Gastroesophageal Reflux (GER) 

and Gastroesophageal Reflux 

Disease (GERD) in Adults 

National Digestive Diseases Information Clearinghouse 

What is GER? 

Gastroesophageal reflux (GER) occurs 

when stomach contents flow back up into the 

esophagus—the muscular tube that carries 

food and liquids from the mouth to the 

stomach. 

GER is also called acid reflux or acid 

regurgitation because the stomach’s digestive 

juices contain acid. Sometimes people with 

GER can taste food or acidic fluid in the 

back of the mouth. Refluxed stomach acid 

that touches the lining of the esophagus 

can cause heartburn. Also called acid 

indigestion, heartburn is an uncomfortable, 

burning feeling in the midchest, behind 

the breastbone, or in the upper part of the 

abdomen—the area between the chest and 

the hips. 

Occasional GER is common. People may be 

able to control GER by 

•	 avoiding foods and beverages that 

contribute to heartburn, such as 

chocolate, coffee, peppermint, greasy 

or spicy foods, tomato products, and 

alcoholic beverages 

•	 avoiding overeating 

•	 quitting smoking 

•	 losing weight if they are overweight 

•	 not eating 2 to 3 hours before sleep 

•	 taking over-the-counter medications 

Read more about over-the-counter 

medications in the section “How is GERD 

treated?” 

What is GERD? 

Gastroesophageal reflux disease (GERD) is 

a more serious, chronic––or long lasting–– 

form of GER. GER that occurs more 

than twice a week for a few weeks could 

be GERD, which over time can lead to 

more serious health problems. People with 

suspected GERD should see a health care 

provider. 

What causes GERD? 

Gastroesophageal reflux disease results when 

the lower esophageal sphincter—the muscle 

that acts as a valve between the esophagus 

and stomach—becomes weak or relaxes 

when it should not, causing stomach contents 

to rise up into the esophagus. 

Abnormalities in the body such as hiatal 

hernias may also cause GERD. Hiatal 

hernias occur when the upper part of the 

stomach moves up into the chest. The 

stomach can slip through an opening found 

in the diaphragm. The diaphragm is the 

muscle wall that separates the stomach from 

the chest. Hiatal hernias may cause GERD 

because of stomach acid flowing back up 

through the opening; however, most produce 

no symptoms. 
2 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults 

Other factors that can contribute to GERD 

include 

•	 obesity 

•	 pregnancy 

•	 certain medications, such as asthma 

medications, calcium channel blockers, 

and many antihistamines, pain killers, 

sedatives, and antidepressants 

•	 smoking, or inhaling secondhand smoke 

People of all ages can develop GERD, some 

for unknown reasons. 

What is the gastrointestinal 

(GI) tract? 

The GI tract is a series of hollow organs 

joined in a long, twisting tube from the 

mouth to the anus. The movement of 

muscles in the GI tract, along with the 

release of hormones and enzymes, starts 

the digestion of food. The upper GI tract 

includes the mouth, esophagus, stomach, 

small intestine, and duodenum, which is the 

first part of the small intestine. 

Lower 

esophageal 

sphincter 

Stomach 

Mouth 

Small 

intestine 

Esophagus 

Anus 

Esophagus 

Small 

intestine 

Stomach 

Lower 

esophageal 

sphincter 

Acid 

GERD results when the lower esophageal sphincter—the muscle that acts as a valve between the esophagus and 

stomach—becomes weak or relaxes when it should not, causing stomach contents to rise up into the esophagus. 
 

What are the symptoms of 

GERD? 

The main symptom of GERD is frequent 

heartburn, though some adults with GERD 

do not have heartburn. Other common 

GERD symptoms include 

•	 a dry, chronic cough 

•	 wheezing 

•	 asthma and recurrent pneumonia 

•	 nausea 

•	 vomiting 

•	 a sore throat, hoarseness, or laryngitis— 

swelling and irritation of the voice box 

•	 difficulty swallowing or painful 


swallowing 


•	 pain in the chest or the upper part of 

the abdomen 

•	 dental erosion and bad breath 

How is GERD diagnosed? 

A health care provider may refer people with 

suspected GERD to a gastroenterologist—a 

doctor who specializes in digestive diseases— 

for diagnosis and treatment. 

Lifestyle changes and medications are often 

the first lines of treatment for suspected 

GERD. If symptoms improve with these 

treatment methods, a GERD diagnosis 

often does not require testing. However, 

to confirm a diagnosis, a person may need 

testing if symptoms do not improve. People 

with possible GERD who have trouble 

swallowing also may require testing. 

A completely accurate test for diagnosing 

GERD does not exist. However, several 

tests can help with diagnosis: 

Upper GI series. While a gastroenterologist 

does not use an upper GI series to diagnose 

acid reflux or GERD, the test can provide 

a look at the shape of the upper GI tract. 

