Health Matters

Acid reflux

It’s not unusual to feel a painful burning sensation in your chest after you eat. However, you may have gastroesophageal reflux disease (GERD) if your acid reflux occurs regularly. This disease affects millions of people across the world and yet many of them have never heard of the condition and don’t know much about the recommendation to reduce their risk factors.

  • 783.95m

    cases of GERD globally in 2019 (1)

  • 8-33%

    estimated global prevalence (2)

GERD is a common clinical problem with significant morbidity and potentially decreased quality of life. Early recognition of symptoms is integral to preventing complications of GERD. Behavioural changes and advances in acid suppression remain integral to its treatment (4).

What is gastroesophageal reflux disease (GERD)? (3)

Gastroesophageal reflux occurs when stomach contents back up into the esophagus. When you eat, food moves from your mouth to your stomach through the esophagus, a tube-like structure that is approximately 10 inches long and 1 inch wide in adults. The esophagus is made of tissue and muscle layers that expand and contract to propel food to your stomach through a series of wave-like movements called peristalsis. At the lower end of the esophagus, where it connects to the stomach, there is a circular ring of muscle called the lower esophageal sphincter (LES). After you swallow, the LES relaxes to allow food to enter your stomach, where food mixes with acids that help with digestion. The LES then contracts to prevent the food and acid from backing up into your esophagus.

However, sometimes the LES relaxes inappropriately; this allows stomach contents to wash back into the esophagus. This happens occasionally to everyone. Most of these episodes occur shortly after meals, are brief, and do not cause symptoms. Normally, reflux should rarely occur during sleep. In some people, acid reflux causes bothersome symptoms or injury to the esophagus over time; when this happens, GERD is a consideration.

Symptoms (3, 4)

GERD ‘s condition is often overlooked and its symptoms are often misinterpreted.

The classic and most common symptoms of GERD are heartburn and regurgitation. Heartburn is a burning sensation in the chest, radiating toward the mouth, as a result of acid reflux into the esophagus. Notably, GERD is a common cause of non-cardiac chest pain. Other symptoms of GERD may include chest pain, sore throat, voice hoarseness, cough, or a sense of a lump in the throat.

Furthermore, acid reflux may trigger bronchospasm, which can exacerbate underlying asthma, thereby leading to cough, dyspnea, and wheezing.  Some GERD patients may also experience chronic nausea and vomiting.


Left untreated, GERD can result in several serious complications (4):

  • Chronic esophageal inflammation (esophagitis), which can cause ulcers and bleeding in the lining of the esophagus.
  • Damages to the lining of the esophagus (Barett’s esophagus), which increases the risk of cancer called esophageal adenocarcinoma.
  • Narrowing of the esophagus (esophageal stricture), which may lead to problems with swallowing.

People affected by GERD can also develop complications in the mouth, throat, and lungs, such as asthma and chronic cough.


GERD is usually curable. Some people try to modify their lifestyle, while others find relief in over-the-counter medications and other take antacids.

The goals of treatment in reflux disease, independent of presenting symptom, are to relieve symptoms, heal esophagitis, and prevent recurrence of symptoms and future complications. Some options to achieve these goals include endoscopic antireflux procedures, and sometimes surgical interventions (5).

Successful treatment of GERD symptoms has been associated with significant improvement in quality of life, including decreased physical pain, increased vitality, physical and social function, and emotional well-being (4).

How to prevent health burden?

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Reduce your risk (3, 5)

Main risk factors for GERD:

  • Weak esophageal muscles can impair the ability to push the refluxed content in the esophagus back into the stomach.
  • Nerve sensitivity – There are multiple nerve endings in the esophagus, and the sensitivity of these nerve endings differs among individuals. In some people even normal amounts of reflux can stimulate symptoms.
  • Hiatus hernia is a condition where part of the upper stomach pushes up through the diaphragm. The barrier between the esophagus and stomach is weakened in the presence of a hiatus hernia, which can allow reflux to occur.
  • Increased abdominal pressure such as with obesity or in pregnancy, can reverse the flow gradient from stomach to esophagus.
  • Overstimulated gut-brain connection – The gut-brain axis is a communication network that connects your gut and brain through the nervous system. The gut-brain axis can be overstimulated during times of stress and anxiety, leading to increased focus and worry about esophageal health and symptoms.

