Most people have heartburn from time to time — especially after eating a large or spicy meal. But if your heartburn is a daily event, you may have a more serious health problem known as gastroesophageal reflux disease (GERD).
GERD — also known as acid reflux, indigestion, or sour stomach — happens when stomach acid and other contents back up into your esophagus. This back-up causes reflux symptoms, such as a bitter taste in your mouth or a burning sensation in your stomach, chest, or throat.
UPMC’s gastroenterology experts specialize in diagnosing and treating GERD using the most advanced surgical and nonsurgical techniques.
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What Is Heartburn (GERD)?
GERD — also known as acid reflux, indigestion, or sour stomach — happens when stomach acid and other contents back up into your esophagus. This backup causes reflux symptoms, such as a bitter taste in your mouth or a burning sensation in your stomach, chest, or throat.
What are the types of GERD?
If you have GERD, your doctor may classify your condition based on the severity of your symptoms.
Classifications based on symptoms include:
- Stage 1 (mild) — Occasional acid reflux with mild symptoms that happen a few times a month.
- Stage 2 (moderate) — Frequent symptoms that require treatment with daily medication.
- Stage 3 (severe) — Frequent, severe symptoms that can lead to esophageal inflammation.
- Stage 4 (advanced) — Severe complications, such as Barrett’s esophagus, esophageal cancer, or strictures (narrowing of the esophagus).
Your doctor may also diagnose a specific type of GERD based on the amount of damage to your esophagus.
Types of GERD based on esophageal damage include:
- Nonerosive reflux disease (NERD) — The most common type of GERD, which doesn’t cause damage to the lining of your esophagus.
- Erosive esophagitis — GERD that causes damage to the lining of your esophagus, such as inflammation and ulcers.
- Barrett’s esophagus — Precancerous changes to the cells in the lining of your esophagus.
A related condition called laryngopharyngeal reflux (LPR) is a type of acid reflux that causes symptoms that affect your throat and voice box, such as hoarseness, cough, and sore throat.
How common is GERD?
The American College of Gastroenterology estimates that about 20% of the population in the U.S. has GERD.
What causes GERD?
GERD happens when the valve at the bottom of your esophagus called your lower esophageal sphincter (LES) — which stops stomach acid and contents from coming back up — doesn't close completely. An LES that seals poorly lets stomach acid flow back up into your esophagus and throat, causing a painful burning feeling.
Many factors can cause a GERD flare-up, such as:
- Drinking alcohol and caffeinated drinks, such as coffee, soda, or energy drinks.
- Eating chocolate, spicy dishes, citrus, or fried foods.
- Eating late at night.
- Having a hiatal hernia, which happens when your stomach bulges through your diaphragm.
- Lying down right after a meal.
- Pregnancy.
- Smoking.
GERD risk factors
Some people are more likely to develop GERD.
Risk factors include:
- Being overweight.
- Being pregnant.
- Eating spicy, fatty foods or big meals late at night.
- Having a hiatal hernia.
- Smoking or living with secondhand smoke.
Complications of GERD
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 causes cell changes that increase your risk of getting esophageal cancer.
- Chronic cough — A cough that doesn't go away on its own after several weeks.
- Erosion of tooth enamel — Stomach acid entering your mouth can wear away the protective coating on your teeth.
- Esophageal stricture — Narrowing of your esophagus due to scarring.
- Esophagitis — An irritated or inflamed esophagus.
- Laryngitis — An inflamed voice box.
How can I prevent GERD?
You may not be able to control all your risk factors for GERD.
However, you may be able to prevent GERD or reduce symptoms by:
- Avoiding meals right before bedtime.
- Eating smaller, more frequent meals.
- Elevating the head of your bed if you have symptoms at night.
- Keeping track of foods that cause heartburn and avoiding them.
- Maintaining a healthy weight.
What Are the Signs and Symptoms of GERD?
Symptoms of GERD include:
- A dry cough that doesn't go away.
- A feeling of too much saliva in your mouth.
- A sour, bitter taste in your mouth.
- Asthma symptoms.
