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</div><div><span>Gastroesophageal reflux disease</span></div></div>
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</a><h1 class="with-also" itemprop="name">Gastroesophageal reflux disease</h1>
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</noscript></div><div class="main"><div id="ency_summary"><p>Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak backward from the stomach into the esophagus (food pipe). Food travels from your mouth to the stomach through your esophagus. GERD can irritate the food pipe and cause heartburn and other symptoms.</p></div><section><div class="section"><div class="section-header"><div class="section-title"><h2>Causes</h2></div><div class="section-button"><button type="submit" aria-controls="section-1" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-1"><p>When you eat, food passes from the throat to the stomach through the esophagus. A ring of muscle fibers in the lower esophagus prevents swallowed food from moving back up. These muscle fibers are called the lower esophageal sphincter (LES).</p><p>When this ring of muscle does not close all the way, stomach contents can leak back into the esophagus. This is called reflux or gastroesophageal reflux. Reflux may cause symptoms. Harsh stomach acids can also damage the lining of the esophagus.</p><img title="Gastroesophageal reflux disease" alt="Gastroesophageal reflux disease" src="//medlineplus.gov/ency/images/ency/fullsize/19609.jpg" class="img-e" itemprop="image"/><p>The risk factors for reflux include:</p><ul><li>Use of alcohol (possibly)</li><li><a test="test" href="./001137.htm">Hiatal hernia</a> (a condition in which part of the stomach moves above the diaphragm, which is the muscle that separates the chest and abdominal cavities)</li><li><a test="test" href="./007297.htm">Obesity</a></li><li><a test="test" href="../patientinstructions/000583.htm">Pregnancy</a></li><li><a test="test" href="./000429.htm">Scleroderma</a></li><li>
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Smoking or tobacco use</li><li>Lying down within 3 hours after eating </li></ul><p>Heartburn and gastroesophageal reflux can be caused by or made worse by pregnancy. Symptoms can also be caused by certain medicines, such as:</p><ul><li>Anticholinergics (for example, sea sickness medicine)</li><li>Beta-blockers for high blood pressure or heart disease</li><li>Bronchodilators for <a test="test" href="./000141.htm">asthma</a> or other lung diseases</li><li>Calcium channel blockers for <a test="test" href="./000468.htm">high blood pressure</a></li><li>Dopamine-active drugs for <a test="test" href="./000755.htm">Parkinson disease</a></li><li>Progestin for abnormal menstrual bleeding or birth control</li><li>Sedatives for insomnia or anxiety</li><li>Theophylline (for asthma or other lung diseases)</li><li>Tricyclic antidepressants </li></ul><p>Talk to your health care provider if you think one of your medicines may be causing heartburn. Never change or stop taking a medicine without first talking to your provider.</p><div class="videobox"><div class="group"><img class="rollover_globals" alt="Heartburn" title="Heartburn" src="//medlineplus.gov/ency/images/ency/tnails/200087t.gif"/>Watch this video about:<a class="blk" href="../anatomyvideos/000068.htm">Heartburn</a></div></div></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Symptoms</h2></div><div class="section-button"><button type="submit" aria-controls="section-2" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-2"><p>Common symptoms of GERD include:</p><ul><li>Feeling that food is stuck behind the breastbone</li><li><a test="test" href="./003114.htm">Heartburn</a> or a burning pain in the chest</li><li>Nausea after eating </li></ul><p>Less common symptoms are:</p><ul><li>Bringing food back up (regurgitation)</li><li><a test="test" href="./003072.htm">Cough</a> or <a test="test" href="./003070.htm">wheezing</a></li><li><a test="test" href="./007543.htm">Difficulty swallowing</a></li><li><a test="test" href="./003068.htm">Hiccups</a></li><li><a test="test" href="./003054.htm">Hoarseness</a> or change in voice</li><li><a test="test" href="./000655.htm">Sore throat</a></li></ul><p>Symptoms may get worse when you bend over or lie down, or after you eat. Symptoms may also be worse at night.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Exams and Tests</h2></div><div class="section-button"><button type="submit" aria-controls="section-3" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-3"><p>You may not need any tests if your symptoms are mild.</p><p>If your symptoms are severe or they come back after you have been treated, your provider may recommend a test called an <a test="test" href="./003888.htm">upper endoscopy</a> (EGD).</p><ul><li>This is a test to examine the lining of the esophagus, stomach, and first part of the small intestine.</li><li>It is done with a small camera (flexible endoscope) that is inserted down the throat.</li></ul><p>You may also be recommended to have one or more of the following tests:</p><ul><li>A test that measures how often stomach acid enters the esophagus</li><li>A test to measure the pressure inside the lower part of the esophagus (<a test="test" href="./003884.htm">esophageal manometry</a>)</li></ul><p>A positive <a test="test" href="./003393.htm">stool occult blood test</a> may diagnose bleeding that is coming from the irritation in the esophagus, stomach, or intestines.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Treatment</h2></div><div class="section-button"><button type="submit" aria-controls="section-4" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-4"><p>You can make many <a test="test" href="../patientinstructions/000197.htm">lifestyle changes</a> to help treat your symptoms such as avoiding tobacco, alcohol, or foods that cause your symptoms.</p><p>Other tips include:</p><ul><li>If you are overweight or obese, in many cases, losing weight can help.</li><li>Raise the head of the bed if your symptoms get worse at night.</li><li>Have your dinner 2 to 3 hours before going to sleep. Avoid eating food after dinner.</li><li>Avoid medicines such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). Take acetaminophen (Tylenol) to relieve pain.</li><li>Take all of your medicines with plenty of water. When your provider gives you a new medicine, ask whether it will make your heartburn worse.