Reflux Disease (GERD)

What Is Gastroesophageal Reflux Disease (GERD)?

Gastroesophageal reflux disease (GERD) is a chronic digestive condition in which stomach acid and contents flow backward (reflux) into the esophagus — the tube that connects the mouth to the stomach. While occasional reflux occurs in many people, GERD refers to frequent or persistent reflux that causes symptoms or complications. Left untreated, GERD can lead to inflammation of the esophagus and other long‑term issues.

What Causes GERD?

GERD occurs when the lower esophageal sphincter (LES) — a ring of muscle at the bottom of the esophagus — doesn’t close properly or relaxes inappropriately. This allows stomach acid to rise into the esophagus. Several factors may contribute:

  • Hiatal hernia, where part of the stomach pushes into the chest through the diaphragm
  • Obesity or increased abdominal pressure
  • Pregnancy
  • Certain foods and beverages that relax the LES (e.g., caffeine, chocolate, fatty foods)
  • Smoking or alcohol use
  • Delayed stomach emptying

Signs and Symptoms

GERD can cause a variety of symptoms, including:

  • Heartburn — a burning sensation in the chest or throat
  • Regurgitation of sour or bitter liquid
  • Difficulty swallowing (dysphagia)
  • Chest discomfort after eating
  • Chronic cough or hoarseness
  • A feeling of a lump in the throat

Symptoms may worsen after meals, when lying down, or at night.

Diagnosis and Evaluation

Diagnosis typically begins with a clinical evaluation of symptoms. Additional testing may include:

  • Upper endoscopy to visualize the esophagus and check for irritation or damage
  • pH monitoring to measure acid exposure in the esophagus
  • Esophageal manometry to assess muscle function
  • Barium swallow X‑ray to evaluate the structure and motion of the esophagus

Treatment Options

GERD treatment focuses on reducing acid exposure, relieving symptoms, and preventing complications:

  • Lifestyle changes — weight loss, avoiding trigger foods, eating smaller meals, and elevating the head of the bed
  • Medications — antacids, H2 blockers, and proton pump inhibitors (PPIs) to reduce or block stomach acid
  • Surgical options — for patients with persistent symptoms or complications despite medical therapy; procedures may include fundoplication to reinforce the LES

Most patients experience significant symptom improvement with a combination of lifestyle modifications and medical therapy. Surgical options are considered when conservative measures are insufficient or when complications arise.

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Frequently Asked Questions

GERD (gastroesophageal reflux disease) is a chronic condition in which stomach acid frequently flows back into the esophagus, causing irritation and symptoms such as heartburn and regurgitation.

GERD develops when the lower esophageal sphincter (LES) does not function properly, allowing acid to reflux frequently. Factors such as hiatal hernia, obesity, certain foods, and smoking can contribute.

Symptoms include heartburn, regurgitation, difficulty swallowing, chest discomfort after eating, chronic cough, and hoarseness.

Diagnosis includes clinical evaluation, and may involve upper endoscopy, pH monitoring, esophageal manometry, and barium swallow to assess the esophagus and acid exposure.

Yes. Many patients improve with lifestyle changes and medications that reduce or block acid production. Surgery is usually reserved for persistent symptoms or complications.

Surgery may be considered when symptoms persist despite medical treatment, when complications like severe esophagitis develop, or when there is a large hiatal hernia contributing to reflux.