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This topic is about
gastroesophageal reflux disease (GERD) in adults. For
information on reflux in babies and children, see
Gastroesophageal Reflux in Babies and Children. For information on reflux while pregnant, see Gastroesophageal Reflux Disease During Pregnancy. For information about occasional heartburn, see Heartburn.
stomach acid and juices flow from the stomach back up
into the tube that leads from the throat to the stomach (esophagus). This causes
heartburn. When you have heartburn that bothers you often, it is called gastroesophageal reflux disease, or GERD.
Eating too much or bending forward after eating sometimes causes
heartburn and a sour taste in the mouth. But having heartburn from time to time
doesn't mean that you have GERD. With GERD, the reflux and heartburn last longer and
come more often. If this happens to you, be sure to get it treated, because
GERD can cause
ulcers and damage to your esophagus.
Normally when you swallow your food, it first travels down the food pipe (esophagus). A valve opens to let the
food pass into the stomach, and then the valve closes. With GERD, the valve doesn't
close tightly enough. Stomach acid and juices from the stomach flow back up
(reflux) into the esophagus.
The main symptom of GERD is
heartburn. It may feel like a burning, warmth, or pain just behind the
breastbone. It is common to have symptoms at night when you're trying to
If you have pain behind your breastbone, it is important to
make sure that it isn't caused by a problem with your heart. The burning sensation
caused by GERD usually occurs after you eat. Pain from the heart usually feels
like heaviness, tightness, discomfort, or a dull
ache. It occurs most often after you are active.
First, your doctor will do
a physical exam and ask you questions about your health. You may or may not
need further tests. Your doctor may just treat your symptoms by recommending
medicines that reduce or block stomach acid. These include H2 blockers such as famotidine (Pepcid) and proton pump inhibitors such as omeprazole (Prilosec). If your
heartburn goes away after you take the medicine, your doctor will likely
For mild symptoms of GERD, you
can try over-the-counter medicines. These include antacids (for example, Tums),
H2 blockers (for example, Pepcid), and proton pump inhibitors (for example,
Prilosec). Changing your diet, losing weight if needed, and making other
lifestyle changes can also help. If you still have symptoms after trying
lifestyle changes and over-the-counter medicines, talk to your doctor.
Your doctor may recommend surgery if medicine doesn't work or if you
can't take medicine because of the side effects. Fundoplication
surgery strengthens the valve between the esophagus and the stomach. But many
people continue to need some medicine even after surgery.
common in pregnant women. Lifestyle changes and antacids are usually tried
first to treat pregnant women who have GERD. Antacids are safe to use for
heartburn symptoms during pregnancy. If lifestyle changes and antacids don't
help control your symptoms, talk to your doctor about using other medicines.
Most of the time, symptoms get better after the baby is born.
You may need to take medicine for many
years to help control the symptoms. But you can also make changes to your lifestyle
to help relieve your symptoms of GERD. Here are some things to try:
Learning about gastroesophageal reflux disease (GERD):
Living with GERD:
Health Tools help you make wise health decisions or take action to improve your health.
Gastroesophageal reflux disease (GERD) happens when
stomach acid and juices back up, or reflux, into the
esophagus, the tube that connects the throat
to the stomach. This occurs when the valve between the lower end of the
esophagus and the stomach (the
lower esophageal sphincter) does not close tightly
Most of the time, GERD happens when the valve relaxes at the wrong time and stays open too long. Normally, the valve is only open for a few seconds when you swallow. Some foods, like peppermint and chocolate, may relax the valve so it doesn't close tightly. Alcohol, tobacco, and some medicines can also relax the valve.
Some foods can make GERD worse. Avoiding them can help reduce heartburn. These include citrus fruits, fatty and fried foods, garlic and onions, spicy foods, and tomato-based foods like spaghetti sauce and pizza.
Other things can make stomach juices back up,
The main symptoms of
gastroesophageal reflux disease (GERD) include:
Heartburn caused by GERD is
usually felt within 2 hours after you eat. If your heartburn lasts for several
hours—for example, all night—you may have severe GERD.
Other symptoms of GERD may include:
Gastroesophageal reflux disease (GERD) may cause
inflammation in the esophagus, the tube that connects the throat to the stomach. This condition is
called esophagitis. GERD without esophagitis is sometimes called nonerosive
If you have mild GERD symptoms—an uncomfortable
feeling of burning, warmth, heat, or pain just behind the breastbone—you may be able to treat
yourself with nonprescription medicines that reduce or block acid.
Advanced GERD can cause complications such as:
Some people who have GERD may be at increased risk for
cancer of the esophagus.
Things that increase your
risk for symptoms of
gastroesophageal reflux disease (GERD) include your lifestyle and certain health conditions.
The main symptom of
gastroesophageal reflux disease (GERD) is an
uncomfortable feeling of burning, warmth, heat, or pain just behind the
breastbone, a feeling commonly referred to as heartburn. Sometimes heartburn
can feel like the chest pain of a heart attack.
Call 911 or other emergency services immediately if:
After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.
Call your doctor immediately if
Call your doctor if your GERD symptoms:
Watchful waiting is a wait-and-see approach. Occasional mild heartburn can often be relieved
by making lifestyle changes and taking nonprescription medicines that reduce or
block acid. Contact a doctor if
you have any of the symptoms listed above.
