Gastroesophageal Reflux Disease

Medically reviewed by Carina Fung, PharmD, BCPPS

What is GERD?

Gastroesophageal reflux disease (GERD)1 is a digestive disease that occurs when the contents of the stomach repeatedly flow back into the tube connecting the throat to the stomach (the esophagus, commonly referred to as the “food pipe”).

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This back-flow of stomach acid (called acid reflux) can irritate the lining of the esophagus. Prolonged acid reflux often results in a burning sensation in the chest (known as heartburn). Along with heartburn, another common symptom of GERD is the regurgitation of acid.

While uncomfortable, GERD doesn’t always damage the esophagus. The condition’s symptoms may be present whether or not they’ve damaged the tissues lining the esophagus. When it does cause evident tissue damage, the condition is referred to as esophagitis2 or erosive GERD, while GERD that doesn’t result in esophageal damage is known as non-erosive GERD.

Most people experience at least mild acid reflux from time to time. Heartburn is also common, and can occur for a number of reasons—it isn’t always a symptom of GERD, and it may result from a number of other disorders both inside and outside the esophagus. People with GERD, however, experience mild acid reflux at least two times per week or moderate-to-severe acid reflux at least once per week.

It’s possible to have GERD without having any apparent symptoms. When this occurs, the condition is usually only detected after complications have begun to develop. The symptoms of GERD are also frequently misunderstood. Because of this, GERD often goes undiagnosed, despite being a treatable condition.

GERD vs. acid reflux

Although GERD and acid reflux are often used interchangeably3, they don’t refer to the same thing.

As with GERD, acid reflux—sometimes referred to as gastroesophageal reflux (GER)—occurs when the stomach’s acidic contents travel up the food pipe (esophagus). People with both GERD and acid reflux often experience heartburn as a result of this back-flow.

GERD, in particular, describes frequent episodes of acid reflux. GERD can be thought of as the disease, while acid reflux is a symptom. In other words, while patients who experience acid reflux may not have GERD, all patients with GERD have acid reflux.

While both GERD and acid reflux cause the same symptoms, most cases of acid reflux are acute (meaning they only occur for a short period of time every once in a while). GERD, on the other hand, refers to chronic (frequent or long-lasting) acid reflux.

For most people, the discomfort caused by intermittent episodes of acid reflux can be alleviated with over-the-counter medications and lifestyle changes. Those with GERD, however, may need stronger prescription medications (or, in severe cases, surgery) to manage the signs and symptoms of the disease.

How common is GERD?

GERD is a common condition: it affects about one in every five people4 in the United States. It has been shown that 44% of the US’s population5 experiences symptoms related to GERD at least once per month.

While anyone can develop GERD regardless of age, gender, or ethnicity, some people are more prone to developing the condition than others (see “risk factors” below).

As previously mentioned, there are two main subtypes (forms) of GERD. Esophagitis, also known as erosive GERD, refers to GERD that causes damage to the tissues of the esophagus. The subtype of GERD referred to as non-erosive reflux disease, or NERD, does not cause tissue damage. This form of the disease is much more common, affecting roughly 50–70% of the general population6.

Ultimately, however, determining the accurate number of people with GERD has remained challenging. It’s difficult to identify those living with the disease, as many potential cases go unreported.

GERD causes

GERD is caused by frequent (chronic) acid reflux.

Normally, the circular band of muscle found at the bottom of the esophagus, known as the lower esophageal sphincter (LES), prevents the stomach’s contents from flowing back into the esophagus. For a variety of reasons, the LES can weaken and become loose, causing it to relax when it shouldn’t. When the LES is compromised, the contents of the stomach are allowed to flow back up into the esophagus, resulting in acid reflux.

Because the esophagus isn’t made to withstand the acidity of the stomach’s contents, people often experience a burning sensation when acid reflux occurs. This burning sensation (called heartburn) can occur in the chest or abdomen and is the most common symptom of acid reflux.

People without GERD occasionally experience heartburn as a result of acid reflux. However, for people with the condition, acid reflux is so frequent that it causes persistent burning and discomfort. Over time, constant acid reflux can damage the esophageal tissue (as is the case in esophagitis, or erosive GERD).

