GERD is a chronic condition characterized by the backflow (or reflux) of stomach contents into the esophagus and throat through a dysfunctional esophageal sphincter. Up to 1 out of 6 people are affected globally, but the prevalence varies widely between regions. Though it isn’t life-threatening, it does have a substantial negative impact on quality of life, and if left untreated, may increase the risk of esophageal cancer. The causes and disease progression of GERD aren’t completely understood, but it can be managed or treated with lifestyle modifications, drugs, and surgery.^[1][2]

The reflux of acidic stomach contents can lead to tooth erosion, chest pain, chronic cough, laryngitis, asthma, and the burning sensation commonly known as heartburn. ^[1] GERD is also associated with an increased risk of non-alcoholic fatty liver disease and the development of Barrett’s Esophagus, an inflammatory condition which can lead to esophageal cancer.^[3][2]

GERD can be diagnosed based on symptoms, but in some cases a diagnosis might involve referral to a gastroenterologist for further testing. These tests allow the gastroenterologist to observe the tissues of the esophagus (with an upper endoscopy), measure the pH (acidity) of the esophagus, or watch the esophageal sphincter in action (with a barium swallow).^[4][5]

GERD is treated progressively, beginning with lifestyle modifications (such as weight loss and keeping the head elevated while sleeping); if those modifications aren’t possible or don’t provide complete symptom control, then acid-suppressing drugs, such as proton pump inhibitors (PPIs) or histamine receptor (H2) blockers, may be added. More recently, concerns have grown regarding long-term PPI use and potential side effects.^[6] Clinical evidence suggests that long-term PPI use may lead to a less diverse gut microbiome with a greater incidence of potentially pathogenic species.^[7] Lower gut health in relation to long-term PPI use may lead to increased risk of pathogenic growth,^[8] such as Clostridium difficile,^[9] and to community-acquired pneumonia.^[10] Less recent reports also cite long-term PPI use as a possible explanation for increased risk of bone fracture^[11] through mineral metabolism impairment.^[12]

Antidepressants and prokinetics, the latter of which stimulate the digestive tract, are sometimes added to PPI therapy for enhanced symptom relief.^[13] Surgery may be required in some cases of GERD to repair a hiatal hernia if present and/or to fortify the esophageal sphincter. The sphincter may be fortified by wrapping it with either the top portion of the stomach (called a fundoplication) or a ring of magnets (called a magnetic sphincter augmentation).^[14][15]

A number of supplements, including certain prebiotics, fermented soy, xylitol-malic acid tablets, rose oil, and traditional Chinese medicinal herbs have been studied for GERD, with mixed results. Most were associated with improved quality of life and mild to moderate heartburn relief, but more research is needed to confirm these preliminary findings.^{[16][17][18][19][20][21][22]}

Traditional dietary advice for GERD includes eating smaller meals, avoiding meals close to bedtime, and limiting common triggers (which often include spicy, acidic, or fatty foods), but improvements are generally mild. The low-FODMAP diet is similarly helpful.^[23]

Certain breathing exercises, such as diaphragmatic breathing, may increase the pressure of the lower esophageal sphincter, which could alleviate reflux, although more research is needed to determine if this translates into reductions in GERD symptoms or improvements in quality of life.^[24]

The reflux of stomach contents is caused by the lower esophageal sphincter relaxing or being subjected to abnormally high pressure, which could be due to delayed stomach emptying, a hiatal hernia (one in which the stomach bulges through the diaphragm into the chest cavity), or visceral hypersensitivity (excessive signaling from the nerves of internal organs).^[1] Contrary to popular belief, H. pylori isn’t a confirmed cause of GERD, and its treatment has been linked to improvements, worsening, or no effect on GERD symptoms.^[25][3] Current evidence has not been able to point to stomach acidity alone as a cause of GERD, and it’s likely that multiple factors contribute to the condition.^[26][27][28]

Risk factors for GERD include being 50 years or older, smoking, frequently using non-steroidal anti-inflammatory (NSAID) drugs or aspirin, having obesity, living at a low socioeconomic status, and drinking alcohol.^[1][29] Sleep deprivation can worsen GERD symptoms.^[30]