Heartburn, Gastroesophageal Reflux 

(GER), and Gastroesophageal Reflux 

Disease (GERD) 

National Digestive Diseases Information Clearinghouse 

National 

Institute of 

Diabetes and 

Digestive 

and Kidney 

Diseases 

NATIONAL 

INSTITUTES 

OF HEALTH 

U.S. Department 

of Health and 

Human Services

What is GERD? 

Gastroesophageal reflux disease (GERD) 

is a more serious form of gastroesophageal 

reflux (GER), which is common. GER 

occurs when the lower esophageal sphincter (LES) opens spontaneously, for varying 

periods of time, or does not close properly 

and stomach contents rise up into the 

esophagus. GER is also called acid reflux 

or acid regurgitation, because digestive 

juices—called acids—rise up with the food. 

The esophagus is the tube that carries food 

from the mouth to the stomach. The LES 

is a ring of muscle at the bottom of the 

esophagus that acts like a valve between 

the esophagus and stomach. 

When acid reflux occurs, food or fluid can 

be tasted in the back of the mouth. When 

refluxed stomach acid touches the lining of 

the esophagus it may cause a burning sensation in the chest or throat called heartburn or acid indigestion. Occasional GER 

is common and does not necessarily mean 

one has GERD. Persistent reflux that 

occurs more than twice a week is considered GERD, and it can eventually lead to 

more serious health problems. People of 

all ages can have GERD. 

What are the symptoms of 

GERD? 

The main symptom of GERD in adults is 

frequent heartburn, also called acid indigestion—burning-type pain in the lower 

part of the mid-chest, behind the breast 

bone, and in the mid-abdomen. Most 

children under 12 years with GERD, and 

some adults, have GERD without heartburn. Instead, they may experience a 

dry cough, asthma symptoms, or trouble 

swallowing. 

What causes GERD? 

The reason some people develop GERD is 

still unclear. However, research shows that 

in people with GERD, the LES relaxes 

while the rest of the esophagus is working. 

Anatomical abnormalities such as a hiatal 

hernia may also contribute to GERD. A 

hiatal hernia occurs when the upper part of 

the stomach and the LES move above the 

diaphragm, the muscle wall that separates 

the stomach from the chest. Normally, the 

diaphragm helps the LES keep acid from 

rising up into the esophagus. When a hiatal 

hernia is present, acid reflux can occur 

more easily. A hiatal hernia can occur in 

people of any age and is most often a normal finding in otherwise healthy people 

over age 50. Most of the time, a hiatal 

hernia produces no symptoms. 
Other factors that may contribute to GERD 

include 

•	 obesity 

•	 pregnancy 

•	 smoking 

Common foods that can worsen reflux 

symptoms include 

•	 citrus fruits 

•	 chocolate 

•	 drinks with caffeine or alcohol 

•	 fatty and fried foods 

•	 garlic and onions 

•	 mint flavorings 

•	 spicy foods 

•	 tomato-based foods, like spaghetti 

sauce, salsa, chili, and pizza 

What is GERD in children? 

Distinguishing between normal, physiologic reflux and GERD in children is 

important. Most infants with GER are 

happy and healthy even if they frequently 

spit up or vomit, and babies usually outgrow GER by their first birthday. Reflux 

that continues past 1 year of age may be 

GERD. Studies show GERD is common 

and may be overlooked in infants and 

children. For example, GERD can present as repeated regurgitation, nausea, 

heartburn, coughing, laryngitis, or 

respiratory problems like wheezing, 

asthma, or pneumonia. Infants and 

young children may demonstrate irritability or arching of the back, often during or 

immediately after feedings. Infants with 

GERD may refuse to feed and experience 

poor growth. 

Talk with your child’s health care provider 

if reflux-related symptoms occur regularly 

and cause your child discomfort. Your 

health care provider may recommend 

simple strategies for avoiding reflux, 

such as burping the infant several times 

during feeding or keeping the infant in 

an upright position for 30 minutes after 

feeding. If your child is older, your health 

care provider may recommend that your 

child eat small, frequent meals and avoid 

the following foods: 

•	 sodas that contain caffeine 

•	 chocolate 

•	 peppermint 

•	 spicy foods 

•	 acidic foods like oranges, tomatoes, 

and pizza 

•	 fried and fatty foods 

Avoiding food 2 to 3 hours before bed 

may also help. Your health care provider 

may recommend raising the head of your 

child’s bed with wood blocks secured 

under the bedposts. Just using extra 

pillows will not help. If these changes 

do not work, your health care provider 

may prescribe medicine for your child. 