- Chest pain after you eat. (Chest pain from a heart issue is more likely to happen after exercise.)
- Hoarseness.
- Nausea.
- Persistent heartburn, especially after you eat or when you lie down.
When should I see a doctor about my GERD symptoms?
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.
How Do You Diagnose GERD?
Your doctor may recommend getting tested for GERD if you have frequent or long-term heartburn and other risk factors for developing the condition.
What to expect during your visit
If your doctor suspects GERD, they will:
- Ask about your symptoms.
- Perform a physical exam.
- Order other tests.
- Review your health history and medications.
Tests to diagnose GERD
Tests to diagnose GERD include:
- Esophageal imaging (barium swallow study) — You will swallow a chalky liquid to help your esophagus appear more clearly on x-ray images.
- Esophageal pH test — Your doctor will insert a thin tube through your nose and down your throat to measure acid levels in your esophagus.
- Upper gastrointestinal (GI) endoscopy and biopsy — Your doctor will use a lighted tube with a camera called an endoscope to look inside your esophagus and stomach. During the procedure, your doctor may take several tissue samples from the lining of your esophagus and stomach for analysis in a lab.
GERD prognosis
Most people can manage GERD symptoms with lifestyle changes and medications. If lifestyle changes and medications don’t help, surgery is an effective treatment option for GERD.
With treatment, people with GERD can live normal lives.
How Do You Treat GERD?
The goals of GERD treatment are to reduce symptoms and damage to the lining of your esophagus.
Treatment options for GERD may include:
Lifestyle changes to treat GERD
Your doctor may recommend lifestyle changes to manage your GERD symptoms, including:
- Avoiding meals right before bedtime.
- Eating smaller, more frequent meals.
- Elevating the head of your bed if you have symptoms at night.
- Keeping track of foods that cause heartburn and avoiding them.
- Maintaining a healthy weight.
Medication to treat GERD
Your doctor may suggest medications and lifestyle changes to manage your GERD symptoms.
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 under the brand names PEPCID® or Zantac 360®. Or your doctor can prescribe drugs with cimetidine or nizatidine.
- Proton pump inhibitors (PPIs) — These drugs are the best at lowering the amount of acid your stomach makes and can help heal your esophageal lining. There are many active PPIs your doctor can prescribe. You can also buy them at the drug store under the brand names Prilosec OTC®, Nexium®, and Prevacid®.
Surgery for GERD
If your GERD symptoms don’t improve with lifestyle changes or medication, surgery may be an option.
Minimally invasive procedures UPMC surgeons use to treat GERD include:
Laparoscopic Nissen fundoplication for GERD
At UPMC, we treat GERD using a minimally invasive surgical technique called laparoscopic Nissen fundoplication (LNF). This is the most common surgical procedure for treating GERD.
During the LNF procedure, surgeons:
- Use a narrow tube-like instrument — called a trocar — to act as a portal into your abdomen.
- Insert a laparoscope, fitted with a tiny video camera, through the trocar. It magnifies the view of your internal organs on a television monitor.
- Insert four additional portals to accommodate other surgical instruments.
- Wrap the top of your stomach, which is called the fundus, around the bottom of your esophagus. This technique repairs the LES valve at the end of your esophagus.
After the procedure, your medical team will close the small incisions using stitches or special surgical tape. Within a few weeks, the incisions will be barely visible.
LINX procedure for GERD
UPMC surgeons also perform the minimally invasive LINX® procedure for selected people with GERD.
The LINX procedure involves implanting a small band of magnetic beads around the lower part of your esophagus to prevent acid reflux. The beads help to strengthen the LES — your body’s natural antireflux barrier — so it works more effectively.
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.
Why Choose UPMC for GERD Care?
When you choose UPMC for GERD care, you will receive:
- Access to board-certified specialists — Our gastrointestinal specialists are experienced in caring for people with GERD and related complications.
- Expert diagnosis and personalized care — Our team will develop a customized treatment plan to reduce your risk of complications and improve your quality of life.
- A full range of treatment options — We use the latest nonsurgical, minimally invasive, and surgical techniques to provide comprehensive GERD care.
