Gastroesophageal Reflux (GERD)

Overview

Gastroesophageal reflux disease (GERD) is a condition where stomach acid frequently flows back up into the tube connecting your mouth and stomach (the oesophagus). This backwash (acid reflux) can irritate the lining of your oesophagus, causing heartburn and other symptoms. It is more than just occasional heartburn – it happens regularly and can affect your daily life.

Yes, GERD is very common. Around one in five adults in the UK experience heartburn or acid reflux at least once a week. Many people have it without realising, and it can be mild or severe.

GERD can affect anyone, but it is more common in people who are overweight, pregnant, or older than 40. It also affects people with certain conditions, such as a hiatal hernia or connective tissue disorders.

Symptoms

Common symptoms

• Heartburn – a burning pain or discomfort in the chest, often after eating or at night.
• Regurgitation – a sour or bitter-tasting fluid backing up into your throat or mouth.
• A feeling of a lump in the throat.
• Persistent cough or sore throat.
• Chest pain (not related to the heart).
• Difficulty swallowing or a feeling of food stuck in the chest.

Symptoms in children

• Frequent vomiting or spitting up.
• Coughing, especially at night.
• Poor feeding or refusal to eat.
• Irritability or crying after meals.
• Fussiness or arching their back during feeding.
• Poor weight gain or weight loss.

Symptoms in older adults

• Chest pain that may be mistaken for angina.
• Chronic cough or hoarseness.
• Aspiration pneumonia (from stomach contents entering the lungs).
• Less typical heartburn – older adults may have fewer classic symptoms.
• Difficulty swallowing (dysphagia), which may indicate strictures.

Causes

Main causes

• A weakened or relaxed lower oesophageal sphincter (the ring of muscle at the bottom of the oesophagus) that fails to close properly, allowing stomach acid to flow back up.
• Hiatal hernia – part of the stomach pushes up through the diaphragm into the chest, which can weaken the sphincter.
• Increased pressure on the stomach from pregnancy, obesity, or tight clothing.
• Certain foods and drinks that relax the sphincter or increase stomach acid.

Risk factors

• Being overweight or obese.
• Pregnancy.
• Smoking or exposure to second-hand smoke.
• Eating large meals or eating late at night.
• Consuming fatty, fried, spicy, or acidic foods.
• Drinking alcohol, coffee, or carbonated drinks.
• Taking certain medications, such as aspirin, ibuprofen, or some blood pressure drugs.
• Having a connective tissue disorder like scleroderma.

When to see a doctor

See a doctor urgently if:

• You have chest pain with shortness of breath, sweating, or nausea – call your local emergency number immediately.
• You are vomiting blood or have black, tarry stools – seek urgent care.
• You have difficulty swallowing that is getting worse – see a doctor or go to the emergency department.

Book a routine appointment if:

• You have heartburn or acid reflux more than twice a week.
• Your symptoms are severe or interfere with your daily activities or sleep.
• You have been using over-the-counter medicines for more than two weeks and still have symptoms.
• You have a chronic cough, hoarseness, or a feeling of a lump in your throat.

Diagnosis

Your doctor will start by asking about your symptoms and medical history, and may perform a physical exam. Based on your history, they may diagnose GERD without tests, especially if typical symptoms like heartburn and regurgitation are present and improve with treatment.

Tests that may be done

• Upper endoscopy – a thin, flexible tube with a camera is passed down your throat to look at the lining of your oesophagus and stomach. It can detect inflammation, ulcers, or a hiatal hernia.
• Oesophageal pH monitoring – a small device measures acid levels in your oesophagus over 24 to 48 hours.
• Oesophageal manometry – a tube measures the muscle contractions in your oesophagus.
• Barium swallow – you drink a chalky liquid, and X-rays track its path through your digestive system.

What to expect at your appointment

Most GERD diagnoses can be made on symptoms alone. If tests are needed, they are usually done to check for complications or to confirm the diagnosis when symptoms are not typical. The procedures are generally safe and well-tolerated.

