What you should know about GERD

Clinically reviewed by: Optum National Clinical Review Team

If you’re someone who experiences heartburn, you know the signs: a harsh, burning feeling in your chest usually after eating a large meal, spicy food or when you’re lying down. Frequent, persistent heartburn is the most common symptom of GERD (gastroesophageal reflux disease) and an estimated 20% of the population is living with it.¹ Symptoms can not only interfere with your quality of life, but also can lead to serious illness. GERD doesn’t have to put a stop to your life, your doctor can discuss the lifestyle changes and treatment options available, so you can continue doing the things you love.

But first, what causes GERD?

When you eat, food travels from your mouth, down the esophagus and into your stomach. At the lower end of the esophagus is a small ring of muscle, the lower esophageal sphincter (LES) that acts like a one-way trap door that allows food to pass into your stomach. Normally, the LES closes immediately after swallowing to prevent back-up of stomach fluids.

When the LES isn’t functioning properly, highly acidic fluids can flow back up into the esophagus, irritating and inflaming it, causing heartburn. Other, less common symptoms of GERD include vomiting or regurgitation, difficulty swallowing, and chronic coughing or wheezing. Left untreated, chronic reflux can lead to severe esophageal damage including Barrett’s esophagus, a pre-cancerous condition that increases the risk of esophageal cancer.

Some people are born with a naturally weak LES. Other things associated with reflux are certain foods, being overweight, certain medications, smoking, drinking alcohol or changes in body position (bending over or lying down).² A hiatal hernia, in which the top part of the stomach bulges above the diaphragm and into the chest cavity may also contribute to GERD.¹

How is GERD diagnosed?

GERD is typically diagnosed based on your symptoms and medical history. If your doctor suspects you may have GERD, they will either talk to you about medication and treatment options or refer you to a gastroenterologist. You may also be sent for additional testing such as an upper gastrointestinal endoscopy and/or an esophageal pH monitoring test if:

• Your symptoms are linked to other health conditions.³
• Your symptoms suggest further health complications.³
• Your symptoms do not improve with treatment or lifestyle changes.³

An endoscopy is generally an outpatient procedure, usually with light sedation. During the procedure, a very thin, lighted tube — also known as an endoscope — is inserted into the esophagus enabling the doctor to closely examine it. Esophageal pH monitoring is done to detect stomach acid in the esophagus and the severity of reflux disease. It involves either placement of a small catheter through the nose into the esophagus (catheter monitoring) or use of a small capsule directly attached to the esophagus during endoscopy (capsule monitoring).³

What are the treatment options for heartburn?

GERD is generally treated in three progressive steps. Simply making lifestyle and diet changes such as losing weight, quitting smoking, reduced alcohol consumption, and altering eating and sleeping patterns may help. If symptoms persist, you can ask your doctor about over-the-counter medications including antacids to neutralize the stomach and/or other non-prescription medicines to reduce the amount of acid your stomach produces. If these do not provide effective relief, prescription drugs may be needed to alleviate symptoms and aid in healing esophageal irritation. Always consult with your doctor before taking any medication.

If none of these steps works, or you are unable to take the medications, anti-reflux surgery may be an option for you. Commonly, GERD surgery includes hiatal hernia repair and fundoplication. Fundoplication is a procedure to tighten the LES by wrapping the upper portion of the stomach around the lowest portion of the esophagus — much the way a bun wraps around a hot dog.

If needed, your doctor may choose to perform fundoplication either as a laparoscopic procedure or open surgery. If a laparoscopic procedure is performed, your surgeon will make small incisions to enter the abdomen through narrow, tube-like instruments, leaving several small scars.⁴ A larger incision across the abdomen is made during open surgery.⁴ Your surgeon can best explain the benefits and potential short- and long-term side effects of anti-reflux surgery.

If you have persistent heartburn, speak with your doctor who can assess which treatment is right for you.

Disclaimer:

The information featured in this site is general in nature. The site provides health information designed to complement your personal health management. It does not provide medical advice or health services and is not meant to replace professional advice or imply coverage of specific clinical services or products. The inclusion of links to other web sites does not imply any endorsement of the material on such websites.

1. Acid Reflux. https://gi.org/topics/acid-reflux. Accessed May 1, 2023.
2. Gastroesophageal reflux disease. https://medlineplus.gov/ency/article/000265.htm. Last reviewed February 26, 2023. Accessed May 1, 2023.
3. Diagnosis of GER & GERD. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/diagnosis. Last reviewed July 2020. Accessed May 11, 2023.
4. Treatment for GER & GERD. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/treatment. Last reviewed July 2020. Accessed May 11, 2023.