GERD patients who have certain symptoms, such as difficulty in swallowing or painful swallowing, should be considered for endoscopy. Patients who fail to respond to therapy are also candidates for endoscopy. Some physicians advocate endoscopy for all patients with long-standing GERD in order to rule out Barrett's esophagus. This condition has been linked to cancer of the esophagus and must be carefully watched. The major factor is meals.
Meals stimulate the stomach to produce more acid that can reflux up into the esophagus.
In some patients, lying down or taking certain medications can worsen acid reflux. Spicy foods do not cause GERD, although they do seem to worsen GERD symptoms in some people. This is because food fills the stomach and induces more transient relaxations of the lower esophageal sphincter. In addition, all meals stimulate acid production in the stomach to aid digestion and can increase reflux into the esophagus in GERD sufferers. Any very large meal might be expected to produce heartburn in some people.