In rare cases, a child may need surgery. 

For information about GER in infants, 

children, and adolescents, see the 

Gastroesophageal Reflux in Infants and 

Gastroesophageal Reflux in Children and 

Adolescents fact sheets from the National 

Institute of Diabetes and Digestive and 

Kidney Diseases (NIDDK). 

2 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) 
How is GERD treated? 

See your health care provider if you have 

had symptoms of GERD and have been 

using antacids or other over-the-counter 

reflux medications for more than 2 weeks. 

Your health care provider may refer you to 

a gastroenterologist, a doctor who treats 

diseases of the stomach and intestines. 

Depending on the severity of your GERD, 

treatment may involve one or more of the 

following lifestyle changes, medications, 

or surgery. 

Lifestyle Changes 

•	 If you smoke, stop. 

•	 Avoid foods and beverages that
 

worsen symptoms.
 

•	 Lose weight if needed. 

•	 Eat small, frequent meals. 

•	 Wear loose-fitting clothes. 

•	 Avoid lying down for 3 hours after
 

a meal.
 

•	 Raise the head of your bed 6 to
 

8 inches by securing wood blocks
 

under the bedposts. Just using
 

extra pillows will not help.
 

Medications 

Your health care provider may recommend 

over-the-counter antacids or medications 

that stop acid production or help the 

muscles that empty your stomach. You can 

buy many of these medications without a 

prescription. However, see your health 

care provider before starting or adding 

a medication. 

Antacids, such as Alka-Seltzer, Maalox, 

Mylanta, Rolaids, and Riopan, are usually 

the first drugs recommended to relieve 

heartburn and other mild GERD symptoms. Many brands on the market use 

different combinations of three basic salts— 

magnesium, calcium, and aluminum—with 

hydroxide or bicarbonate ions to neutralize 

the acid in your stomach. Antacids, however, can have side effects. Magnesium salt 

can lead to diarrhea, and aluminum salt 

may cause constipation. Aluminum and 

magnesium salts are often combined in a 

single product to balance these effects. 

Calcium carbonate antacids, such as Tums, 

Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause 

constipation as well. 

Foaming agents, such as Gaviscon, work by 

covering your stomach contents with foam 

to prevent reflux. 

H2 blockers, such as cimetidine (Tagamet 

HB), famotidine (Pepcid AC), nizatidine 

(Axid AR), and ranitidine (Zantac 75), 

decrease acid production. They are available in prescription strength and over-thecounter strength. These drugs provide 

short-term relief and are effective for about 

half of those who have GERD symptoms. 

Proton pump inhibitors include omeprazole (Prilosec, Zegerid), lansoprazole 

(Prevacid), pantoprazole (Protonix), 

rabeprazole (Aciphex), and esomeprazole 

(Nexium), which are available by prescription. Prilosec is also available in over-thecounter strength. Proton pump inhibitors 

are more effective than H2 blockers and can 

relieve symptoms and heal the esophageal 

lining in almost everyone who has GERD. 

Prokinetics help strengthen the LES and 

make the stomach empty faster. This group 

includes bethanechol (Urecholine) and 

metoclopramide (Reglan). Metoclopramide also improves muscle action in the 

digestive tract. Prokinetics have frequent 

side effects that limit their usefulness— 

fatigue, sleepiness, depression, anxiety, 

and problems with physical movement. 

3 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) 
Because drugs work in different ways, combinations of medications may help control 

symptoms. People who get heartburn after 

eating may take both antacids and H2 

blockers. The antacids work first to neutralize the acid in the stomach, and then 

the H2 blockers act on acid production. 

By the time the antacid stops working, the 

H2 blocker will have stopped acid production. Your health care provider is the best 

source of information about how to use 

medications for GERD. 

What if GERD symptoms 

persist? 

If your symptoms do not improve with 

lifestyle changes or medications, you may 

need additional tests. 

•	 Barium swallow radiograph uses 

x rays to help spot abnormalities such 

as a hiatal hernia and other structural 

or anatomical problems of the esophagus. With this test, you drink a solution and then x rays are taken. The 

test will not detect mild irritation, 

although strictures—narrowing of 

the esophagus—and ulcers can be 

observed. 

