Acid Reflux and GERD: Symptoms, Causes, and Treatment

Acid reflux, also known as gastroesophageal reflux, occurs when stomach acid flows backward into the esophagus, the tube connecting your mouth to your stomach. This backflow happens when the lower esophageal sphincter (LES)—a ring of muscle at the bottom of the esophagus—weakens or relaxes inappropriately. Occasional acid reflux is common and affects most people at some point, particularly after large meals or when lying down soon after eating.

When acid reflux occurs frequently (more than twice a week) or causes complications, it's called gastroesophageal reflux disease (GERD). GERD affects approximately 20% of Americans, making it one of the most common digestive disorders in the United States. The condition can range from mild discomfort to severe symptoms that significantly impact quality of life and, if left untreated, can lead to serious complications including esophageal damage, strictures, and even esophageal cancer.

The most common symptom of acid reflux is heartburn—a burning sensation in the chest that often occurs after eating and may worsen when lying down or bending over. However, GERD can cause many other symptoms, including regurgitation of food or sour liquid, difficulty swallowing, chronic cough, and throat irritation. Understanding the causes, triggers, and treatment options for acid reflux and GERD can help you manage symptoms effectively and prevent complications.

Common Causes

Hiatal Hernia

A hiatal hernia occurs when the upper part of your stomach pushes through the diaphragm into your chest cavity. This anatomical abnormality weakens the lower esophageal sphincter and makes it easier for stomach acid to flow back into the esophagus. Hiatal hernias are more common in people over 50 and those who are overweight or obese.

Signs a hiatal hernia might be present:

• Symptoms worsen when lying down or bending over
• You experience frequent belching or difficulty swallowing
• You're over age 50 or have a history of obesity
• Imaging tests or endoscopy reveal a hernia

Obesity and Excess Weight

Being overweight or obese significantly increases your risk of GERD. Excess weight, particularly around the abdomen, puts pressure on your stomach, forcing stomach contents and acid up into the esophagus. Studies show that even modest weight gain can trigger GERD symptoms, while weight loss often provides significant relief.

Signs weight might be contributing:

• Your BMI is over 25 (overweight) or 30 (obese)
• You carry excess weight around your midsection
• Symptoms developed or worsened after weight gain
• You notice improvement in symptoms when you lose weight

Dietary Triggers

Certain foods and beverages can trigger or worsen acid reflux by relaxing the lower esophageal sphincter, increasing stomach acid production, or irritating the esophageal lining. Common triggers include fatty or fried foods, chocolate, caffeine, alcohol, carbonated beverages, citrus fruits, tomatoes, spicy foods, garlic, and onions.

Signs diet might be a major factor:

• Symptoms consistently occur after eating certain foods
• You notice patterns between meals and heartburn
• Symptoms improve when you avoid trigger foods
• Large meals consistently cause discomfort

Pregnancy

Pregnancy commonly causes acid reflux, especially in the second and third trimesters. Hormonal changes relax the lower esophageal sphincter, and the growing uterus puts pressure on the stomach, forcing acid upward. Up to 80% of pregnant women experience heartburn at some point during pregnancy.

Signs pregnancy is the cause:

• You're pregnant, particularly in the second or third trimester
• Symptoms started or worsened during pregnancy
• You didn't have reflux issues before pregnancy
• Symptoms are worse when lying down

Smoking

Tobacco use weakens the lower esophageal sphincter, reduces saliva production (which helps neutralize acid), impairs muscle reflexes in the throat, and increases stomach acid production. Smoking also slows digestion, keeping food in the stomach longer and increasing reflux risk.

Signs smoking is contributing:

• You're a current smoker or recently quit
• Symptoms worsen after smoking
• You have other smoking-related health issues
• You notice improvement when you reduce or quit smoking

Medications

Certain medications can trigger or worsen acid reflux by relaxing the lower esophageal sphincter or irritating the esophageal lining. Common culprits include aspirin and other NSAIDs (ibuprofen, naproxen), certain blood pressure medications (calcium channel blockers), some asthma medications, sedatives, and antidepressants.

Signs medications might be contributing:

• Symptoms started after beginning a new medication
• You take NSAIDs regularly for pain or inflammation
• You're on multiple medications that can affect the LES
• Symptoms improve when you stop the medication (consult your doctor first)

Delayed Stomach Emptying

Gastroparesis, or delayed stomach emptying, can contribute to GERD by keeping food and acid in the stomach longer than normal. This condition is more common in people with diabetes, after certain surgeries, or with certain neurological conditions. The prolonged presence of food in the stomach increases pressure and reflux risk.

