Heartburn

Heartburn

Understanding Gastroesophageal Reflux

The National Institute of Diabetes and Digestive and Kidney Diseases

What is GER?

Gastroesophageal reflux (GER) happens when your stomach contents come back up into your esophagus.
Stomach acid that touches the lining of your esophagus can cause heartburn, also called acid indigestion.

Does GER have another name?

Doctors also refer to GER as:

  • acid indigestion
  • acid reflux
  • acid regurgitation
  • heartburn
  • reflux

How common is GER?

Having GER once in a while is common.

What is GERD?

Gastroesophageal reflux disease (GERD) is a more serious and long-lasting form of GER.

What is the difference between GER and GERD?

GER that occurs more than twice a week for a few weeks could be GERD. GERD can lead to more serious health problems over time. If you think you have GERD, you should see your doctor.​

How common is GERD?

GERD affects about 20 percent of the U.S. population.1

Who is more likely to have GERD?
Anyone can develop GERD, some for unknown reasons. You are more likely to have GERD if you are:

  • overweight or obese
  • a pregnant woman​
  • taking certain medicines
  • a smoker or regularly exposed to secondhand smoke

What are the complications of GERD?

Without treatment, GERD can sometimes cause serious complications over time, such as:

Esophagitis
Esophagitis is inflammation in the esophagus. Adults who have chronic esophagitis over many years are more likely to develop precancerous changes in the esophagus.

Esophageal stricture
An esophageal stricture happens when your esophagus becomes too narrow. Esophageal strictures can lead to problems with swallowing.

Respiratory problems
With GERD you might breathe stomach acid into your lungs. The stomach acid can then irritate your throat and lungs, causing respiratory problems, such as:

  • asthma—a long-lasting disease in your lungs that makes you extra sensitive to things that you’re allergic to
    chest congestion, or extra fluid in your lungs
    a dry, long-lasting cough or a sore throat
  • hoarseness—the partial loss of your voice
  • laryngitis—the swelling of your voice box that can lead to a short-term loss of your voice
  • pneumonia—an infection in one or both of your lungs—that keeps coming back
  • wheezing—a high-pitched whistling sound when you breathe

Barrett’s esophagus
GERD can sometimes cause Barrett’s esophagus. A small number of people with Barrett’s esophagus develop a rare yet often deadly type of cancer of the esophagus.

If you have GERD, talk with your doctor about how to prevent or treat long-term problems.​

How do you control GER and GERD?

You may be able to control gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) by:

  • not eating or drinking items that may cause GER, such as greasy
  • or spicy foods and alcoholic drinks
  • not overeating
  • not eating 2 to 3 hours before bedtime
  • losing weightExternal NIDDK Link if you’re overweight or obese
  • quitting smoking and avoiding secondhand smoke
  • taking over-the-counter medicines, such as Maalox, or Rolaids​

How do doctors treat GERD?

Depending on the severity of your symptoms, your doctor may recommend lifestyle changes, medicines, surgery, or a combination.

Lifestyle changes
Making lifestyle changes can reduce your GER and GERD symptoms. You should:

  • lose weight, if needed.
  • wear loose-fitting clothing around your abdomen. Tight clothing can squeeze your stomach area and push acid up into your esophagus.
  • stay upright for 3 hours after meals. Avoid reclining and slouching when sitting.
  • sleep on a slight angle. Raise the head of your bed 6 to 8 inches by safely putting blocks under the bedposts. Just using extra pillows will not help.
  • quit smoking and avoid secondhand smoke.

Over-the-counter and prescription medicines​
You can buy many GERD medicines without a prescription. However, if you have symptoms that will not go away, you should see your doctor.
All GERD medicines work in different ways. You may need a combination of GERD medicines to control your symptoms.

Antacids. Doctors often first recommend antacids to relieve heartburn and other mild GER and GERD symptoms. Antacids include over-the-counter medicines such as:

  • Maalox
  • Mylanta
  • Riopan
  • ​Rolaids

Antacids can have side effects, including diarrhea and constipation.

H2 blockers. H2 blockers decrease acid production. They provide short-term or on-demand relief for many people with GER and GERD symptoms. They can also help heal the esophagus, although not as well as other medicines. You can buy H2 blockers over-the-counter or your doctor can prescribe one. Types of H2 blockers include

  • cimetidine (Tagamet HB)
  • famotidine (Pepcid AC)
  • nizatidine (Axid AR)
  • ranitidine (Zantac 75)

If you get heartburn after eating, your doctor may recommend that you take an antacid and an H2 blocker. The antacid neutralizes stomach acid, and the H2 blocker stops your stomach from creating acid. By the time the antacid stops working, the H2 blocker has stopped the acid.

Proton pump inhibitors (PPIs). PPIs lower the amount of acid your stomach makes. PPIs are better at treating GERD symptoms than H2 blockers.1 They can heal the esophageal lining in most people with GERD. Doctors often prescribe PPIs for long-term GERD treatment.

However, studies show that people who take PPIs for a long time or in high doses are more likely to have hip, wrist, and spinal fractures. You need to take these medicines on an empty stomach so that your stomach acid can make them work.

Several types of PPIs are available by a doctor’s prescription, including

  • esomeprazole (Nexium)
  • lansoprazole (Prevacid)
  • omeprazole (Prilosec, Zegerid)
  • pantoprazole (Protonix)
  • rabeprazole (AcipHex)

Talk with your doctor about taking lower-strength omeprazole or lansoprazole, sold over the counter.

Prokinetics. Prokinetics help your stomach empty faster. Prescription prokinetics include

  • bethanechol (Urecholine)
  • metoclopramide (Reglan)

Both of these medicines have side effects, including

  • nausea
  • diarrhea
  • fatigue, or feeling tired
  • depression
  • anxiety
  • delayed or abnormal physical movement

Prokinetics can cause problems if you mix them with other medicines, so tell your doctor about all the medicines you’re taking.

Antibiotics. Antibiotics, including erythromycin, can help your stomach empty faster. Erythromycin has fewer side effects than prokinetics; however, it can cause diarrhea.

Surgery
Your doctor may recommend surgery if your GERD symptoms don’t improve with lifestyle changes or medicines. You’re more likely to develop complications from surgery than from medicines.
Fundoplication is the most common surgery for GERD. In most cases, it leads to long-term reflux control.

A surgeon performs fundoplication using a laparoscope, a thin tube with a tiny video camera. During the operation, a surgeon sews the top of your stomach around your esophagus to add pressure to the lower end of your esophagus and reduce reflux. The surgeon performs the operation at a hospital. You receive general anesthesia and can leave the hospital in 1 to 3 days. Most people return to their usual daily activities in 2 to 3 weeks.

Endoscopic techniques, such as endoscopic sewing and radiofrequency, help control GERD in a small number of people. Endoscopic sewing uses small stitches to tighten your sphincter muscle. Radiofrequency creates heat lesions, or sores, that help tighten your sphincter muscle. A surgeon performs both operations using an endoscope at a hospital or an outpatient center, and you receive general anesthesia.

The results for endoscopic techniques may not be as good as those for fundoplication. Doctors don’t use endoscopic techniques often.