There’s nothing that ruins a good meal quite like it coming back up. The burning sensation in the chest that follows is known as heartburn, and it can happen if food or stomach acid reenters the esophagus after eating. For many, heartburn is a once-in-a-while occurrence. It can flare up after eating a big, fatty meal, but it tends to go away on its own or with the help of over-the-counter antacids. But for some, heartburn is a frequent problem.
People who experience heartburn more than twice a week may be dealing with a condition called GERD, or gastroesophageal reflux disease. As uncomfortable as the burning sensation may be, lifestyle and medication treatment options exist to help relieve GERD symptoms.
[READ: Best Medicines for Heartburn, Nausea and Digestive Issues]
What Is GERD?
GERD is a condition in which the acid in the stomach refluxes, or comes up, into the esophagus, or the tube that connects your mouth and stomach.
Some doctors may also refer to the condition by a number of other names including:
— Acid indigestion
— Acid regurgitation
— Heartburn
— Reflux
GERD occurs due to complications with the lower esophageal sphincter, also known as the lower valve of the esophagus. In a healthy esophagus, this valve opens to let food enter the stomach and closes after the food goes in. In an esophagus with GERD, this valve doesn’t close all the way, or may open back up, giving food and acid the opportunity to travel back up the esophagus and cause symptoms.
GERD is a common problem in the United States. The American College of Gastroenterology reports that up to 20% of the U.S. population is thought to have GERD and that almost everyone will experience heartburn in their life.
“It’s actually very common for the valve to open when it’s not supposed to,” says Dr. Scott Gabbard, a gastroenterologist with the Cleveland Clinic in Ohio.
Simple heartburn becomes GERD when it happens two or more times per week.
GERD Symptoms
Most classic GERD symptoms are well-known and easily identified in American adults, though chest pain can be confused with the signs of a heart attack.
Common GERD symptoms include:
— Heartburn
— Chest pain
— Chronic cough
— Burping or belching
— Regurgitation
— Nausea
— Water brash
— Getting full quickly
— Having difficulty swallowing
— A “lump” in your throat
— Hoarseness
The most common GERD symptom is heartburn. As you may infer from its name, heartburn refers to a “burning sensation around the area where your heart is,” says Dr. Babak Firoozi, a board-certified gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California. For people with GERD, heartburn symptoms can flare up after a meal or when the patient lies down at night.
After heartburn, Gabbard says the second typical symptom is regurgitation.
If you experience regurgitation, you might not feel a burning sensation like in heartburn, but “you’ll have the sensation of stomach contents and food coming up through the stomach and into the throat and mouth,” Gabbard adds.
Dr. Lisa A. Lih-Brody, a gastroenterologist and clinical assistant professor of medicine at NYU Langone Health, adds that on rare occasions, people with GERD may have “extra esophageal manifestations, such as a sore throat, hoarse voice, pneumonia and a cough.”
Additionally, some people who don’t have diagnosed GERD may experience occasional symptoms of GERD. For those who don’t have symptoms frequently enough to warrant a diagnosis may be experiencing GER — or gastroesophageal reflux, sans disease.
Severe symptoms of GERD
Some symptoms of GERD are severe, and should lead you to seek medical attention right away
Among them:
— Activity-triggered chest pain
— Unintentional weight loss
— Choking or serious trouble swallowing
— Throwing up blood or dark brown material
— Red or black stools
GERD symptoms in babies
Reflux is normal and especially common in the first year of life, since babies don’t have a lot of room in their digestive tracts and spend more time in reflux-inducing positions (namely lying down).
But it can be especially difficult to identify in little ones because reflux looks a lot like normal spit-up and how they react to it varies widely.
Here are some symptoms of reflux in babies:
— Frequent projectile vomiting
— Green or yellow spit-up
— Bloody or dark brown spit-up
— Refusing food
— Bloody stool
— Difficulty breathing
— Chronic cough
— Begins spitting up after the age of 6 months
— Irritability after eating
[READ: What Helps With Nausea in Children? When to Be Concerned]
GERD Diet
Some people with GERD may notice that they experience more intense symptoms after eating certain foods. If this happens to you, it can be a good idea to remove those foods from your diet or eat them in moderation.
Some foods and lifestyle habits that doctors say may trigger symptoms for some — but not all — patients include:
— Caffeine
— Acidic foods, like tomato sauce and citrus fruits
— Spicy foods
— Fatty foods
— Large meals
— Tobacco use
— Alcohol
A GERD diagnosis can have varying impacts on different people’s palettes, so a food that triggers your symptoms may go down smoothly for someone else.
When it comes to a gold standard GERD diet, “there’s not anything that is uniformly recommended for everyone with reflux,” Firoozi says. Rather than rely on one guidebook, he recommends patients keep a food diary to keep track of what foods do or don’t feel good in their body.
Gabbard adds that people with GERD may find that large or fatty meals are more problematic — and there’s a scientific reason for that.
“Eating fatty meals triggers the valve to open more,” Gabbard says. “It’s probably a trait that has evolved to allow people to belch so they don’t feel so much pain after eating a large meal.”