An x-ray technician performs this test at 

a hospital or an outpatient center, and a 

radiologist—a doctor who specializes in 

medical imaging—interprets the images. 

This test does not require anesthesia. No 

eating or drinking is allowed before the 

procedure, as directed by the health care 

staff. People should check with their 

gastroenterologist about what to do to 

prepare for an upper GI series. 

During the procedure, the person will stand 

or sit in front of an x-ray machine and drink 

barium, a chalky liquid. Barium coats the 

esophagus, stomach, and small intestine so 

the radiologist and gastroenterologist can 

see theses organs’ shapes more clearly on 

x rays. The barium shows problems related 

to GERD, such as hiatal hernias. While an 

upper GI series cannot detect mild irritation, 

the test can detect esophageal strictures— 

narrowing of the esophagus that can result 

from GERD—as well as ulcers, or sores. 

A person may experience bloating and 

nausea for a short time after the test. For 

several days afterward, barium liquid in 

the GI tract causes white or light-colored 

stools. A health care provider will give the 

person specific instructions about eating and 

drinking after the test. 

Upper endoscopy. A gastroenterologist 

may use an upper endoscopy, also known 

as an esophagogastroduodenoscopy, if a 

person continues to have GERD symptoms 

despite lifestyle changes and treatment 

with medications. An upper endoscopy is a 

common test used to evaluate the severity 

of GERD. This procedure involves using 

an endoscope—a small, flexible tube with a 

light—to see the upper GI tract. 

A gastroenterologist performs this test at 

a hospital or an outpatient center. The 

person may receive a liquid anesthetic that is 

gargled or sprayed on the back of the throat. 

3 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults 
 

If sedation is used, a health care provider 

will place an intravenous (IV) needle in the 

person’s vein. 

After the person receives sedation, the 

gastroenterologist carefully feeds an 

endoscope through the mouth and down 

the esophagus, then into the stomach and 

duodenum. A small camera mounted on 

the endoscope transmits a video image to a 

monitor, allowing close examination of the 

intestinal lining. The gastroenterologist uses 

the endoscope to take a biopsy, a procedure 

that involves taking a small piece of 

esophageal tissue. A pathologist—a doctor 

who specializes in diagnosing diseases—will 

examine the tissue with a microscope and 

determine the extent of inflammation. 

A gastroenterologist diagnoses GERD when 

the test shows injury to the esophagus in 

a person who has had moderate to severe 

GERD symptoms. 

Esophageal pH monitoring. The most 

accurate test to detect acid reflux, esophageal 

pH monitoring measures the amount of 

liquid or acid in the esophagus as the person 

goes about normal activities, including eating 

and sleeping. A gastroenterologist performs 

this test at a hospital or an outpatient center 

as a part of an upper endoscopy. The person 

can remain awake during the test. Sedation 

is not required for the test; however, it can 

be used if necessary. 

A gastroenterologist will pass a thin tube, 

called a nasogastric probe, through the 

person’s nose or mouth to the stomach. The 

gastroenterologist will then pull the tube 

back into the esophagus, where it will be 

taped to the person’s cheek and remain in 

place for 24 hours. The end of the tube in 

the esophagus has a small probe to measure 

when and how much liquid or acid comes up 

into the esophagus. The other end of the 

tube, attached to a monitor outside the body, 

shows the measurements taken. 

This test is most useful when combined with 

a carefully kept diary of when, what, and 

how much food the person eats and GERD 

symptoms that result. The gastroenterologist 

can see correlations between symptoms and 

certain foods or times of day. The procedure 

can also help show whether reflux triggers 

respiratory symptoms. 

Esophageal manometry. Esophageal 

manometry measures muscle contractions 

in the esophagus. A gastroenterologist may 

order this test when considering a person for 

anti-reflux surgery. The gastroenterologist 

performs this test during an office visit. A 

person may receive anesthetic spray on 

the inside of the nostrils or back of the 

throat. The gastroenterologist passes a 

soft, thin tube through the person’s nose 

into the stomach. The person swallows as 

the gastroenterologist pulls the tube slowly 

back into the esophagus. A computer 

measures and records the pressure of the 

muscle contractions in different parts of the 

esophagus. The test can show if symptoms 

are due to a weak sphincter muscle. A 

health care provider can also use the test to 

diagnose other disorders of the esophagus 

that might have similar symptoms as 

heartburn. Most people can resume regular 

activity, eating, and medications right after 

the test. 

How is GERD treated? 

Treatment for GERD may involve one or 

more of the following, depending on the 

severity of symptoms: lifestyle changes, 

medications, or surgery. 

