Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is a chronic digestive disorder in which stomach contents back up into the esophagus, causing repeated symptoms or complications over time.

Overview

Gastroesophageal reflux happens when stomach contents come back up into the esophagus. It is a normal process in the body that occurs in healthy individuals. It often happens without causing symptoms. In some cases, gastroesophageal reflux causes heartburn.

GERD is a more severe and long-lasting condition in which gastroesophageal reflux causes repeated symptoms that are bothersome or lead to complications over time. Without treatment, GERD can sometimes cause serious complications over time.

Related Terms: Gastroesophageal reflux is also known as:

Acid indigestion
Acid reflux
Acid regurgitation
Heartburn
Reflux

Signs and Symptoms

Adults

Gastroesophageal reflux and GERD commonly cause the following symptoms in adults:

Heartburn: A painful, burning feeling in the middle of the chest, behind the breastbone, rising from the lower tip of the breastbone toward the throat
Regurgitation: Stomach contents coming back up through the esophagus and into the throat or mouth, which may cause you to taste food or stomach acid

Not all adults with GERD have heartburn or regurgitation. Other symptoms may include:

Chest pain
Nausea
Difficulty or pain with swallowing
Chronic cough or hoarseness

See a doctor right away if you have:

Chest pain
Loss of appetite
Persistent vomiting
Problems swallowing or pain while swallowing
Signs of bleeding in the digestive tract, such as vomit that contains blood or looks like coffee grounds or stool that contains blood or looks black and tarry
Unexplained weight loss

Infants and Children

Symptoms of gastroesophageal reflux and GERD vary by age among children.

In infants, gastroesophageal reflux commonly causes:

Regurgitation
Spitting up

Infants with GERD may also have:

Arching of the back and abnormal movements of the neck and chin (this may be associated with or during feeds)
Choking, gagging, or problems swallowing
Irritability, particularly when it occurs with regurgitation
Loss of appetite or refusing to eat
Poor weight gain, cough, or wheezing
Vomiting

Symptoms in older children and teens may be similar to those in adults. Symptoms in young children may be more similar to those seen in infants.

In children who are too young to describe their symptoms, parents/caregivers may notice:

Arching of the back and abnormal movements of the neck and chin (this may be associated with or during feedings)
Irritability or crying more than usual
Loss of appetite or refusing to eat
Poor growth, weight loss, or gaining less weight than expected

Related Health Effects

Without treatment, GERD can sometimes cause serious complications over time.

An esophageal stricture happens when the esophagus becomes too narrow. Esophageal strictures can lead to problems with swallowing.

GERD can sometimes lead to Barrett’s esophagus, a condition in which tissue similar to the lining of the intestine replaces the tissue lining the esophagus. A small number of people with Barrett’s esophagus develop a type of cancer called esophageal adenocarcinoma.

Esophagitis is inflammation in the esophagus. Esophagitis may cause ulcers and bleeding in the lining of the esophagus. Chronic esophagitis increases the chance of developing esophageal stricture and Barrett’s esophagus.

Some people with GERD develop complications in the mouth, throat, or lungs. These may include:

In children, complications outside the esophagus may also include recurring pneumonia and wheezing. Stomach contents can also enter the airway, known as aspiration.

Causes and Risk Factors

Adults

The diaphragm and a ring of muscle called the lower esophageal sphincter most often prevent gastroesophageal reflux. GERD may develop if the lower esophageal sphincter becomes weak or relaxes when it shouldn’t.

Factors that may affect the lower esophageal sphincter and lead to GERD include:

Some medicines can cause GERD or make GERD symptoms worse, including:

Benzodiazepines (sedatives that make you calmer or sleepy)
Calcium channel blockers, which are used to treat high blood pressure
Certain asthma medicines
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Tricyclic antidepressants

A hiatal hernia, a condition in which the opening in the diaphragm lets the upper part of the stomach move up into the chest, can also increase the chance of getting GERD or make symptoms worse.

In addition, stress and anxiety can increase GERD symptoms, especially among people who do not respond well to therapy.

Infants and Children

In the first six months of life, infants spend much of their time lying down and do not have a fully developed esophagus and lower esophageal sphincter. They also eat meals that are primarily liquid and larger, relative to their body size, than older children or adults. These factors make it more likely that stomach contents will come back up into the esophagus. As infants spend more time upright, eat more solid foods, and grow and develop, they typically experience less gastroesophageal reflux.

GERD is more common in premature infants and in infants with certain health conditions, including cystic fibrosis, cerebral palsy, hiatal hernia, and previous surgery to correct esophageal atresia.

GERD is more common in children who are overweight, have obesity, or have a large waist size. Children are more likely to have GERD if they have health conditions that affect the upper GI tract, including:

Conditions that affect the nervous system, such as cerebral palsy
Conditions that affect the lungs, such as cystic fibrosis
Hiatal hernia
Previous surgery to correct esophageal atresia, a type of birth defect

Diagnosis

Adults

In most cases, doctors diagnose gastroesophageal reflux and GERD by reviewing symptoms and medical history. Your doctor may refer you to a gastroenterologist to diagnose and treat GERD.