Signs delayed emptying might be involved:

• You feel full quickly when eating or have prolonged fullness after meals
• You experience nausea, vomiting, or bloating
• You have diabetes or a neurological condition
• Symptoms are worse after eating, even small meals

When to See a Doctor

While occasional heartburn is normal, you should consult a healthcare provider if:

• Heartburn occurs more than twice a week or interferes with daily activities
• Symptoms persist despite over-the-counter antacids or lifestyle changes
• You have difficulty swallowing or pain when swallowing
• You experience persistent nausea or vomiting
• You have unexplained weight loss
• You vomit blood or have black, tarry stools (signs of bleeding)
• You have chest pain, especially if it's severe or accompanied by jaw or arm pain (could indicate a heart problem)
• You have a chronic cough, hoarseness, or asthma that may be related to reflux
• You've been using over-the-counter antacids for more than two weeks
• You have a family history of esophageal cancer or Barrett's esophagus
• You're over age 50 and have new or worsening symptoms

Seek immediate medical attention if you experience severe chest pain, especially if accompanied by shortness of breath, jaw pain, or arm pain, as these could indicate a heart attack rather than reflux.

Self-Care and Relief Strategies

Modify Your Diet

Identify and avoid your personal trigger foods. Common triggers include fatty foods, chocolate, caffeine, alcohol, citrus, tomatoes, and spicy foods. Eat smaller, more frequent meals rather than large meals. Avoid eating within 2-3 hours of bedtime. Chew food thoroughly and eat slowly to aid digestion.

Lose Excess Weight

If you're overweight, losing even 5-10% of your body weight can significantly reduce GERD symptoms. Focus on gradual, sustainable weight loss through a balanced diet and regular physical activity. Avoid crash diets or extreme calorie restriction, which can worsen symptoms.

Elevate the Head of Your Bed

Raise the head of your bed 6-8 inches using blocks or a wedge pillow. This uses gravity to help keep stomach acid from flowing into your esophagus while you sleep. Don't just use extra pillows, as this can bend your body in ways that increase abdominal pressure.

Avoid Tight Clothing

Wear loose-fitting clothes, especially around your waist and abdomen. Tight belts, waistbands, and shapewear can put pressure on your stomach and worsen reflux symptoms.

Quit Smoking

If you smoke, quitting is one of the most effective ways to reduce GERD symptoms. Smoking weakens the lower esophageal sphincter and increases acid production. Seek support through smoking cessation programs, nicotine replacement therapy, or medications if needed.

Manage Stress

Stress doesn't directly cause GERD, but it can worsen symptoms and make you more aware of discomfort. Practice stress-reduction techniques like deep breathing, meditation, yoga, or regular exercise. Adequate sleep is also important for managing stress and overall health.

Use Over-the-Counter Medications Wisely

Antacids (Tums, Rolaids) provide quick but temporary relief by neutralizing stomach acid. H2 blockers (famotidine, ranitidine) reduce acid production and provide longer relief. Proton pump inhibitors (omeprazole, esomeprazole) are the most effective for reducing acid production but should be used as directed and not long-term without medical supervision.

Frequently Asked Questions

Prevention Tips

Preventing acid reflux and GERD involves lifestyle modifications and avoiding known triggers. Maintain a healthy weight through balanced diet and regular exercise, as excess weight is one of the strongest risk factors for GERD. Eat smaller, more frequent meals rather than large meals that overfill your stomach. Avoid eating within 2-3 hours of bedtime to allow your stomach to empty before lying down. Identify and avoid your personal trigger foods, which commonly include fatty foods, chocolate, caffeine, alcohol, citrus, tomatoes, and spicy foods. Elevate the head of your bed 6-8 inches if you experience nighttime symptoms. Quit smoking, as tobacco weakens the lower esophageal sphincter and increases acid production. Limit alcohol consumption, which can relax the LES and increase stomach acid. Avoid tight-fitting clothing around your waist and abdomen. Manage stress through relaxation techniques, as stress can worsen symptoms. Be cautious with medications that can trigger reflux—talk to your doctor about alternatives if you need to take NSAIDs or other problematic medications regularly. Stay upright for at least 2-3 hours after eating, and avoid lying down or bending over immediately after meals. Chew gum after meals to increase saliva production, which helps neutralize acid. Stay hydrated with water throughout the day, but avoid drinking large amounts with meals. By implementing these preventive strategies, you can significantly reduce your risk of developing GERD or minimize symptoms if you already have the condition.

The Bottom Line

Acid reflux and GERD are common digestive conditions that occur when stomach acid flows backward into the esophagus, causing heartburn and other symptoms. While occasional reflux is normal, frequent symptoms (more than twice a week) indicate GERD, which requires medical attention to prevent complications. Common causes include hiatal hernia, obesity, dietary triggers, pregnancy, smoking, and certain medications. The condition can significantly impact quality of life and, if left untreated, may lead to serious complications including esophageal damage and Barrett's esophagus. Fortunately, GERD is highly treatable through lifestyle modifications like weight loss, dietary changes, elevating the head of the bed, and avoiding triggers. Over-the-counter medications provide relief for mild symptoms, while prescription medications may be necessary for more severe cases. If you experience frequent heartburn, difficulty swallowing, or other concerning symptoms, consult a healthcare provider for proper diagnosis and treatment. With appropriate management, most people with GERD can achieve significant symptom relief and prevent long-term complications.