GERD and Heartburn: What Is GERD?
Medically reviewed by Carmen Fookes, BPharm. Last updated on March 8, 2021.
1. What Is GERD? Stomachs Behaving Badly
Do you ever get a burning feeling in your stomach or behind your breastbone after eating?
Can you sometimes feel the acid splashing out of your stomach and rising up towards your mouth...or worse still....burp acid?
Perhaps you often feel bloated or a bit sick after food?
If your answer was "Yes" to any of these questions then you may have heartburn or a condition called gastroesophageal reflux disease, commonly abbreviated as GERD.
2. Cause Of GERD: Stomach Contents Going The Wrong Way Up the One-Way
Our digestive system is supposed to be a one-way street. Food enters our stomach where it is broken down so that nutrients can be absorbed before being excreted out via the intestines and colon.
Guarding the entrance to our stomach is a ring of muscle fibers called the lower esophageal sphincter (LES). The LES prevents swallowed food from moving back up the esophagus and normally remains tightly closed....until we swallow. People with heartburn and GERD have a weakened LES that allows partly digested stomach contents to leak back up the esophagus - causing symptoms.
3. GERD Symptoms: That Burning Feeling
Heartburn is usually felt as a burning pain rising up from the stomach to the esophagus. Heartburn is a common symptom of GERD. Other symptoms may include:
- A feeling that food is stuck behind your breastbone or feeling like there is a lump in your throat
- Chest pain
- Feeling sick after eating food.
Other not-so-common symptoms include:
- Bringing food back up (regurgitation)
- Coughing or wheezing
- Difficulty swallowing
- Hoarseness or a noticeable change in your voice or developing a sore throat.
4. GERD Risk Factors. Why Me?
People are more likely to develop heartburn or GERD if they:
- Are overweight
- Drink alcohol
Both conditions are more common in pregnancy because the stomach is pushed upwards by the baby.
Heartburn and GERD can also be the result of a medical conditions such as scleroderma or a hiatal hernia. Many medications can also exacerbate symptoms. Talk to your doctor if your symptoms worsen or coincided with the start of a new medicine.
5. GERD Mimics: To Worry or Not to Worry?
Some other worrying conditions can mimic symptoms of heartburn or GERD. Always see a doctor if this is the first time you have had symptoms or if they have changed in any way. Other symptoms which are a cause for concern include:
- Coughing spells
- Difficulty swallowing
- Blood specks after you cough, vomit, or in your bowel movements
- Unexplained weight loss.
GERD symptoms tend to be worse at night or after bending over, lying down or eating a big meal. Symptoms that persist all day need to be checked by a doctor.
6. Heart or Heartburn? If in Doubt, Check it Out!
It is important to realize that symptoms of a heart attack or angina can also mimic symptoms of heartburn or GERD. Even experienced doctors can't always tell the difference.
Heart attack symptoms may include a sudden crushing pain in the chest; pain felt in the back, neck, jaw, stomach, arm (especially the left side); sweating; lightheadedness; nausea; chest tightness during physical or emotional stress; or shortness of breath. In some people, particularly women, heart attack symptoms can be subtle.
The best thing to do is to always seek medical attention if you are not sure. There is no one symptom that distinguishes a heart attack from GERD or vice versa.
7. GERD Red Flags: Alert Your Doctor
There's a few other factors relating to GERD that doctors call "red flags".
If anybody in your family has suffered from gastric cancer in the past, or if you have had a previous stomach ulcer, then see a doctor right away.
Medications such as NSAIDs (like aspirin, ibuprofen, naproxen, diclofenac), corticosteroids (prednisone), and iron tablets can aggravate GERD and heartburn so talk with your doctor if you have recently started on these. In addition, tell your doctor about any unusual lumps or bumps you can feel in your stomach.
8. Good GERD Lifestyle Choices
If your doctor has diagnosed you with GERD and is satisfied that nothing else is wrong with you, then you can make some lifestyle changes to improve your symptoms. Lose weight if you are overweight, stop smoking if you smoke, and cut back on alcohol if you drink. Avoid clothes that are too tight around the waistband and reduce the size of your meals. Stay away from acidic and spicy food and take all medications with a big glass of water.
Avoid NSAIDs, such as aspirin and ibuprofen, and do not take medicines just before bed. It's best to remain upright for at least 15 minutes after taking any medication.