•	 Upper endoscopy is more accurate 

than a barium swallow radiograph and 

may be performed in a hospital or a 

doctor’s office. The doctor may spray 

your throat to numb it and then, after 

lightly sedating you, will slide a thin, 

flexible plastic tube with a light and 

lens on the end called an endoscope 

down your throat. Acting as a tiny 

camera, the endoscope allows the doctor to see the surface of the esophagus 

and search for abnormalities. If you 

have had moderate to severe symptoms and this procedure reveals injury 

to the esophagus, usually no other 

tests are needed to confirm GERD. 

The doctor also may perform a biopsy. 

Tiny tweezers, called forceps, are 

passed through the endoscope and 

allow the doctor to remove small 

pieces of tissue from your esophagus. 

The tissue is then viewed with a microscope to look for damage caused by 

acid reflux and to rule out other problems if infection or abnormal growths 

are not found. 

•	 pH monitoring examination involves 

the doctor either inserting a small tube 

into the esophagus or clipping a tiny 

device to the esophagus that will stay 

there for 24 to 48 hours. While you 

go about your normal activities, the 

device measures when and how much 

acid comes up into your esophagus. 

This test can be useful if combined 

with a carefully completed diary— 

recording when, what, and amounts 

the person eats—which allows the 

doctor to see correlations between 

symptoms and reflux episodes. The 

procedure is sometimes helpful in 

detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux. 

A completely accurate diagnostic test for 

GERD does not exist, and tests have not 

consistently shown that acid exposure to 

the lower esophagus directly correlates 

with damage to the lining. 

Surgery 

Surgery is an option when medicine and 

lifestyle changes do not help to manage 

GERD symptoms. Surgery may also be 

a reasonable alternative to a lifetime of 

drugs and discomfort. 

4 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) 
Fundoplication is the standard surgical 

treatment for GERD. Usually a specific 

type of this procedure, called Nissen fundoplication, is performed. During the Nissen 

fundoplication, the upper part of the 

stomach is wrapped around the LES to 

strengthen the sphincter, prevent acid 

reflux, and repair a hiatal hernia. 

The Nissen fundoplication may be performed using a laparoscope, an instrument 

that is inserted through tiny incisions in 

the abdomen. The doctor then uses small 

instruments that hold a camera to look at 

the abdomen and pelvis. When performed 

by experienced surgeons, laparoscopic fundoplication is safe and effective in people 

of all ages, including infants. The procedure is reported to have the same results 

as the standard fundoplication, and people 

can leave the hospital in 1 to 3 days and 

return to work in 2 to 3 weeks. 

Endoscopic techniques used to treat 

chronic heartburn include the Bard 

EndoCinch system, NDO Plicator, and the 

Stretta system. These techniques require 

the use of an endoscope to perform the 

anti-reflux operation. The EndoCinch 

and NDO Plicator systems involve putting 

stitches in the LES to create pleats that 

help strengthen the muscle. The Stretta 

system uses electrodes to create tiny burns 

on the LES. When the burns heal, the scar 

tissue helps toughen the muscle. The longterm effects of these three procedures are 

unknown. 

What are the long-term 

complications of GERD? 

Chronic GERD that is untreated can cause 

serious complications. Inflammation of the 

esophagus from refluxed stomach acid can 

damage the lining and cause bleeding or 

ulcers—also called esophagitis. Scars 

from tissue damage can lead to strictures— 

narrowing of the esophagus—that make 

swallowing difficult. Some people develop 

Barrett’s esophagus, in which cells in the 

esophageal lining take on an abnormal 

shape and color. Over time, the cells can 

lead to esophageal cancer, which is often 

fatal. Persons with GERD and its complications should be monitored closely by a 

physician. 

Studies have shown that GERD may 

worsen or contribute to asthma, chronic 

cough, and pulmonary fibrosis. 

For information about Barrett’s esophagus, 

see the Barrett’s Esophagus fact sheet from 

the NIDDK. 

5 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) 
Points to Remember 

•	 Frequent heartburn, also called acid 

indigestion, is the most common 

symptom of GERD in adults. Anyone 

experiencing heartburn twice a week 

or more may have GERD. 

•	 You can have GERD without having 

heartburn. Your symptoms could 

include a dry cough, asthma symptoms, or trouble swallowing. 

