttime acid reflux can also cause the following symptoms:

• Chronic cough
• Laryngitis
• New or worsening asthma

Infant reflux or gastroesophageal reflux (GER) occurs when a baby’s LES is not fully developed. This allows an infant’s stomach contents to come back up to the esophagus, causing the baby to spit up. This type of reflux is common in infants, with half of infants spitting up multiple times a day for the first three months of their lives. Once your baby’s LES is fully developed, they should stop spitting up. This usually occurs by 12 to 14 months of age.

GERD in infants is a more serious and longer-lasting form of reflux. GERD in babies occurs when an infant’s LES weakens or relaxes when it shouldn’t. This type of reflux may last longer than 12 to14 months.

Signs of GER and GERD in infants include:

• Spitting up more than usual
• Arching their back, typically during or following a feeding
• Irritability after a feeding
• Colic (regular crying for more than 3 hours per day without a known medical cause)
• Coughing, gagging or trouble swallowing
• Trouble breathing or wheezing (a high-pitched whistling sound when breathing)
• Poor feeding or refusal to eat
• Poor weight gain or weight loss
• Vomiting

Seek medical help right away if your infant has any of the following symptoms:

• Vomits large amounts
• Regular projectile or forceful vomiting
• Vomit that is green or yellow, looks like coffee grounds or contains blood
• Trouble breathing
• Regularly refuses feedings
• Cries more than usual and is more irritable than normal
• Signs of dehydration, such as dry diapers or extreme fussiness

GERD is usually a chronic condition. However, there are effective treatment options that can help prevent GERD symptoms from coming back. Most babies with GERD will outgrow the condition by their first birthday. 

Treatment for GERD depends on the severity of your symptoms. Your healthcare provider might recommend you first try lifestyle changes and over-the-counter (OTC) medications to help reduce symptoms of acid reflux.

Lifestyle changes and more natural remedies for GERD may include:

• Lose any excess weight that puts pressure on your abdomen, which can push up your stomach and cause acid to reflux into your esophagus
• Stop smoking and avoid secondhand smoke
• Do not overeat. Consider eating several small meals each day instead of three large meals
• Elevate the head of your bed by six to nine inches with wood or cement blocks under the top legs of your bedframe or a wedge between the mattress and box spring to help ease nighttime GERD symptoms
• Wait to lie down for three hours after eating
• Eat food slowly and chew thoroughly to ease digestion
• Avoid tight-fitting clothing to avoid pressure on your abdomen and LES
• Avoid foods and drinks that trigger your symptoms

Your healthcare provider may also suggest trying an OTC acid-reducing medicine for a short period of time. OTC medications commonly used for acid reflux include:

• Antacids that neutralize stomach acid and offer short-term relief, such as Mylanta, Rolaids and Tums. Antacids help to treat occasional, mild symptoms of reflux.
• H2 blockers to reduce acid production for up to 12 hours, like cimetidine (Tagamet HB) and famotidine (Pepcid AC).
• Proton pump inhibitors (PPIs) are stronger acid blockers and allow for long-term healing of the esophagus. Over-the-counter PPIs include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC, Zegerid OTC). In some cases, your healthcare provider may recommend prescription medications for GERD. These may include prescription-strength H2 blockers, prescription-strength proton pump inhibitors or medications that work to strengthen the LES and help your stomach empty faster.

Usually, GERD can be managed with medication and lifestyle changes. If not, your healthcare provider might recommend surgical treatment, such as:

• Fundoplication, a procedure where the surgeon wraps the top of your stomach around the lower end of your esophagus to add pressure to the LES and prevent reflux.
• LINX device, which is a ring of tiny magnetic beads, can be wrapped around the junction of the stomach and esophagus to keep the junction closed to refluxing acid.

If you are experiencing bothersome symptoms that may be associated with acid reflux or GERD, speak with your healthcare provider about next steps.

Clinically reviewed and updated by Nora Laberee, medical writer, November 2022.