GERD
Also known as Gastro oesophageal reflux disease, Gastroesophageal reflux, Acid reflux, Reflux, Heartburn
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is gerd?
Gastro oesophageal reflux disease occurs when stomach contents flow back into the oesophagus often enough to cause troublesome symptoms or damage. Occasional heartburn is normal; GERD is persistent. Most people are managed well with lifestyle change and acid suppression, but alarm features such as difficulty swallowing or weight loss need prompt investigation.
Causes
- Weakness or inappropriate relaxation of the lower oesophageal sphincter
- Hiatus hernia
- Raised intra abdominal pressure from obesity or pregnancy
- Delayed stomach emptying
- Trigger foods, alcohol and smoking
Symptoms
- Burning discomfort behind the breastbone, often after meals
- Regurgitation of acid or food into the throat
- Symptoms worse lying flat or bending forward
- Chronic cough or hoarseness
- Sensation of a lump in the throat
- Disturbed sleep
Risk factors
- Obesity
- Pregnancy
- Smoking
- Hiatus hernia
- Late evening meals
- Certain medicines including calcium channel blockers
Diagnosis
- Clinical diagnosis from typical symptoms
- Trial of acid suppression as a diagnostic and therapeutic step
- Endoscopy when alarm features are present or symptoms persist
- Oesophageal pH monitoring in unclear cases
- Manometry before considering surgery
Treatment
- Weight loss where relevant, which is among the most effective measures
- Raising the head of the bed and avoiding late meals
- Reducing alcohol, smoking and identified trigger foods
- Antacids and alginates for intermittent symptoms
- Proton pump inhibitors at the lowest effective dose
- Fundoplication surgery for selected refractory cases
Self care
- Eat smaller meals and avoid eating within three hours of bed
- Raise the head of the bed by 10 to 20 centimetres
- Lose weight if overweight, which is highly effective
- Identify personal triggers rather than avoiding all foods
- Stop smoking and reduce alcohol
- Avoid tight waistbands
- Use antacids or alginates for breakthrough symptoms
When to see a doctor
Book an appointment if:
- Symptoms more than twice a week despite lifestyle changes
- Needing acid suppression continuously for months
- Symptoms starting over the age of 55
- Chronic cough, hoarseness or dental erosion
- Symptoms returning quickly when treatment stops
- To review long term proton pump inhibitor use
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Keep to a healthy weight
- Avoid late heavy meals
- Limit alcohol and stop smoking
- Identify and moderate trigger foods
- Review medicines that relax the lower oesophageal sphincter
Outlook
Reflux is usually a long term condition that is well controlled rather than cured. Weight loss and lifestyle change resolve symptoms for many. Proton pump inhibitors are effective, and surgery helps selected people with persistent symptoms. A small proportion develop Barrett oesophagus, which is why alarm symptoms are investigated rather than treated blindly.
Common questions
Which symptoms need urgent investigation?
Difficulty or pain on swallowing, unintentional weight loss, vomiting blood, black tarry stools, persistent vomiting or anaemia all require prompt endoscopy rather than continued treatment on assumption.
Are proton pump inhibitors safe long term?
They are effective and generally well tolerated. Observational studies have raised possible associations with nutrient deficiency and infection, so the usual approach is to use the lowest effective dose and review the need periodically.
Could reflux pain be my heart?
Cardiac pain can closely mimic heartburn. Chest pain with exertion, sweating, breathlessness or radiation to the arm or jaw should be treated as a possible heart problem and assessed urgently.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.