In addition to fatty foods, Lih-Brody says she often recommends patients stay away from “irritants to the GI tract,” which are commonly thought to include treats such as chocolate, peppermint, spearmint, carbonated beverages and alcohol. She adds that not all patients are willing to take this advice: “Americans like to eat things like that, and unfortunately the reflux situation has become an epidemic.”
[READ: Best and Worst Foods to Eat for an Upset Stomach, According to Dietitians]
Causes and Risk Factors
There are lots of factors that can go into the development or worsening of a case of GERD, but some of the most common include:
— Diet. What you eat may make you more vulnerable to GERD symptoms like heartburn. Fatty meals in particular, and in large quantities, can trigger the valve to open so that reflux can occur.
— Obesity. Obesity is a risk factor for reflux, and Lih-Brody says that America’s growing weight problem is part of why the incidence of GERD is on the rise. “Unfortunately, GERD is becoming a worsening problem in the United States. Many of the reasons why this is happening is because the weight of people in America is going up,” she says.
— Age. Anyone can be at risk for GERD, though the disease can be more common with age. This may be because, over time, the elasticity of the esophageal sphincter declines, increasing the risks that the valve will open when it shouldn’t. “Some studies suggest the valve becomes leakier as you age and doesn’t quite work as well as you get older,” Gabbard says.
— Pregnancy. The simple fact of accommodating a baby in your belly can cause crowding among your internal organs and for some women, this means the development of GERD because stomach contents have nowhere else to go but up.
— Frequent use of nonsteroidal pain relievers. Over-the-counter medications like ibuprofen (Advil, Motrin) and naproxen sodium (Aleve) can cause inflammation in the upper gastrointestinal tract, which can trigger or exacerbate symptoms of GERD.
— Having a hiatal hernia. A hiatal hernia occurs when the top part of the stomach pushes through the diaphragm muscle and balloons into the chest cavity. This can force stomach contents where they don’t belong, leading to symptoms of GERD.
— Having an eating disorder. Eating disorders, particularly bulimia, can increase the risk for GERD. Dr. Kaunteya Reddy, the medical director of gastroenterology at Redlands Community Hospital in Redlands, California, says that eating disorder behaviors such as purging, laxative use or diuretic use “can result in symptoms of heartburn due to an enlarged stomach and reflux of gastric contents in the esophagus.” Over time, this may lead to “damage of the esophageal lining resulting in GERD” or even Barrett’s esophagus, he adds.
— Smoking. Using tobacco is also considered a risk factor for GERD.
When to See a Doctor About GERD
If you’re experiencing frequent heartburn — meaning symptoms are regularly occurring more than twice a week — now is a good time to see your doctor.
“If you’re having symptoms more than two to three times a week for more than several months at a time, don’t sit on it,” Lih-Brody says.
It is also crucial to seek medical attention for symptoms such as bleeding, weight loss and anemia, which may signal the presence of ulcers or strictures.
“Unintentional weight loss, signs of bleeding, such as black tarry stools, and if you’re having profound vomiting — these are alarm symptoms that should prompt someone to visit a physician,” Gabbard says.
Most patients start by visiting their primary care doctor. But you may also be referred to a gastroenterologist for additional evaluation and treatment.
GERD Diagnosis
Sometimes, a doctor can diagnose GERD based on your symptoms. Other times, they will want to conduct additional tests to rule out any other conditions or gather more information to guide your treatment.
One common diagnostic test is an endoscopy, a type of imaging test where the doctor threads a thin tube with a camera attached to it into your mouth and down into your esophagus to get a good look at your upper digestive system. During this test, doctors can look for inflammation and any abnormal structures. They can also check pH levels and take a biopsy to detect or rule out malignancies or Barrett’s esophagus.
Endoscopies can also be conducted after someone has already been diagnosed with GERD, especially if their current treatment does not appear to be helping, Firoozi says.
Post endoscopy, if there’s a suspicion of another gastrointestinal disorder such as Crohn’s disease or colitis, you may also undergo a colonoscopy. This procedure is similar to an endoscopy in that a thin tube with a camera is threaded into the body, but the colonoscopy is inserted through the anus and rectum into the colon to look at the lower end of the gastrointestinal tract.
GERD Complications
Long-term GERD sufferers may develop other problems related to this frequent influx of stomach acid into the esophagus. Some of these complications include:
— Ulcers. These sores develop from the constant washing of stomach acid on the inside of the esophagus.
— Esophageal strictures. Over time, the esophagus can narrow, which may make swallowing very difficult.
— Barrett’s esophagus. Barrett’s esophagus is a benign condition in which cells on the inside of the esophagus are replaced with intestinal cells. While the condition isn’t harmful in and of itself, it’s considered precancerous as it can develop into esophageal cancer. Therefore, it needs to be diagnosed and regularly monitored.
— Respiratory problems. It’s believed that there’s an association between GERD and worsening of asthma symptoms in some patients. In other cases, the acid moves far enough up the esophagus to infiltrate the windpipe, causing a cough and sore throat. Some people may develop pneumonia as a result of poorly managed GERD.
