Gastroesophageal Reflux Disease

What is gastroesophageal reflux disease?

Gastroesophageal reflux disease (GERD) occurs when acid and food in the stomach back up into the esophagus.

What causes GERD?

GERD often occurs when the lower muscle (sphincter) of the esophagus does not close properly. The sphincter normally opens to let food into the stomach. It then closes to keep food and stomach acid in the stomach. If the sphincter does not close properly, stomach acid and food back up (reflux) into the esophagus.

The following increases your risk of GERD:
  • Diet: Certain foods may weaken the muscles of the esophagus. These can include chocolate, peppermint, and fried or fatty foods. Drinks with caffeine or alcohol may also increase your risk of GERD. Large meals or lying down after a meal may lead to GERD.

  • Hiatal hernia: This occurs when a part of the stomach moves up into the chest through a small hole.

  • Medicines: Certain medicines can increase the risk of GERD. Ask your caregiver if any of the medicines you take can increase your risk.

  • Obesity: Extra weight may put pressure on your stomach. This pressure causes stomach acid reflux and heartburn.

  • Pregnancy: Your stomach works more slowly due to changes in hormone levels when you are pregnant. Your enlarged uterus may also crowd your stomach and push stomach acid upward.

  • Smoking: This makes the sphincter relax more than usual.

What are the signs and symptoms of GERD?

Heartburn is the most common symptom of GERD. It is a feeling of burning pain in your chest or below the breast bone. This usually occurs after meals and spreads to your neck, jaw, or shoulder. You may also have one or more of the following:

  • Bitter or acid taste in your mouth

  • Coughing, choking, or shortness of breath

  • Trouble or difficulty swallowing

  • Frequent burping or hiccups

  • Vomiting blood or having black, tarry stools

  • Weight loss

How is GERD diagnosed?

Your caregiver will do a physical exam and ask about your symptoms and when they started. Tell your caregiver about other medical conditions you have, your eating habits, and your activities.

  • Esophageal pH monitoring: A small probe is placed inside the esophagus and stomach to check the pH of your stomach acid. The pH measures how much acid is in your stomach. This test also measures the amount of acid that refluxes into the esophagus.

  • Endoscopy: This test uses a scope to see the inside of your esophagus and stomach. A scope is a long, bendable tube with a light on the end. A camera may be hooked to the scope to take pictures. During an endoscopy, caregivers may find problems with how your digestive tract is working. Samples may be taken from your digestive tract and sent to a lab for tests.

  • Upper GI x-rays: During an upper GI series, an x-ray machine is used to take pictures of your stomach and intestines (bowel). You may be given a chalky liquid to drink before the pictures are taken. This liquid helps your stomach and intestines show up better on the x-rays. An upper GI series can show if you have an ulcer, a blocked intestine, or other problems.

  • Esophageal manometry: This test measures the pressure within the esophagus and stomach.

How is GERD treated?

You may have one or more of the following treatments:

  • Medicines:

    • Antacids: This medicine decreases the stomach acid that can irritate your esophagus and stomach. Some antacids may be bought without a doctor's order. Check with your caregiver before you use any of these medicines.

    • Histamine type-2 receptor blockers: This group of medicines is also called H2 blockers. They block acid production in the stomach.

    • Proton pump inhibitors (PPI): This medicine blocks acid production in the stomach. These medicines may cause miscarriages and should not be used by pregnant women.

    • Promotility agents: These medicines cause the lower esophageal sphincter and stomach to contract (tighten) more.

  • Surgery: This may be done when your medicines cannot control your symptoms or other problems are present. Fundoplication is surgery to wrap the upper part of the stomach around the esophageal sphincter to strengthen it. Ask your caregiver for more information about fundoplication.

How can I help prevent GERD?

  • Avoid foods and drinks that may increase heartburn: These include chocolate, peppermint, fried or fatty foods, and drinks that contain caffeine. Foods and drinks that can irritate your esophagus, such as citrus fruits, juices, and alcohol, should also be avoided.

  • Do not eat large meals: When you eat a lot of food at one time, your stomach needs more acid to digest it. Eat 6 small meals each day instead of 3 large ones and eat slowly. Do not eat meals 2 to 3 hours before bedtime, as this may also decrease acid reflux.

  • Elevate the head of the bed: Place 6-inch blocks under the head of your bed frame. You may also use more than one pillow under your head and shoulders while you sleep.

  • Keep a healthy weight: If you are overweight, weight loss may help relieve symptoms of GERD.

  • Stop smoking: Smoking weakens the lower esophageal sphincter.

What are the risks of GERD?

  • You may bleed too much or develop an infection after surgery. Surgery to treat GERD can also make you may feel bloated after meals.

  • If GERD is not treated, the lining of the esophagus may form ulcers and bleed. This may cause blood to appear in your vomit or bowel movement. Ulcers may heal into scars that can narrow the esophagus. GERD may lead to cancer or other medical problems if it is not treated.

Where can I find more information?

  • National Digestive Diseases Information Clearinghouse (NDDIC)
    2 Information Way
    Bethesda , MD 20892-3570
    Phone: 1- 800 - 891-5389
    Web Address:

When should I contact my caregiver?

Contact your caregiver if:

  • Your symptoms get worse or do not improve with treatment.

  • You have questions or concerns about your condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

  • You feel full and cannot burp or vomit.

  • You have severe chest pain and trouble breathing all of a sudden.

  • Your bowel movements are black, bloody, or tarry-looking.

  • Your vomit looks like coffee grounds or has blood in it.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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