Lifestyle Changes 

Some people can reduce GERD symptoms by 

•	 losing weight, if needed 

•	 wearing loose-fitting clothing around 

the stomach area, as tight clothing can 

constrict the area and increase reflux 

4 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults 
 

•	 remaining upright for 3 hours after 


meals 


•	 raising the head of the bed 6 to 8 inches 

by securing wood blocks under the 

bedposts––just using extra pillows will 

not help 

•	 avoiding smoking and being around 


others who are smoking
 

Medications 

People can purchase many GERD 

medications without a prescription; however, 

people with persistent symptoms should still 

see a health care provider. 

Antacids, which include over-the-counter 

medications such as Alka-Seltzer, Maalox, 

Mylanta, Rolaids, and Riopan, are a firstline approach health care providers usually 

recommend to relieve heartburn and other 

mild GERD symptoms. Antacids, however, 

can have side effects, including diarrhea and 

constipation. 

H2 blockers, such as cimetidine (Tagamet 

HB), famotidine (Pepcid AC), nizatidine 

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

decrease acid production. These medications 

are available in both over-the-counter and 

prescription strengths. H2 blockers provide 

short-term or on-demand relief and are 

effective for many people with GERD 

symptoms. They can also help heal the 

esophagus, although not as well as proton 

pump inhibitors (PPIs). 

PPIs include omeprazole (Prilosec, Zegerid), 

lansoprazole (Prevacid), pantoprazole 

(Protonix), rabeprazole (Aciphex), and 

esomeprazole (Nexium), which are 

available by prescription. Omeprazole and 

lansoprazole also come in over-the-counter 

strength. PPIs are more effective than 

H2 blockers and can relieve symptoms and 

heal the esophageal lining in most people 

with GERD. Health care providers most 

commonly prescribe PPIs for long-term 

management of GERD. However, studies 

show people who take PPIs long term or in 

high doses are more likely to have hip, wrist, 

and spinal fractures. People should take 

these medications on an empty stomach in 

order for stomach acid to activate them. 

Prokinetics, which include bethanechol 

(Urecholine) and metoclopramide 

(Reglan), help make the stomach empty 

faster. However, both bethanechol and 

metoclopramide have side effects that often 

limit their use, including nausea, diarrhea, 

tiredness, depression, anxiety, and problems 

with physical movement. Prokinetics can 

interact with other medications, so people 

taking prokinetic agents should tell their 

health care provider about all medications 

they are taking. 

Antibiotics, including one called 

erythromycin, have been shown to 

improve gastric emptying. Erythromycin 

has fewer side effects than bethanechol 

and metoclopramide; however, like all 

antibiotics, it can cause diarrhea. 

All of these medications work in different 

ways, so combinations of medications may 

help control symptoms. People who get 

heartburn after eating may take antacids 

and H2 blockers. The antacids neutralize 

stomach acid, and the H2 blockers stop acid 

production. By the time the antacids stop 

working, the H2 blockers have stopped acid 

production. 

Surgery 

When a person cannot manage severe 

GERD symptoms through medication or 

lifestyle changes, a health care provider may 

recommend surgery. A health care provider 

may also recommend surgery for GERD 

that results from a physical abnormality or 

5 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults 
 

for GERD symptoms that lead to severe 

respiratory problems. Fundoplication is the 

standard surgical treatment for GERD and 

leads to long-term reflux control in most 

cases. A gastroenterologist or surgeon may 

also use endoscopic techniques to treat 

GERD. However, the success rates of 

endoscopic techniques are not completely 

known, as researchers have not tested them 

enough in clinical trials. People are more 

likely to develop complications from surgery 

than from medications. Anti-reflux surgery 

is most successful in people younger than 50. 

Fundoplication is an operation to sew the 

top of the stomach around the esophagus 

to add pressure to the lower end of the 

esophagus and reduce reflux. A surgeon 

performs fundoplication using a laparoscope, 

a thin tube with a tiny video camera attached 

used to look inside the body. The surgeon 

performs the operation at a hospital or an 

outpatient center, and the person receives 

general anesthesia. People can leave the 

hospital or outpatient center in 1 to 3 days 

and return to their daily activities in 2 to 

3 weeks. 

Endoscopic techniques, such as 

endoscopic sewing and radiofrequency, 

help control GERD in a small number 

of people. Endoscopic sewing uses small 

stitches to tighten the sphincter muscle. 

Radiofrequency creates heat lesions that 

help tighten the sphincter muscle. Surgery 

for both techniques requires an endoscope. 

A surgeon performs the operation at a 

hospital or an outpatient center, and the 

person receives anesthesia. Although the 

devices for these procedures are approved, 

results may not be as good as laparoscopic 

surgery, and these procedures are not 

commonly used. 