9. GERD Treatment: Antacids, H2 Blockers, and Proton Pump Inhibitors
There are lots of different medicines available to treat GERD and it is best to talk with your pharmacist or doctor about which one is best for you.
Over the next three slides we will discuss the use of:
10. GERD Treatment: Antacids; Good for Short-Term Occasional Relief
Antacids work by neutralizing the stomach acid that causes heartburn and GERD symptoms. They are readily available from drugstores, supermarkets and gas stations and are OK to use for occasional heartburn only (heartburn that occurs just a few times a month).
All antacids are best taken within an hour of eating the offending meal. Brands containing magnesium can cause diarrhea; brands containing calcium or aluminum may cause constipation. However, often manufacturers combine both products in the same preparation which means these side effects are cancelled out. Antacids can also affect absorption of other medicines so they shouldn't be taken at the same time as your regular pills.
11. GERD Treatment: H2 Blockers; Not As Quick Acting But Longer Lasting
H2 blockers reduce acid production in the stomach by blocking signals that tell the stomach to make acid.
Several can be bought without a prescription at lower doses and are good to use for occasional relief. H2 blockers take about 30 to 90 minutes to start working and some can last up to 24 hours.
There are three H2 blockers available in the U.S. that work in this way:
In April, 2020, the FDA pulled all versions of ranitidine, another H2 blocker, from the U.S. market. GSK had already withdrawn its branded ranitidine product, Zantac, in September 2019, after an independent company called Valisure identified traces of N-nitrosodimethylamine (NDMA) in ranitidine branded products and some generics. NDMA is classified as a probable carcinogen.
12. GERD Treatment: Proton Pump Inhibitors (PPIs); Most Effective But Short Term Use Only
PPIs suppress gastric acid secretion by shutting down the stomach proton pumps. This is the final stage of acid secretion which makes PPIs more effective than H2 blockers. PPIs take a bit longer than H2 blockers to start working.
Different brands of PPIs include dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), and omeprazole (Prilosec), but generic forms are often cheaper. Over-the-counter versions are available, too.
PPI side effects may include a headache, constipation or diarrhea, flatulence, or nausea. PPIs can also interact with some other drugs, such as clopidogrel (Plavix), or affect the absorption of certain drugs, such as iron salts, ketoconazole, and vitamin B12.
PPIs should only be used for a couple of months, maximum, before gradually tapering off to prevent acid rebound. Long-term use has been associated with an increased risk of osteoporosis-related fractures of the hip and spine, kidney disease, Clostridium difficile-associated diarrhea, and several other adverse outcomes.
Zegerid is a combination medicine that contains the PPI omeprazole and sodium bicarbonate, that is also available as a generic. The sodium bicarbonate provides fast-acting relief from GERD symptoms, whereas the omeprazole component takes longer to work but keeps symptoms at bay for the whole day. Side effects include diarrhea (or in some people, constipation) and symptoms may rebound if stopped suddenly. Zegerid is not suitable for people on a low salt (sodium) diet.
Summary: GERD and Heartburn in 6 Points
- Always see your doctor for a proper diagnosis if you are having heartburn or GERD symptoms for the first time.
- Not sure if it is a heart attack or heart burn? Get it checked out right away.
- Lose weight, stop smoking, and avoid alcohol.
- Eat smaller meals and remain upright after taking medications.
- See your doctor if you are self-medicating most days with over-the-counter products.
- Only use PPIs for a maximum of a few months at a time, unless your doctor has advised you otherwise.
Finished: GERD and Heartburn: What Is GERD?
Are the latest diet pills the cure-all for the obesity epidemic? Here, see if prescription medicines for weight loss can help you lose weight.
Society tends to treat menopause as a disease; something to be avoided at all costs. But menopause can be positive. No more monthly mood swings, period accidents, or pregnancy worries. Self-confidence and self-knowledge...
- Gastroesophageal reflux disease (GERD). Mayo Clinic 2020. https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940
- GERD (Chronic Acid Reflux). Cleveland Clinic. 12/06/2019. https://my.clevelandclinic.org/health/diseases/17019-gerd-or-acid-reflux-or-heartburn-overview
- Gaastroesophageal reflux disease (GERD). American Academy of Allergy, Asthma & Immunology. 2021. https://www.aaaai.org/conditions-and-treatments/related-conditions/gastroesophageal-reflux-disease