Some people with hiatal hernia7 may experience some of the same symptoms as those with GERD. Hiatal hernia is a condition in which the upper part of the stomach bulges through an opening in the diaphragm (the muscle separating the chest and abdomen). When this occurs, the LES loses some of the pressure necessary to keep the stomach’s contents in place, sometimes resulting in heartburn or discomfort in the stomach or esophagus. However, while there appears to be a link between hiatal hernia and GERD, the connection isn’t conclusive: many people with one condition never experience the symptoms of the other.

Acid reflux can occur when the diaphragm and LES are intact. Overeating, for instance, can cause distension of the upper part of the stomach, reducing the pressure acting at the LES.

Risk factors for GERD

Some factors that may increase your risk8 of developing GERD include:

  • Obesity or pregnancy, both of which exert pressure on the sphincter and cause it to loosen
  • Hiatal hernia
  • Connective tissue disorders, like scleroderma9
  • Asthma flares, which can cause the LES to loosen and lead to acid reflux
  • Alcohol consumption
  • Regular smoking or exposure to secondhand smoke
  • Overeating
  • Delayed emptying of the stomach
  • Drinking acidic beverages
  • Certain medications, including some forms of asthma medications, high blood pressure medications, pain relievers, sedatives, antihistamines, and antidepressants

GERD symptoms

Most people experience acid reflux at some point in their lives. Burping or belching, bloating, heartburn, and having a bitter or acidic taste in the back of the throat are all signs that acidic stomach contents have flowed into the esophagus. In most cases, however, these symptoms don’t interfere with daily life or cause unbearable discomfort.

GERD, on the other hand, is chronic. Frequent acid reflux can lead to a number of other symptoms10 that are often more uncomfortable or difficult to manage than occasional bouts of acid reflux.

Common signs and symptoms of GERD include11:

  • Acid regurgitation, which presents with the sensation of food, acid, or sour liquid in your throat or mouth
  • Heartburn: Usually occurs after eating, and may be worse at night
  • Waterbrash: A sudden increase in saliva
  • Discomfort or the sensation of having a lump in your throat
  • Dysphagia (difficulty swallowing): This requires immediate medical attention.
  • Chest pain: Also requires medical attention, as this may be a sign of heart attack.

Over time, chronic acid reflux (particularly nighttime acid reflux) can lead to:

  • Laryngitis (inflammation of the voice box)
  • Inflammation of the gums
  • Chronic cough
  • Erosion of the tooth enamel and cavities
  • Sour taste and bad breath
  • Disrupted sleep
  • New or worsening asthma

If you experience any of the signs and symptoms of GERD or rely on over-the-counter drugs for heartburn more than twice a week, see your healthcare provider. They will be able to provide you with the proper diagnosis and determine the best course of treatment for your condition.

Complications from GERD

Especially when left untreated, GERD can lead to several complications12, including:

  • Esophageal ulcer: In people with erosive GERD (esophagitis), the esophagus becomes corroded by the back-flow of stomach acid. In some cases, this can cause an open sore called an esophageal ulcer to form. This ulcer may bleed and make swallowing difficult and painful.
  • Esophageal stricture (narrowing of the esophagus): Frequent exposure of the esophagus to stomach acid can cause scarring. This scarring then heals and forms scar tissue, which may narrow the food pipe over time.
  • Barrett’s esophagus: Barrett’s esophagus refers to a condition in which prolonged exposure to stomach acid causes the lining of the esophagus to change and become more like the lining of the small intestine. This condition is more common in people who have had GERD for a long time or developed it at a young age.

While most people with Barrett’s esophagus don’t develop cancer13, some patients with the condition may develop a precancerous change in the esophageal tissue (called dysplasia) that increases the risk of developing esophageal cancer.

  • Asthma: People with GERD have been found to trigger symptoms of asthma in some patients. Conversely, people with asthma appear to be prone to having GERD, with as many as 89% of all asthma patients14 being affected by the disease.
  • Lung diseases: When large amounts of stomach contents are regurgitated into the lungs, lung diseases, such as aspiration pneumonitis and aspiration pneumonia15, may develop.

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