Lifestyle modifications:

  • Stress reduction – Integrate methods to reduce stress in your life to disrupt the overstimulated gut-brain connection. These include
    mindfulness, meditation, and massage therapy.
  • Belly breathing or diaphragmatic breathing can help strengthen the diaphragm and reduce esophageal disease and reflux. A video on diaphragmatic breathing can be found here:
  • Weight management – Losing weight, particularly weight around the abdomen, is a powerful tool to improve GERD symptoms for
    patients that are overweight. Maintaining a healthy weight is important to control GERD in patients with a normal weight.
  • Change your eating habits – Including the acidity of food, as well as size and timing of meals, particularly with respect to sleep.
    • Reduce offending food items (alcohol, soda, caffeine, smoking, trigger foods)
    • Eat small meals
    • Avoid eating too close to going bed
  • Quit smoking – Saliva helps to neutralize refluxed acid, and smoking reduces the amount of saliva in the mouth and throat. Smoking also lowers the pressure in the lower esophageal sphincter and provokes coughing, causing frequent episodes of acid reflux in the esophagus. Quitting smoking can reduce or eliminate symptoms of mild reflux.
  • Chewing gum or using lozenges can increase saliva production, which may help to neutralize and clear stomach acid that has entered the esophagus.
  • Avoid tight-fitting clothing as it can increase discomfort, and may also increase pressure in the abdomen, forcing stomach contents into the esophagus.

Lifestyle modification measures including avoidance of refluxogenic foods, food avoidance for at least 2–3 hours before recumbency, positional changes during the sleep period, and weight loss have been proposed for management of GERD. Late evening meals have been shown to contribute to reflux. Head of bed elevation as well as left lateral decubitus position have been shown to improve nocturnal esophageal acid exposure.

When to see a doctor?

Seek immediate medical care if you have chest pain, especially if you also have shortness of breath, or jaw or arm pain. These may be signs and symptoms of a heart attack (6)

Make an appointment with your doctor if you (6):

  • Experience severe or frequent GERD symptoms
  • Take over-the-counter medications for heartburn more than twice a week

GERD is usually diagnosed clinically with classic symptoms and response to acid suppression. The most utilized diagnostic test for the evaluation of GERD and its possible complications is the upper gastrointestinal endoscopy, or esophagogastroduodenoscopy (EGD). The primary benefit of endoscopy is direct visualization of the esophageal mucosa. Ambulatory pH monitoring is considered the gold standard in the diagnosis of acid reflux (1).

Last update: 15 May 2024

1. Zhang D, Liu S, Li Z, Wang R. Global, regional and national burden of gastroesophageal reflux disease, 1990-2019: update from the GBD 2019 study. Ann Med. 2022 Dec;54(1):1372-1384. doi: 10.1080/07853890.2022.2074535. PMID: 35579516; PMCID: PMC9122392. Available at:,%2C%20and%2077.19%25%2C%20respectively accessed 15.05.2024
2. Sawyer, M. A., MD. (n.d.). Gastroesophageal Reflux Disease (GERD) Imaging: Practice Essentials, Radiography, Nuclear Imaging. Available at:  accessed 11.05.2024
3. American Gastroenterology Association – Yadlapati R, Gyawali CP, Pandolfino JE. Best Practice Advice for Personalized Approach to the Evaluation and Management of GERD 2022. Available at: Accessed 15.05.2024
3. Clarrett DM, Hachem C. Gastroesophageal Reflux Disease (GERD). Mo Med. 2018 May-Jun;115(3):214-218. PMID: 30228725; PMCID: PMC6140167. Available at: Accessed 15.05.2024
4. Gastroesophageal reflux disease (GERD) – Symptoms and causes – Mayo Clinic. (2023, January 4). Mayo Clinic. Available at: Accessed 11.05.2024
5. Chen JW, Vela MF, Peterson KA, Carlson DA. AGA Clinical Practice Update on the Diagnosis and Management of Extraesophageal Gastroesophageal Reflux Disease: Expert Review. Clin Gastroenterol Hepatol. 2023 Apr 13:S1542-3565(23)00143-X. doi: 10.1016/j.cgh.2023.01.040. Epub ahead of print. PMID: 37061897. Accessed 15.05.2024
6. Vaezi MF, Katzka D, Zerbib F. Extraesophageal Symptoms and Diseases Attributed to GERD: Where is the Pendulum Swinging Now? Clin Gastroenterol Hepatol. 2018 Jul;16(7):1018-1029. doi: 10.1016/j.cgh.2018.02.001. Epub 2018 Feb 7. PMID: 29427733. Accessed 15.05.2024

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