— Sleep disturbances. Constant heartburn can lead to difficulty sleeping for many people. Many doctors also advise patients to sleep sitting up to prevent reflux from entering the esophagus, and this change in position can also disrupt sleep.
— Dental problems. These problems can include halitosis (bad breath) and cavities if stomach acid reaches back into the mouth and damages tooth enamel.
— Esophageal cancer. The big concern about GERD is that it can set the stage for esophageal cancer. As stomach acid causes inflammation, that can lead to genetic mutations in cells in the esophagus which could one day lead to cancer.
Health Care Providers That Treat GERD
GERD Treatment
GERD treatment often starts at home. Depending on the severity of your symptoms, you may be able to manage your condition with lifestyle changes — many of which are related to meals and movement.
Among other daily interventions, Firoozi recommends being mindful of the volume of food you are eating at each meal and keeping your body in an upright position while and after a meal to “allow gravity to do its work and prevent reflux from happening.”
Other at-home tips to manage GERD include:
— Not lying down after you eat
— Not eating late at night
— Sleeping with your head elevated
— Sleeping on your left side
“Elevating the head of the bed has been shown to reduce reflux,” Gabbard says.
He also says sleeping on the left side can help. Sleeping on your left side positions the problematic valve at the top of the stomach so that when it opens, “only air comes back up,” Gabbard says. “If you elevate the head but also lock a patient on the left side, we found that reduced nighttime reflux symptoms by 75%.”
If you are overweight, losing weight may also help with GERD symptoms. This is because extra weight can put extra pressure on the abdomen, increasing the likelihood for reflux to occur, Firoozi says.
“If a patient is overweight, which means they have a BMI greater than 30, losing about three BMI points has been shown to help with GERD,” Lih-Brody adds.
For some patients with morbid obesity, surgical intervention to address the obesity may help reduce symptoms of GERD. You can figure out your own body mass index, which is a calculation of height versus weight, using the National Heart, Lung and Blood Institute’s online BMI calculator.
GERD Medications
Many medications can treat symptoms of GERD, including:
— Proton pump inhibitors, or PPI, such as omeprazole (Prilosec), esomeprazole (Nexium) and lansoprazole (Prevacid)
— Histamine 2 blockers, or H2RA
— Potassium-competitive acid blockers, or PCABs, such as vonoprazan
Proton pump inhibitors
PPIs are a class of drugs that reduce the amount of acid manufactured in the stomach by blocking actions of the proton pump, which is responsible for the secretion of gastric acid. These drugs can be available by prescription or over the counter. PPIs are typically the first line of treatment for GERD.
Histamine 2 blockers
H2RAs are another class of drugs that reduce the amount of acid manufactured in the stomach. In contrast to PPIs, which block acid at the pump, they specifically target histamine 2, which is one acid-suppressing stimuli in the stomach. H2RAs can start working quicker than PPIs but may not last as long. H2RAs are also available by prescription or over-the-counter.
Potassium-competitive acid blockers
PCABs are a newer class of acid-suppressing drug. They work similarly to the above drug classes and are also reported to take effect more rapidly than PPIs and help with acid stability in non-meal times.
GERD medication precautions
Because these drugs reduce the amount of acid made by the stomach, they in turn reduce the amount of acid that can be refluxed after eating and help with symptoms. However, these drugs do not prevent the valve from opening in the esophagus, which is the root issue of the condition, Gabbard says.
As of June 2025, “there’s still no FDA-approved medicine that helps prevent the valve from opening,” Gabbard adds. “The problem is you still have the valve opening and the contents coming back up, but there’s no acid in that content, so patients don’t feel it.”
Lih-Brody warns against using an over-the-counter drug in the place of a doctor’s visit.
“See a doctor,” she says. “Don’t just self-medicate. That’s the true danger.”
Seeing a doctor is important because if your symptoms are being caused by something other than or in addition to GERD, like cancer, they will need to be treated appropriately.
Some over-the-counter proton pump inhibitors have warnings on their packaging, such as to not take for longer than a 14-day cycle — for a reason, Firoozi says.
“They don’t want you to self-treat for months and months where there could be something going on there,” he explains.
The medications are “generally safe,” but it is always best to consult a doctor to help guide your treatment, he adds.
Some patients may be afraid to use proton pump inhibitors due to retrospective studies that found the drugs to be linked to increased risks of health issues like bone fractures and kidney disease, Gabbard says. However, research as a whole is mixed, and other studies have not shown these increased risks.
In his practice, Gabbard uses PPIs and says the benefits of the drugs, like reducing symptoms to avoid risks like Barrett’s esophagus or cancer, outweigh the negatives. Still, it is best to consult a doctor if you have questions about use. If medications are not working, an endoscopy may need to be performed to determine the issue.
“If the regurgitation is a regular and bothersome phenomenon where it’s affecting quality of life, that’s clearly a time to see a physician, because reflux can turn into some bad things. When you have acid reflux some of the serious conditions can arise,” Gabbard says.
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A Patient’s Guide to GERD originally appeared on usnews.com
Update 06/16/25: This story was previously published at an earlier date and has been updated with new information.
