GER is also commonly referred to as acid reflux, acid regurgitation, heartburn, or simply reflux. Occasional GER is normal and experienced by many people.

Patients with ongoing or worsening symptoms should seek medical evaluation.

GERD affects an estimated 20% of people in the United States.

Who is at higher risk for GERD?

GERD can affect anyone, but risk is higher in individuals who:

• Are overweight or obese

  
  

• Are pregnant

  
  

• Take certain medications

  
  

• Smoke or are exposed to secondhand smoke

Complications of GERD

Without treatment, GERD can lead to significant complications, including:

Esophageal Complications

• Esophagitis: Inflammation of the esophagus that may cause ulcers or

  bleeding and increase the risk of strictures and Barrett’s esophagus

  
  

• Esophageal stricture: Narrowing of the esophagus that can cause difficulty swallowing

  
  

• Barrett’s esophagus: Replacement of normal esophageal lining with intestinal-type tissue, which increases the risk of esophageal adenocarcinoma

Complications Outside the Esophagus

GERD may also affect nearby structures, leading to:

• Asthma or worsening respiratory symptoms

  
  

• Chronic cough

  
  

• Hoarseness or laryngitis

  
  

• Erosion of tooth enamel

Esophageal Cancer

Chronic, untreated GERD is the strongest known risk factor for esophageal adenocarcinoma, the most common type of esophageal cancer in the United States. Research shows that individuals with frequent heartburn (two or more times per week) have a significantly increased risk. Those with long-standing, severe symptoms over many years face an even higher risk. Despite advances in understanding, this cancer remains highly fatal.

Treatment Options

Lifestyle Modifications

Lifestyle changes are a key component of GERD management and include:

• Avoiding trigger foods and beverages such as chocolate, coffee, peppermint, fatty or spicy foods, tomato products, citrus juices, and alcohol

  
  

• Quitting smoking, which worsens reflux and increases cancer risk

  
  

• Limiting or eliminating alcohol consumption

  
  

• Losing weight if overweight, as excess abdominal fat significantly increases reflux risk

Eating and Sleeping Habits

• Avoid eating within two to three hours of bedtime

  
  

• Remain upright after meals

  
  

• Elevate the head of the bed 6–10 inches using a foam wedge; pillows alone are not effective

  
  

• Avoid tight clothing that increases abdominal pressure

Medications

Over-the-Counter Options

OTC medications can help with occasional symptoms and include:

• Antacids that neutralize stomach acid (e.g., calcium carbonate)

  
  

• Barrier agents that reduce reflux (e.g., alginate-based products)

  
  

• Acid-reducing medications such as H2 blockers (e.g., famotidine)

Patients who require OTC medications more than twice per week should consult a physician, as frequent symptoms may indicate GERD requiring further evaluation.

Prescription Medications

Proton pump inhibitors (PPIs) are the primary prescription treatment for GERD and work by significantly reducing stomach acid production. PPIs are available both over the counter and by prescription, though prescription doses may be higher.

The duration of therapy depends on symptom severity and response to treatment. Mild cases may require only short-term treatment, while patients with esophagitis or ulcers may need long-term or maintenance therapy.

Diagnosis

Diagnostic Testing for GERD

Testing may be recommended when symptoms are unclear, persistent, or associated with warning signs such as difficulty swallowing, bleeding, weight loss, or lack of response to medication.

Upper GI Series (Barium Esophagram)

This test involves swallowing a liquid barium solution while X-rays track its movement through the esophagus and stomach. It evaluates swallowing coordination, esophageal structure, and areas of narrowing or delayed emptying.

Upper Endoscopy

Upper endoscopy allows direct visualization of the esophagus, stomach, and duodenum using a flexible camera while the patient is sedated. It is used to:

• Assess inflammation or damage from reflux

  
  

• Identify strictures or obstructions

  
  

• Detect precancerous changes such as Barrett’s esophagus

  
  

• Measure acid exposure when evaluating patients for surgery

Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

Acid Reflux/GERD | ACG