</li></ul><p>You may use <a test="test" href="../patientinstructions/000198.htm">over-the-counter antacids</a> after meals and at bedtime, although the relief may not last very long. Common side effects of antacids include diarrhea or constipation.</p><p>Other over-the-counter and prescription medicines can treat GERD. They work more slowly than antacids, but give you longer relief. Your pharmacist, provider, or nurse can tell you how to take these medicines.</p><ul><li>Proton pump inhibitors (PPIs) decrease the amount of acid produced in your stomach.</li><li>H2 blockers also lower the amount of acid released in the stomach.</li></ul><p>Anti-reflux surgery may be an option for people whose symptoms do not go away with lifestyle changes and medicines. Heartburn and other symptoms should improve after surgery. But you may still need to take medicines for your heartburn.</p><p>There are also new therapies for reflux that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach).</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Outlook (Prognosis)</h2></div><div class="section-button"><button type="submit" aria-controls="section-5" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-5"><p>Most people respond to lifestyle changes and medicines. However, many people need to continue taking medicines to control their symptoms.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Possible Complications</h2></div><div class="section-button"><button type="submit" aria-controls="section-6" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-6"><p>Complications may include:</p><ul><li>Worsening of <a test="test" href="./000141.htm">asthma</a></li><li>A change in the lining of the esophagus that can increase the risk of cancer (<a test="test" href="./001143.htm">Barrett esophagus</a>)</li><li>Bronchospasm (irritation and spasm of the airways due to acid)</li><li>Long-term (chronic) cough or hoarseness</li><li>Dental problems</li><li><a test="test" href="./003228.htm">Ulcer</a> in the esophagus</li><li>Stricture (a narrowing of the esophagus due to scarring from chronic irritation)</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>When to Contact a Medical Professional</h2></div><div class="section-button"><button type="submit" aria-controls="section-7" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-7"><p>Contact your provider if symptoms do not improve with lifestyle changes or medicine.</p><p>Also contact if you have:</p><ul><li>Bleeding</li><li>Choking (coughing, shortness of breath)</li><li>Feeling filled up quickly when eating</li><li>Frequent vomiting</li><li>Hoarseness</li><li>Loss of appetite</li><li>Trouble swallowing (dysphagia) or pain with swallowing (odynophagia)</li><li>Weight loss</li><li>A feeling like food or pills are sticking behind the breast bone<br/></li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Prevention</h2></div><div class="section-button"><button type="submit" aria-controls="section-8" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-8"><p>Avoiding factors that cause <a test="test" href="./003114.htm">heartburn</a> may help prevent symptoms. Obesity is linked to GERD. Maintaining a healthy body weight may help prevent the condition.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Alternative Names</h2></div><div class="section-button"><button type="submit" aria-controls="section-Alt" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Alt"><p>Peptic esophagitis; Reflux esophagitis; GERD; Heartburn - chronic; Dyspepsia - GERD</p></div></div></section><section><div class="section sec-mb"><div class="section-header"><div class="section-title"><h2>Patient Instructions</h2></div><div class="section-button"><button type="submit" aria-controls="section-carepnt" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div name="Patient Instructions" class="section-body" id="section-carepnt"><ul class="side-nav"><li><a href="../patientinstructions/000289.htm">Anti-reflux surgery - children - discharge </a></li>
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<li><a href="../patientinstructions/000160.htm">Anti-reflux surgery - discharge </a></li>
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<li><a href="../patientinstructions/000197.htm">Gastroesophageal reflux - discharge</a></li>
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<li><a href="../patientinstructions/000225.htm">Heartburn - what to ask your provider</a></li>
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<li><a href="../patientinstructions/000198.htm">Taking antacids</a></li>
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/19609t.jpg" alt="Gastroesophageal reflux disease" title="Gastroesophageal reflux disease" class="side-img"/><a href="../imagepages/19609.htm">Gastroesophageal reflux disease</a></li>
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</ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>References</h2></div><div class="section-button"><button type="submit" aria-controls="section-Ref" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Ref"><p>Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Cooney KA, eds. <em>Goldman-Cecil Medicine</em>. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 124.</p><p>Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the diagnosis and management of Gastroesophageal Reflux Disease. <em>Am J Gastroenterol</em>. 2022;117(1):27-56. PMID: 34807007 <a href="https://pubmed.ncbi.nlm.nih.gov/34807007/" target="_blank">pubmed.ncbi.nlm.nih.gov/34807007/</a>.</p><p>National Institute of Diabetes and Digestive and Kidney Diseases website. Acid reflux (GER & GERD) in adults. <a href="https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults" target="_blank">www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults</a>. Updated July 2020. Accessed July 26, 2024.</p><p>Richter JE, Vaezi MF. Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. <em>Sleisenger and Fordtran's Gastrointestinal and Liver Disease</em>. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 46.</p></div></div></section>
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<section><div class="section"><div class="section-header"><div class="section-title"><h2>Review Date 1/30/2023</h2></div><div class="section-button"><button type="submit" aria-controls="section-version" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<div id="section-version" class="section-body"><p>Updated by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Internal review and update on 07/26/24 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.</p>
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