What are the long-term 

complications of GERD? 

Untreated GERD can sometimes cause 

serious complications over time, including 

•	 esophagitis—irritation of the esophagus 

from refluxed stomach acid that 

damages the lining and causes bleeding 

or ulcers. Adults who have chronic 

esophagitis over many years are more 

likely to develop precancerous changes 

in the esophagus. 

•	 strictures that lead to swallowing 


difficulties. 


•	 respiratory problems, such as trouble 

breathing. 

•	 Barrett’s esophagus, a condition in 

which the tissue lining the esophagus 

is replaced by tissue similar to the 

lining of the intestine. A small number 

of people with Barrett’s esophagus 

develop a rare yet often deadly type 

of cancer of the esophagus. Read 

more in Barrett’s Esophagus at 

www.digestive.niddk.nih.gov. 

A health care provider should monitor a 

person with GERD to prevent or treat longterm complications. 

Eating, Diet, and Nutrition 

People with GERD can often reduce reflux 

by avoiding foods and drinks that worsen 

symptoms. Other dietary changes that can 

help reduce symptoms include decreasing 

fat intake and eating small, frequent meals 

instead of three large meals. People who 

are overweight can talk with a health care 

provider about dietary changes that can 

help them lose weight, which may decrease 

GERD symptoms. 

6 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults 
 

Points to Remember 

•	 Gastroesophageal reflux (GER) 

occurs when stomach contents flow 

back up into the esophagus. 

•	 GER is also called acid reflux or 

acid regurgitation because the 

stomach’s digestive juices contain 

acid. 

•	 Gastroesophageal reflux disease 

(GERD) is a more serious, chronic 

form of GER. 

•	 GERD results when the lower 

esophageal sphincter becomes 

weak or relaxes when it should not, 

causing stomach contents to rise up 

into the esophagus. 

•	 The main symptom of GERD is 

frequent heartburn, though some 

adults with GERD do not have 

heartburn. 

•	 Other common GERD symptoms 

include asthma or recurrent 

pneumonia, difficulty swallowing or 

painful swallowing, and pain in the 

chest. 

•	 A health care provider may refer 

people with suspected GERD to 

a gastroenterologist for diagnosis 

and treatment. 

•	 Treatment for GERD may involve 

one or more of the following, 

depending on the severity of 

symptoms: lifestyle changes, 

medications, or surgery. 

•	 A health care provider should 


monitor a person with GERD 


to prevent or treat long-term 


complications.
 

Hope through Research 

The Division of Digestive Diseases and 

Nutrition at the National Institute of 

Diabetes and Digestive and Kidney Diseases 

(NIDDK) supports basic and clinical 

research into GI diseases, including GER 

and GERD. 

Clinical trials are research studies involving 

people. Clinical trials look at safe and 

effective new ways to prevent, detect, or 

treat disease. Researchers also use clinical 

trials to look at other aspects of care, such 

as improving the quality of life for people 

with chronic illnesses. To learn more about 

clinical trials, why they matter, and how to 

participate, visit the NIH Clinical Research 

Trials and You website at www.nih.gov/health/ 

clinicaltrials. For information about current 

studies, visit www.ClinicalTrials.gov. 

For More Information 

American College of Gastroenterology 

6400 Goldsboro Road, Suite 200 

Bethesda, MD 20817–5846 

Phone: 301–263–9000 

Fax: 301–263–9025 

Email: info@acg.gi.org 

Internet: www.gi.org 

American Gastroenterological Association 

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 

700 West Virginia Street, Suite 201 

Milwaukee, WI 53204 

Phone: 1–888–964–2001 or 414–964–1799 

Fax: 414–964–7176 

Email: iffgd@iffgd.org 

Internet: www.iffgd.org 

7	 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults 
Acknowledgments 

Publications produced by the Clearinghouse 

are carefully reviewed by both NIDDK 

scientists and outside experts. This 

publication was originally reviewed by M. 

Brian Fennerty, M.D., Oregon Health and 

Science University, and Benjamin D. Gold, 

M.D., Emory University School of Medicine. 

You may also find additional information about this 

topic by visiting MedlinePlus at www.medlineplus.gov. 

This publication may contain information about 

medications and, when taken as prescribed, 

the conditions they treat. 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 

health care provider for more information. 

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If a product is not mentioned, the omission does not 

mean or imply that the product is unsatisfactory. 

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Internet: www.digestive.niddk.nih.gov 

The National Digestive Diseases Information 

Clearinghouse (NDDIC) is a service of the 

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and Kidney Diseases (NIDDK). The 

NIDDK is part of the National Institutes of 

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the Clearinghouse provides information 

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The NDDIC answers inquiries, develops and 

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NIH Publication No. 13–0882

September 2013

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