The following health professionals can evaluate
symptoms of GERD:
You may be referred to a doctor who specializes in
diseases of the digestive tract (gastroenterologist) to check severe
GERD symptoms or to get an opinion on whether surgery is needed. If you are
thinking about having surgery, you may also be referred to a general surgeon
who has experience treating stomach and esophagus problems.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
To find out if you have gastroesophageal reflux disease (GERD), your doctor may
first ask you questions about your symptoms, such as whether you have a
frequent uncomfortable feeling of burning, warmth, heat, or pain just behind
the breastbone (heartburn). If you have heartburn often, your doctor may prescribe medicines
to treat GERD without doing any other tests.
If medicines don't help, you may have other tests. These may include:
gastroesophageal reflux disease (GERD) is aimed at:
Treatment starts with changing habits, avoiding things that trigger your symptoms, and taking nonprescription medicines that reduce or block acids. If you still have symptoms after taking medicines for a few weeks, you may need prescription medicines. You may need to keep up with treatment over the long term to prevent GERD symptoms from coming back. If GERD keeps coming back or gets worse, you may need to think about surgery.
Making lifestyle changes is an important part of treating symptoms of GERD. Quitting smoking, losing weight if you need to, and changing your eating habits can all help you feel better.
If you have been
using nonprescription medicines to treat your symptoms for longer than 2 weeks,
talk to your doctor. Stomach acid could be causing damage
to your esophagus. If you
have GERD symptoms often, or if they are very bad, your doctor may recommend that you use
Be sure to continue to take
medicines as instructed by your doctor, because stopping treatment will often
bring symptoms back.
An important part of treating GERD is avoiding triggers. These things can include:
If you think that your symptoms are
worse after you eat a certain food, you can stop eating that food to see if it
If you think a medicine is making your
symptoms worse, talk to your doctor.
symptoms don't get better with treatment, or if they get worse, your doctor may suggest that you
take your medicine more often. Or you may be switched to a higher dose or a
Your doctor may also refer you to a
specialist for an
upper gastrointestinal endoscopy. Sometimes, GERD leads to other health problems, such as Barrett's esophagus. Part of your treatment may involve more endoscopies and other tests to monitor your health.
Sometimes surgery is needed, such as when medicines don't relieve symptoms or if you're unable to take medicines over a long period of time. Surgery can have benefits but can also cause problems with swallowing and burping. Some people still need to take medicines after surgery. And some people need to have surgery again.
may cause gastroesophageal reflux disease (GERD) as a side effect. If any medicines you take
seem to be the cause of your heartburn, talk with your doctor. Don't stop
taking a prescription medicine until you talk with your doctor.
If you have been using nonprescription medicines to treat your symptoms for
longer than 2 weeks, talk to your doctor. If you have gastroesophageal reflux disease (GERD), the stomach acid
could be causing damage to your esophagus. Your doctor can help you find the
right treatment. Making lifestyle changes is still an important part of the
treatment of GERD when you are using medicine.
blockers, and proton pump inhibitors—either prescription or nonprescription—are usually tried first. Medicines can:
Medicine may not prevent all of your GERD symptoms all the time. Even if you're taking an acid reducer every day, you may still have heartburn from time to time. It's okay to take antacids when you have heartburn like this. But if you feel like your daily medicine isn't working to control your GERD symptoms, talk with your doctor. You may need to try a different medicine.
Be sure to keep taking
medicines as instructed by your doctor, because stopping treatment will often
bring symptoms back.
Surgery may be used to treat
gastroesophageal reflux disease (GERD) symptoms that
have not been well controlled by medicines.
be an option when:
The benefits of surgery need to be compared to the possible complications and new symptoms you may have after surgery. Surgery for GERD can cause problems with swallowing and burping. It can also cause extra gas in the digestive tract, which leads to bloating and passing gas (flatulence).
After surgery, you may need to have other procedures to fix these problems. Some people still have to take medicine to control their symptoms, even after surgery. And some people need to have surgery again.
Fundoplication surgery is the most
common surgery used to treat GERD. This surgery strengthens the valve between
the esophagus and stomach (lower esophageal sphincter) to keep acid from
backing up into the esophagus as easily. It relieves GERD symptoms and inflammation of the esophagus (esophagitis).
Other types of surgery
for gastroesophageal reflux disease may include:
The American College of Gastroenterology is an organization of digestive disease specialists. The website contains information about common gastrointestinal problems.
The American Gastroenterological Association is a
society of doctors who specialize in the digestive system
(gastroenterologists). This Web site can help you find a gastroenterologist in
your area. They also have patient information on many gastrointestinal diseases
This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
Other Works Consulted
Agency for Healthcare Research and Quality (2011). Comparative Effectiveness of Management Strategies
for Gastroesophageal Reflux Disease: Update
(AHRQ Publication No. 11-EHC049-EF). Rockville, MD: Agency for Healthcare Research and Quality. Also available online: http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=781.
American Gastroenterological Association (2008).
American Gastroenterological Association medical position statement on the
management of gastroesophageal reflux disease. Gastroenterology, 135(4): 1383–1391.
Saltzman JR, Poneros JM (2009). Gastroesophageal reflux disease. In NJ Greenberger et al., eds., Current Diagnosis and Treatment: Gastroenterology, Hepatology, and Endoscopy, pp. 139–147. New
March 6, 2012
Adam Husney, MD - Family Medicine & Peter J. Kahrilas, MD - Gastroenterology
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