Treatment

Treatment for GERD aims to reduce acid reflux, relieve symptoms, and prevent complications. It often starts with lifestyle changes and over-the-counter remedies. If those are not enough, your doctor can recommend prescription medications or other treatments.

Self-care at home

• Eat smaller, more frequent meals instead of large ones.
• Avoid lying down for at least 3 hours after eating.
• Raise the head of your bed by 15–20 cm (6–8 inches) with blocks or a wedge pillow.
• Lose weight if you are overweight.
• Quit smoking.
• Avoid foods and drinks that trigger your symptoms – common triggers include fatty or fried foods, spicy dishes, citrus, tomatoes, chocolate, mint, garlic, onions, caffeine, and alcohol.
• Wear loose-fitting clothes around your waist.
• Chew gum (sugar-free) after meals to increase saliva and neutralise acid.

Medical treatments

Your doctor may suggest over-the-counter antacids or medications that reduce or block stomach acid production. These include H2 blockers and proton pump inhibitors (PPIs). For some people, a combination of lifestyle changes and medication is needed. Do not use these medicines for more than two weeks without talking to a doctor. Prescription-strength versions are available for more severe cases.

When is surgery considered?

Surgery may be an option if medications do not control symptoms or if you cannot take them long-term. The most common procedure is fundoplication, where the top of the stomach is wrapped around the lower oesophagus to strengthen the valve. Another option is a LINX device, a ring of magnetic beads placed around the oesophagus. Surgery is not for everyone, and you should discuss the risks and benefits with a specialist.

Living with this condition

Living with GERD often means making changes to your eating and sleeping habits. Many people find that their symptoms improve greatly with lifestyle adjustments. Keeping a diary of symptoms and triggers can help you manage better. Some days may be harder, but most people can lead a normal life with proper treatment.

Lifestyle tips

• Maintain a healthy weight.
• Eat slowly and mindfully.
• Sleep with your head elevated.
• Avoid eating at least 3 hours before bedtime.
• Manage stress through relaxation techniques like deep breathing or meditation.
• Stay active, but avoid vigorous exercise right after eating.

Diet and exercise

A GERD-friendly diet focuses on low-acid, low-fat foods. Good choices include lean proteins (chicken, fish, tofu), whole grains, vegetables (except tomatoes and onions), and non-citrus fruits. Regular exercise can help with weight loss and stress reduction, but avoid high-impact activities or heavy lifting right after meals, as they can worsen reflux.

Mental health and emotional wellbeing

Living with a chronic condition like GERD can be stressful and frustrating, especially if symptoms disrupt sleep or social activities. Some people may feel anxious about eating out or travelling. It is important to talk to your doctor about your feelings and seek support if needed. You are not alone.

Prevention

Not all cases of GERD can be prevented, especially if you are predisposed. But you can reduce your risk or the severity of symptoms by maintaining a healthy weight, not smoking, eating a balanced diet, and avoiding trigger foods. Managing stress and not lying down after meals also help.

Complications

If left untreated

• Oesophagitis – inflammation and irritation of the oesophageal lining.
• Oesophageal stricture – narrowing of the oesophagus due to scar tissue, making swallowing difficult.
• Barrett's oesophagus – changes in the cells lining the oesophagus that slightly increase the risk of oesophageal cancer.
• Chronic cough, asthma, or laryngitis from acid irritating the airways.
• Dental erosion due to acid in the mouth.

Long-term outlook

With proper management, most people with GERD can control their symptoms and prevent complications. Even those with Barrett's oesophagus can be monitored regularly, and the risk of cancer remains low. The key is to work with your healthcare provider to find a treatment plan that works for you and to stick with healthy habits.

Find support

International organisations

• Guts UK (Gastroenterology charity) ↗

Local organisations

• NHS (UK National Health Service) ↗ · UK

Helplines

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