If symptoms suggest gastroesophageal reflux or GERD, doctors may recommend treatment with medicines and lifestyle changes instead of doing tests. Doctors may recommend medical tests if:

Symptoms suggest a possible complication of GERD
Symptoms suggest another health problem that causes symptoms similar to GERD
Symptoms don’t improve after treatment with medicines and lifestyle changes

Tests doctors may order include:

Upper gastrointestinal (GI) endoscopy uses a flexible tube with a camera on the end, called an endoscope, to see the lining of the upper GI tract, including the esophagus, stomach, and the first portion of the small intestine, called the duodenum. During the procedure, a doctor may take small pieces of tissue, called biopsies, from the lining of the esophagus for examination under a microscope.
Esophageal pH monitoring is the most accurate way to detect stomach acid in the esophagus. Two types are available: catheter monitoring, in which a thin, flexible tube passes through the nose and into the esophagus to measure acid and nonacid reflux; and capsule monitoring, in which a small, wireless capsule is placed on the lining of the esophagus to measure acid reflux. During monitoring, you wear a monitor that tracks information about your diet, sleep, and symptoms.

Infants and Children

Doctors diagnose gastroesophageal reflux and GERD in children and infants by reviewing symptoms and medical history. Doctors may refer a child to a pediatric gastroenterologist to diagnose and treat GERD.

In addition to upper GI endoscopy and esophageal pH monitoring, doctors may also order an upper GI series, a procedure using X-rays and a chalky liquid called barium to view the upper GI tract, to check for anatomic problems that may be causing or worsening symptoms.

Treatment and Management

Adults

Doctors may recommend lifestyle changes, medicines, surgery, or a combination of these treatments.

Lifestyle changes may include:

Losing weight if overweight or having obesity
Elevating the head during sleep by placing a foam wedge or extra pillows under the head and upper back to raise the head 6 to 8 inches. Sleeping on your left side may also be helpful.
Quitting smoking and vaping
Avoiding alcohol
Eating meals at least three hours before lying down or going to bed
Avoiding foods and drinks that trigger or worsen symptoms

Foods and drinks commonly linked to GERD symptoms include:

Acidic foods, such as citrus fruits and tomatoes
Alcoholic drinks
Chocolate
Coffee and other sources of caffeine
High-fat foods
Mint
Spicy foods

Antacids relieve mild heartburn and other mild gastroesophageal reflux and GERD symptoms. They are available over the counter but should not be used every day or for severe symptoms without discussing use with a doctor.

Proton pump inhibitors (PPIs) lower the amount of acid the stomach makes and are better at treating GERD symptoms than H2 blockers. PPIs can heal the esophageal lining in most people with GERD. They are available over the counter or by prescription, and doctors may prescribe them for long-term treatment. Research also suggests that taking PPIs may increase the chance of Clostridioides difficile (C. diff) infection. Experts are still studying the effects of taking PPIs for a long time or in high doses.

H2 blockers lower the amount of acid the stomach makes. They can help heal the esophagus, but not as well as PPIs. H2 blockers are available over the counter or by prescription.

Potassium-competitive acid blockers (P-CABs) are a newer class of acid lowering drugs that lower the amount of acid the stomach makes and are recommended in cases that do not improve with PPIs. They are faster-acting compared to PPIs and there is no need for meal-dependent dosing. P-CABs are available by prescription.

Other medicines may be recommended if antacids, H2 blockers, PPIs, and P-CABs don’t improve symptoms.

Surgery may be recommended if GERD symptoms don’t improve with lifestyle changes and medicines, or if you wish to stop taking long-term GERD medicines. You are more likely to develop complications from surgery than from medicines.

Fundoplication is the most common surgery for GERD. A surgeon sews the top of the stomach around the end of the esophagus to add pressure to the lower esophageal sphincter and help prevent reflux. Laparoscopic fundoplication, a procedure in which surgeons make small cuts in the abdomen, is more common than open fundoplication.
Weight-loss surgery (metabolic and bariatric surgery), most often gastric bypass surgery, may be recommended for people with GERD and obesity. It can help with weight loss and reduce GERD symptoms.

Infants

Most infants with gastroesophageal reflux do not need treatment. Gastroesophageal reflux symptoms typically improve on their own by the time a child is 12 to 14 months old.

Lifestyle changes for infants may include:

Avoiding secondhand smoke exposure
Burping the infant more often
Holding the infant upright for 20 to 30 minutes after eating (an infant should always be placed on his or her back for sleep)
Changing the infant’s diet

Talk with a doctor before changing your infant’s diet to try to treat gastroesophageal reflux or GERD symptoms. A doctor may recommend:

Avoiding overfeeding or giving smaller, more frequent feedings
Feeding thicker food, such as adding cereal to formula or stored breast milk
Removing cow’s milk protein from the infant’s diet

Doctors may recommend PPIs or H2 blockers if an infant has esophagitis or bothersome GERD symptoms that don’t improve after lifestyle changes. Do not give infants medicines unless told to do so by a doctor.

Doctors don’t often recommend surgery to treat GERD in infants and may do so only if symptoms are severe and other treatments don’t help.

Children

Lifestyle changes may include:

Sleeping with the head elevated or on the left side
Avoiding eating just before lying down or going to bed
Changing eating habits or diet
Avoiding secondhand smoke

Doctors typically prescribe PPIs to treat GERD in children for 4 to 8 weeks; in some cases, they may prescribe PPIs for long-term treatment. Doctors may recommend short-term use of antacids for older children or teens but do not recommend long-term antacid use.

Fundoplication is the most common surgery for GERD in children. Children are more likely to develop complications from surgery than from medicines.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on GERD.

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

NIH conducts and supports clinical trials in many diseases and conditions, including digestive diseases. These trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

Researchers are studying many aspects of GERD, such as how diet affects symptoms, new ways to diagnose the disease, new treatments for GERD, and risk factors for GERD complications, such as Barrett’s esophagus and esophageal cancer.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies. 