Almost everyone has heartburn now and then, especially after a large or spicy meal. But when acid reflux happens often, it may be gastroesophageal reflux disease, or GERD. Left untreated, GERD can damage the esophagus. This guide explains the symptoms, common triggers and treatments, and the warning signs that need a doctor’s attention.
What is acid reflux?
At the bottom of your esophagus (food pipe), a ring of muscle called the lower esophageal sphincter acts like a valve. It opens to let food into the stomach and closes to keep stomach contents from flowing back up.
Acid reflux happens when this valve relaxes or weakens at the wrong time, letting stomach acid rise into the esophagus. GERD is when reflux happens repeatedly, causes troublesome symptoms or leads to complications. Many clinicians consider reflux symptoms twice a week or more as a sign of possible GERD.
Common symptoms
- Heartburn: a burning feeling behind the breastbone, often after eating or when lying down
- Regurgitation: sour or bitter liquid or food coming back into the throat or mouth
- Chest discomfort
- Difficulty or discomfort when swallowing
- A feeling of a lump in the throat
- Chronic dry cough, hoarseness or frequent throat clearing
- Worsening asthma symptoms
- Bad breath or tooth enamel erosion
Important: chest pain can be a sign of a heart attack. If you have chest pain with shortness of breath, sweating, or pain spreading to the arm, jaw or back, call emergency services immediately.
Common triggers
Triggers differ from person to person. Keeping a food and symptom diary can help you identify yours.
Foods and drinks
- Fatty or fried foods
- Spicy foods
- Chocolate
- Peppermint
- Citrus fruits and tomatoes, including sauces
- Onions and garlic
- Coffee and other caffeinated drinks
- Carbonated drinks
- Alcohol
Habits and other factors
- Large meals
- Lying down within two to three hours of eating
- Tight clothing around the waist
- Smoking
- Excess weight, especially around the abdomen
- Pregnancy
- A hiatal hernia, where part of the stomach pushes up through the diaphragm
- Some medicines, such as certain pain relievers, some blood pressure medicines and some sedatives
Lifestyle changes that help
Small changes often bring meaningful relief:
- Eat smaller meals and stop eating two to three hours before bed.
- Raise the head of your bed by 6 to 8 inches using blocks or a wedge pillow, if symptoms occur at night. Extra pillows alone are less effective.
- Try sleeping on your left side.
- Lose weight if you are overweight.
- Stop smoking.
- Limit alcohol and the foods you find trigger your symptoms.
- Wear looser clothing around the waist.
Medicines for acid reflux and GERD
Antacids
Products containing calcium carbonate, magnesium or aluminum neutralize stomach acid and give quick, short-term relief. They are best for occasional symptoms.
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H2 blockers
Medicines such as famotidine reduce acid production. They work more slowly than antacids but last longer and can be taken before a meal that tends to cause symptoms.
Proton pump inhibitors (PPIs)
Medicines such as omeprazole, esomeprazole, lansoprazole and pantoprazole are the most effective at reducing acid. They work best when taken 30 to 60 minutes before a meal, usually breakfast. Over-the-counter PPIs are intended for a 14-day course; if you need them longer or more often, see a clinician.
Long-term PPI use can be appropriate for people with GERD complications, but it should be reviewed regularly with your clinician to use the lowest effective dose. Do not stop a long-term PPI suddenly without advice, because symptoms can rebound.
When to see a doctor
Make an appointment if:
- You have reflux symptoms twice a week or more
- Over-the-counter medicines do not control your symptoms
- You have needed medicine for more than two weeks
Alarm symptoms that need prompt evaluation
- Difficulty swallowing or food sticking
- Pain when swallowing
- Unintentional weight loss
- Vomiting, especially vomiting blood or material that looks like coffee grounds
- Black, tarry stools
- Anemia
- New symptoms starting after age 60
How GERD is diagnosed
Many people are diagnosed based on symptoms and a trial of medicine. Further tests may include:
- Upper endoscopy: a thin camera examines the esophagus and stomach and can take small tissue samples.
- Ambulatory pH monitoring: measures how often and how long acid enters the esophagus over 24 to 96 hours.
- Esophageal manometry: measures muscle movement in the esophagus, often before surgery.
Possible complications
Untreated GERD can lead to:
- Esophagitis: inflammation and ulcers in the esophagus
- Esophageal stricture: narrowing from scar tissue, causing swallowing problems
- Barrett’s esophagus: changes in the lining of the esophagus that slightly raise the risk of esophageal cancer and need regular monitoring
Surgical and procedural options
For people whose symptoms are not controlled by medicine, or who do not want long-term medicine, options include fundoplication, where the top of the stomach is wrapped around the lower esophagus to strengthen the valve, and a magnetic sphincter device placed around the lower esophagus. A gastroenterologist or surgeon can explain the benefits and risks.
You can read more from the National Institute of Diabetes and Digestive and Kidney Diseases.
Frequently asked questions
Is milk good for heartburn?
Milk may soothe briefly, but its fat and protein can stimulate more acid later. It is not a reliable treatment.
Can GERD cause a cough?
Yes. Reflux can irritate the throat and airways, causing a chronic cough or hoarseness, sometimes without heartburn.
Can GERD be cured?
Many people control GERD well with lifestyle changes and medicine. Surgery can provide long-term relief for selected patients.
The bottom line
Occasional heartburn is common and usually harmless. Frequent reflux, alarm symptoms or the need for regular medicine are reasons to see a clinician. Smaller meals, avoiding late eating, raising the head of the bed and the right medicine can bring lasting relief.
This article is for general information and is not a substitute for advice from a qualified healthcare professional.