•	 If you have been using antacids for 

more than 2 weeks, it is time to see 

your health care provider. Most doctors can treat GERD. Your health 

care provider may refer you to a gastroenterologist, a doctor who treats 

diseases of the stomach and intestines. 

•	 Health care providers usually recommend lifestyle and dietary changes to 

relieve symptoms of GERD. Many 

people with GERD also need medication. Surgery may be considered as a 

treatment option. 

•	 Most infants with GER are healthy 

even though they may frequently spit 

up or vomit. Most infants outgrow 

GER by their first birthday. Reflux 

that continues past 1 year of age may 

be GERD. 

•	 The persistence of GER along with 

other symptoms—arching and irritability in infants, or abdominal and chest 

pain in older children—is GERD. 

GERD is the outcome of frequent and 

persistent GER in infants and children 

and may cause repeated vomiting, 

coughing, and respiratory problems. 

Hope Through Research 

The reasons certain people develop 

GERD and others do not remain 

unknown. Several factors may be 

involved, and research is under way to 

explore risk factors for developing 

GERD and the role of GERD in other 

conditions such as asthma and 

laryngitis. 

6	 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) 
For More Information

American College of Gastroenterology

P.O. Box 342260

Bethesda, MD 20827–2260

Phone: 301–263–9000

Internet: www.acg.gi.org

American Gastroenterological Association

National Office

4930 Del Ray Avenue

Bethesda, MD 20814

Phone: 301–654–2055

Fax: 301–654–5920

Email: member@gastro.org

Internet: www.gastro.org

International Foundation for Functional

Gastrointestinal Disorders

P.O. Box 170864

Milwaukee, WI 53217–8076

Phone: 1–888–964–2001 or 414–964–1799

Fax: 414–964–7176

Email: iffgd@iffgd.org

Internet: www.aboutgerd.org

North American Society for Pediatric

Gastroenterology, Hepatology, and

Nutrition

P.O. Box 6 

Flourtown, PA 19031

Phone: 215–233–0808

Fax: 215–233–3918 

Email: naspghan@naspghan.org 

Internet: www.naspghan.org

Pediatric/Adolescent Gastroesophageal

Reflux Association, Inc.

P.O. Box 486

Buckeystown, MD 21717–0486

Phone: 301–601–9541

Email: gergroup@aol.com

Internet: www.reflux.org

7 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD)

You may also find additional information about this

topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about 

medications. When prepared, this publication

included the most current information available. 

For updates or for questions about any medications,

contact the U.S. Food and Drug Administration 

toll-free at 1–888–INFO–FDA (1–888–463–6332) 

or visit www.fda.gov. Consult your doctor for more

information.

The U.S. Government does not endorse or favor any

specific commercial product or company. Trade,

proprietary, or company names appearing in this

document are used only because they are considered

necessary in the context of the information provided.

If a product is not mentioned, the omission does not

mean or imply that the product is unsatisfactory.
National Digestive Diseases 

Information Clearinghouse 

2 Information Way
 

Bethesda, MD 20892–3570
 

Phone: 1–800–891–5389
 

Fax: 703–738–4929
 

Email: nddic@info.niddk.nih.gov
 

Internet: www.digestive.niddk.nih.gov
 

The National Digestive Diseases Information 

Clearinghouse (NDDIC) is a service of the 

National Institute of Diabetes and Digestive and 

Kidney Diseases (NIDDK). The NIDDK is 

part of the National Institutes of Health of 

the U.S. Department of Health and Human 

Services. Established in 1980, the Clearinghouse provides information about digestive 

diseases to people with digestive disorders and 

to their families, health care professionals, and 

the public. The NDDIC answers inquiries, 

develops and distributes publications, and 

works closely with professional and patient 

organizations and Government agencies to 

coordinate resources about digestive diseases. 

Publications produced by the Clearinghouse are 

carefully reviewed by both NIDDK scientists 

and outside experts. This fact sheet was 

reviewed by M. Brian Fennerty, M.D., Oregon 

Health and Science University, and Benjamin 

D. Gold, M.D., Emory University School of 

Medicine. 

This publication is not copyrighted. The 

Clearinghouse encourages users of this fact 

sheet to duplicate and distribute as many 

copies as desired. 

This fact sheet is also available at 

www.digestive.niddk.nih.gov. 

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 07–0882 

May 2007