It’s normal to experience heartburn once in a while. But frequent heartburn or certain other symptoms may be signs of gastroesophageal reflux disease (GERD), a chronic disorder in which stomach acid frequently backs up into the esophagus and often the throat.
Affecting as much as 20% of the population according to some studies, GERD is one of the most common medical disorders, says Dr. David Purow, chairman of the medical board at Huntington Hospital and eastern regional director for gastrointestinal endoscopy for Northwell Health. If it goes untreated, GERD can potentially lead to serious health problems.
GERD symptoms
Frequent heartburn, in which you feel discomfort in your chest, and regurgitation, in which you get a taste in your throat of food or acid coming back up, are the classic symptoms of GERD, says Purow. But not everyone with GERD feels these symptoms, or any symptoms at all.
“Less typical GERD symptoms include hoarseness, chronic cough, a sore throat and a globus sensation (feeling like there’s a lump) in the throat,” among other symptoms, says Dr. Alexandra Guillaume, director of the Gastrointestinal Motility Center at Stony Brook Medicine and a co-founder and board member of the Association of Black Gastroenterologists and Hepatologists. “People often attribute these symptoms to allergies or post-nasal drip, but they may reflect GERD.”
Potential complications
Chronic reflux should not be ignored, because it can cause esophageal inflammation and lead to serious health concerns. A small subset of people with GERD will develop a condition known as Barrett’s esophagus, which can be a precursor to esophageal cancer.
“Unlike stomach cells, cells in the esophagus do not have a mechanism to protect themselves from stomach acid,” Purow says. “When someone has chronic reflux over time, the body may try to get smart and protect itself by changing the cells lining the esophagus to be more resistant to acid. This condition is known as Barrett’s esophagus, which can lead to cancer in a small number of people.”
Damage from stomach acid can also lead to a stricture, or narrowing, of the esophagus, which can make swallowing difficult, according to Guillaume, who adds, “If you have difficulty swallowing or pain with swallowing, see your doctor promptly.” Esophageal stricture is best treated as early as possible to prevent it from worsening.
Lifestyle modifications
The good news is that various interventions can be highly effective at reducing GERD symptoms and lowering the risk of long-term complications. Generally speaking, lifestyle modifications are the first line of defense.
“Easy fixes include changing some of the things you eat and drink,” says Guillaume.
Certain foods are known to trigger reflux, including tomato-based products, citrus fruits, peppermint, fatty or spicy foods, onions, garlic, chocolate, caffeine and alcohol. Triggers can vary from person to person. “When you have symptoms, pay attention to the foods you had, and avoid or cut down on them,” Guillaume says.
Guillaume also strongly cautions patients to avoid eating late at night or just before lying down. “Leave at least a four-hour gap between eating and getting into a supine position,” she says. This allows gravity to do its work.
“Gravity is our friend,” Purow says. “When we are upright, stomach acid tends to stay in the stomach, but if we are lying down, it’s easier for it to flow into the esophagus.” Sleeping with your head higher than your feet can also help you take advantage of gravity.
Avoiding smoking and maintaining a healthy weight can also prevent GERD symptoms, Guillaume says.
Some of Purow’s patients have noticed that their reflux disappears when they stay below a certain weight. “They’ve identified a ‘magic weight.’ For example, say it’s 185 pounds. When they’re over that weight, they’ll get reflux, but when they’re under it, they won’t,” he says.
People with a hiatal hernia are also at increased risk for GERD.
Medications and other interventions
Some GERD patients, particularly those with a hiatal hernia, find that their symptoms persist despite lifestyle modifications. In these cases, medication is typically recommended in addition to the modifications. Three classes of medications treat GERD: H2 blockers (such as Pepcid) and proton pump inhibitors (PPIs), which include Nexium, Prilosec and Prevacid, have been around for a long time and treat GERD by reducing stomach acid. The third class, vonoprazan (brand name Voquezna), is an acid blocker that the Food and Drug Administration (FDA) approved to treat GERD in 2023. “We are very excited about this class because it was the first novel treatment for reflux in about 30 years,” says Purow. However, since most insurance companies do not cover the medication yet, it has not been widely used, he adds.
While some patients will need only a short course of medication, long-term use is recommended for other patients. In a small number of GERD patients, surgery may be indicated.
“If someone does not do well with medication for whatever reason, we will consider, on a case-by-case basis, if they are a candidate for surgical management of GERD,” Guillaume says.
