What is GERD (Gastroesophageal Reflux Disease)?
- Share via
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 Contents
- What are the Key Symptoms of GERD
- How Common is GERD?
- The Root Causes of GERD and Hiatal Hernia
- Types and Classifications
- Complications
- Why Managing GERD Can Be Complicated
- Closing Thoughts
- References
What 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
