GERD (Acid Reflux): Causes, Symptoms & Treatment

A guide to gastroesophageal reflux disease (GERD) - chronic acid reflux, its symptoms, complications, and treatment options

10 min readLast updated: 2026-02-17

Quick Facts

Prevalence
~20% of adults in Western countries
Key Symptom
Heartburn 2+ times per week
Complication
Barrett's esophagus in 10-15% of GERD patients

What Is GERD?

Gastroesophageal reflux disease (GERD) is a chronic digestive condition in which stomach acid or bile frequently flows back (refluxes) into the esophagus, the tube connecting the mouth to the stomach. This backwash (acid reflux) irritates the esophageal lining and can cause symptoms and complications over time. While occasional acid reflux is normal, GERD is diagnosed when reflux occurs frequently (typically twice a week or more) and causes troublesome symptoms or complications.

GERD affects approximately 20% of adults in Western countries, making it one of the most common digestive disorders.

Why Reflux Happens
The lower esophageal sphincter (LES) is a ring of muscle at the junction of the esophagus and stomach that normally acts as a one-way valve, allowing food to pass into the stomach but preventing stomach contents from flowing back. In GERD, this sphincter relaxes inappropriately or becomes weakened, allowing acid to reflux into the esophagus. A hiatal hernia (where part of the stomach pushes through the diaphragm) can also contribute.

Symptoms

Typical symptoms:

  • Heartburn: A burning sensation in the chest, usually after eating, that may worsen when lying down or bending over
  • Regurgitation: A sour or bitter taste in the back of the mouth from stomach contents flowing back

Atypical symptoms:

  • Chronic cough, especially at night
  • Hoarseness or voice changes (laryngopharyngeal reflux)
  • Chest pain (can mimic cardiac chest pain)
  • Difficulty swallowing (dysphagia)
  • Sensation of a lump in the throat (globus)
  • Worsening asthma
  • Dental erosion

Treatment

Lifestyle modifications (essential for all patients):

  • Elevate the head of the bed 6-8 inches
  • Avoid eating 2-3 hours before bedtime
  • Lose weight if overweight
  • Avoid trigger foods (fatty foods, chocolate, caffeine, alcohol, citrus, tomatoes, spicy foods)
  • Quit smoking
  • Wear loose-fitting clothing
  • Eat smaller, more frequent meals

Medications:

  • Antacids (Tums, Maalox): Provide quick but temporary relief
  • H2 receptor blockers (famotidine): Reduce acid production; good for mild symptoms
  • Proton pump inhibitors (PPIs): Omeprazole, esomeprazole, lansoprazole, pantoprazole -- most effective acid-suppressing therapy; standard 4-8 week course

Surgical options (for refractory cases):

  • Fundoplication (Nissen): The top of the stomach is wrapped around the LES to strengthen it
  • LINX device: A ring of magnetic beads placed around the LES
Warning
Seek urgent medical attention if you experience difficulty swallowing, painful swallowing, unintentional weight loss, vomiting blood, or black tarry stools. These may indicate complications of GERD such as stricture, bleeding, or malignancy. Chest pain should always be evaluated to rule out cardiac causes.
Clinical Note
Long-term PPI use (beyond 8 weeks) should be at the lowest effective dose. PPIs are generally safe, but long-term use has been associated with small increased risks of C. difficile infection, bone fractures, kidney disease, and vitamin B12/magnesium deficiency. Patients should have their PPI indication reassessed periodically.

When to See a Doctor

See a doctor if heartburn occurs more than twice a week, symptoms persist despite over-the-counter medications, you have difficulty swallowing, or symptoms significantly affect your quality of life.

Sources

  1. [1]Katz PO, Dunbar KB, Schnoll-Sussman FH, et al.. "ACG Clinical Guideline: Guidelines for the Diagnosis and Management of GERD." American Journal of Gastroenterology, 2022.
  2. [2]Vakil N, van Zanten SV, Kahrilas P, et al.. "Updated Guidelines for the Diagnosis and Treatment of GERD." American Journal of Gastroenterology, 2006.

Medically reviewed by

Medical Review Team, Gastroenterology

Last updated: 2026-02-17Sources: 2

The content on Medical Atlas is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider.

Related Conditions

Omeprazole