Heartburn (GERD) Causes, Symptoms, and Treatments

GERD happens when a valve at the bottom of the esophagus — which stops stomach contents from coming back up — doesn't close completely. This lets stomach acid flow back up the throat, causing a painful burning feeling.

Many factors can cause a GERD flare-up, such as:

• Eating late at night.
• Lying down right after a meal.
• Pregnancy.
• Eating chocolate, spicy dishes, citrus, or fried foods.
• Drinking alcohol and caffeinated drinks like coffee, soda, or energy drinks.
• Smoking.
• Having a hiatal hernia.

Certain medicines can also increase your risk of GERD.

They include:

• Some sedatives.
• High blood pressure medicines.
• Antidepressants.
• Asthma medicines.
• NSAIDs. These drugs include aspirin and ibuprofen. They're often found under Bayer^®, Advil^®, and Motrin^® brand names.

Some people are more likely to suffer from GERD.

Risk factors include:

• Being overweight, especially if you have excess belly fat.
• Being pregnant.
• Smoking or living with secondhand smoke.
• Having a hiatal hernia.
• Taking certain medicines.
• Eating spicy, fatty foods or big meals late at night.

Left untreated, GERD can lead to other, more severe health problems, such as:

• Asthma. Coughing, wheezing, and trouble breathing at night.
• Barrett's esophagus. Damage from stomach acid makes the esophagus lining look like the lining of the intestines. It increases the risk of getting cancer.
• Chronic cough. A cough that doesn't go away on its own after eight weeks.
• Erosion of tooth enamel. Stomach acid entering the mouth can wear away at the teeth.
• Esophageal stricture. Narrowing of the esophagus due to scarring.
• Esophagitis. An irritated or inflamed esophagus.
• Laryngitis. An inflamed voice box.

Preventing heartburn or GERD may need trial and error until you find what works for you.

Tactics to try:

• Eat smaller, more frequent meals.
• Don't eat right before bedtime.
• Maintain a healthy weight.
• Keep track of foods that lead to heartburn and avoid them.
• Keep the head of your bed elevated if you have symptoms at night.
• Ask your doctor if heartburn could be a side effect of the medicines you take. Don't stop taking a prescribed drug without your doctor's consent.

• Persistent heartburn, especially after you eat or when you lie down.
• A sour, bitter taste in your mouth.
• Chest pain after you eat. (Chest pain from a heart issue is more likely to happen after exercise.)
• Hoarseness.
• A dry cough that doesn't go away.
• Asthma symptoms.
• Nausea.
• A feeling of too much saliva in your mouth.

Ask your doctor about GERD if you have heartburn more than two times a week.

See a doctor right away if you have these GERD symptoms:

• Trouble swallowing or feeling that food got trapped behind your chest.
• Vomiting blood.
• Tarry, black stools.
• A feeling of choking from acid reflux.
• Unexplained weight loss.

Your doctor will ask about your symptoms and medical history.

If your GERD symptoms are severe, they may suggest the following tests:

• Upper GI endoscopy. A tiny camera on a tube lets the doctor see your esophagus and stomach.
• Esophageal pH test. A thin tube from your nose into your esophagus measures acid levels in the esophagus.
• Esophageal imaging, or barium swallow study. You swallow a drink with chalky liquid that helps your esophagus appear on an x-ray.

Sometimes simple changes can curb heartburn or GERD.

Some tactics to try:

• Avoid spicy, fatty, or acidic foods that trigger heartburn.
• Stop eating at least three hours before bedtime.
• Lose weight.
• Quit smoking.
• Cut back on alcohol or stop drinking altogether.
• Avoid tight clothing.
• Elevate the head of your bed if you have symptoms at night.

Your doctor may suggest medicines along with lifestyle changes.

Some drugs that treat GERD have side effects. Some you can only take for a few weeks at a time, not long-term.

Over-the-counter and prescription drugs to treat heartburn and GERD include:

• Antacids. Medicines with calcium carbonate can relieve mild symptoms of GERD. Brand names include TUMS, Rolaids®, and Alka-Seltzer®. You shouldn't use them for severe symptoms as they can cause diarrhea or constipation.
• H2 blockers. These drugs lower the amount of acid your stomach makes. You can buy the drug at the drugstore as the brand name PEPCID® or Zantac 360®. Or your doctor can prescribe drugs with cimetidine or nizatidine.
• Proton pump inhibitors (PPIs). These drugs also lower the acid your stomach makes and can help heal the esophageal lining. There are many active PPIs your doctor can presescribe. Or you can buy them at the drug store under brand names Prilosec OTC®, Nexium®, and Prevacid®.

Surgery is an option for people whose GERD doesn't respond to lifestyle changes and medicine.

• Bariatric surgery. For people with GERD and obesity, this weight-loss surgery (sometimes called gastric bypass surgery) may help. It can help you lose weight and reduce GERD symptoms.
• Fundoplication. In this surgery, a doctor sews the top of your stomach around the end of your esophagus. This adds pressure to the lower esophageal sphincter and can help prevent reflux.