Gastroesophageal Reflux Disease (GERD)

What is gastroesophageal reflux disease (GERD)?

Gastroesophageal reflux disease, commonly known as GERD, is a chronic condition in which stomach acid or stomach contents flow backward into the esophagus. This reflux occurs when the lower esophageal sphincter, a ring of muscle at the junction between the esophagus and stomach, does not function properly. As a result, acid irritates the lining of the esophagus and causes discomfort.

Many people experience occasional heartburn, described as a burning sensation behind the breastbone, often after large meals or the consumption of certain trigger foods such as spicy, fatty, or acidic foods. GERD is diagnosed when reflux symptoms are frequent, persistent, or lead to complications. Because symptoms of GERD can overlap with those of other conditions, including cardiac or pulmonary disorders, proper evaluation is important. Untreated or long-standing GERD may result in complications such as esophagitis, strictures, or Barrett’s esophagus.

Causes of GERD

GERD develops when the normal barrier between the stomach and esophagus is weakened. This is most often due to dysfunction of the lower esophageal sphincter, which allows acid to escape upward into the esophagus. Increased pressure within the abdomen, such as from obesity or pregnancy, can worsen reflux symptoms.

Other contributing factors include hiatal hernia, delayed gastric emptying, certain medications, and lifestyle habits such as large meals, lying down soon after eating, tobacco use, and alcohol consumption. While diet alone does not cause GERD, specific foods may trigger or worsen symptoms in susceptible individuals. Identifying contributing factors helps guide effective treatment.

Symptoms of GERD

The most common symptom of GERD is heartburn, often described as a burning or pressure in the chest. Symptoms frequently occur after eating or when lying down and may worsen at night. Many patients also experience regurgitation, in which sour or bitter-tasting fluid or food moves back up into the throat or mouth.

Other symptoms may include difficulty swallowing, a sensation of food sticking in the chest, chronic cough, hoarseness, sore throat, or chest pain. Some individuals experience breakthrough symptoms even while taking medications. Because GERD symptoms vary widely and may mimic other conditions, persistent or worsening symptoms should be evaluated by a health care provider.

Diagnosis of GERD

GERD may initially be diagnosed based on symptoms and response to treatment. However, patients with persistent symptoms, complications, or incomplete relief may require further evaluation to identify the underlying cause and guide management.

Diagnostic testing may include upper endoscopy to evaluate the esophagus, stomach, and gastroesophageal junction for inflammation, narrowing, or structural abnormalities. Acid reflux testing, such as wireless pH monitoring, measures the frequency and severity of acid exposure in the esophagus. Esophageal manometry evaluates the strength and coordination of esophageal muscle contractions, while imaging studies, such as barium swallow examinations, assess structure and swallowing function. A comprehensive evaluation allows providers to distinguish GERD from other esophageal disorders and tailor treatment to each patient’s specific condition.

Treatment of GERD

Treatment of GERD is individualized and depends on symptom severity, test results, and patient preferences. Many patients benefit from lifestyle modifications, including dietary changes, weight management, avoiding meals close to bedtime, and elevating the head of the bed. Medications such as acid-suppressing therapies are commonly used to reduce symptoms and promote healing of the esophagus.

For patients whose symptoms persist despite medical therapy, additional interventions may be recommended. Endoscopic or surgical treatments can address structural contributors such as hiatal hernia or reflux caused by mechanical dysfunction. Minimally invasive surgical options, including laparoscopic hiatal hernia repair, may be appropriate in selected cases. For patients with obesity and severe reflux, bariatric procedures such as gastric bypass may provide both weight loss and symptom improvement.

UTHealth Houston Gastroenterology & Digestive Health offers a comprehensive esophageal health evaluation to precisely determine the cause of reflux symptoms and develop a personalized treatment plan. Early and appropriate management can reduce symptoms, prevent complications, and improve quality of life.