Acid Reflux (GERD): Symptoms, Causes & Treatment

Updated in March 2024

Gastroesophageal reflux (also known as GERD or acid reflux), happens when there is recurrent acid build-up in the stomach that rises to the esophagus. This causes heartburn, which is associated with a burning sensation in the throat and chest region. Other symptoms of GERD can include constant burping, indigestion or a dry cough.

The severity of the inflammation experienced depends on the acidity of the gastric content as well as how much comes into contact with the lining of the esophagus. The stomach contains a mucus lining that protects its tissue from being burned by acid, however the esophagus does not contain this protective lining. Therefore, the esophagus becomes damaged when it comes into contact with acid, causing the characteristic symptoms of GERD.

GERD symptoms are very uncomfortable, and therefore you should see a gastroenterologist for treatment as soon as possible. The doctor will be able to assess you and indicate the most suitable treatment.

Imagem ilustrativa número 3

Main symptoms

GERD symptoms can emerge in a matter of minutes or a few hours after eating, and they mainly include:

  • A burning sensation felt in the throat and/or the chest;
  • Bloating;
  • Frequent burping;
  • Indigestion;
  • Dry cough after eating;
  • Difficulty swallowing food;
  • Recurrent asthma crisis or infections of the upper airways.

These symptoms tend to get worse when the person bends down to get something from the floor or when the person remains in a horizontal position after a meal (e.g. at night, when lying down in bed).

Constant reflux can cause intense inflammation in the esophageal lining, also called esophagitis. If this condition is left untreated, it can increase the risk of cancer.  

Symptoms in babies 

Some symptoms that can suggest this condition in babies include frequent vomiting, restless sleep, difficulty with breastfeeding and gaining weight, and hoarseness due to the inflammation of the larynx.  

In addition, babies can also develop repetitive ear infections due to frequent inflammation of the airways. They are also at risk for aspiration pneumonia, due to the entry of food into the lungs.  

Symptoms during pregnancy

The symptoms of reflux during pregnancy are the same as those seen in women who are not pregnant. They are more frequently noted after the end of the first trimester. Symptoms are usually related to hormonal changes that are common during pregnancy, as well the baby's growth in the uterus.

Also recommended: Heartburn During Pregnancy: Causes & How to Treat

Common causes

The main causes of acid reflux are:

  • Anatomical changes or changes in the functioning of the sphincter found between the esophagus and the stomach. The function of this sphincter is to allow food to enter the stomach and prevent its back-up;
  • Use of some medications, such as some antihistamines, antidepressants and calcium channel blockers;
  • Hiatal hernia;
  • Weakness of the muscles in the area.

There are some factors that can also increase the risk for reflux, such as obesity, a high fat diet, large meals (especially before bed), excessive alcohol intake, caffeinated or carbonated drinks and smoking.

Confirming a diagnosis

Diagnosis for gastroesophageal reflux (GERD) must be confirmed by a family doctor, gastroenterologist or pediatrician, or a G.P. It is normally concluded by assessment of symptoms.

Some testing may be necessary to confirm diagnosis and to assess the severity of the reflux (e.g. endoscopy, an esophageal motility study or a 24 hour pH impedence study).

Treatment options

Treatment for GERD usually starts with changes to lifestyle and diet. In many cases, these adjustments can sufficiently relieve symptoms without further medical interventions.

However, if symptoms do not improve with a conservative approach, your gastroenterologist may recommend medications. Medications can be used long-term, or just to treat flare-ups. In more complicated cases of GERD, if medications are not effective, the doctor may advise surgery to try to resolve the cause of the reflux.

The main forms of treatment used in cases of reflux include:

1. Lifestyle changes

People who lead a less healthy lifestyle are at a greater risk for developing various health problems, including excessive production of gastric acid. Excess acid can eventually cause reflux symptoms.

If you suffer from reflux, or if you wish to prevent it from occurring, you should consider the following lifestyle tips:

  • Maintain a healthy weight. Being overweight causes greater pressure in the abdominal region, increasing the chances of gastric acid rising up to the esophagus.
  • Avoid smoking, as cigarettes can affect the esophageal sphincter's ability to close and block out stomach acid
  • Avoid lying down for up to 2 hours after meals, as this is when your stomach will contain the highest quantity of acid
  • Avoid tight-fitting clothing, especially high-waisted shirts and pants, as they can put pressure on the stomach area and worsen reflux.

In addition, when going to bed, you can try to keep the head of the bed higher than your feet. To do this, you can place a high pillow under your mattress or place wooden wedges beneath the legs of the headboard. Ideally, you should sleep at an incline of 15 to 20cm (about 6 to 8 in)

2. Diet changes

In addition to the lifestyle changes outlined above, you can also consider diet changes. These are simple and natural ways you can alleviate reflux symptoms.

You should try to eat smaller meals with more frequency (e.g. every three hours).  This helps the stomach from getting too full and makes it easier to empty it, preventing reflux.

In addition, you should increase your intake of fruits and vegetables and avoid less healthy foods, like processed foods, red meat, or fried foods. These changes help to reduce gastric acid production and may relieve your symptoms. Another important tip is to drink sodas, coffee and alcohol in moderation, as these can bring about  reflux symptoms.

Read more about the GERD diet that your doctor may recommend.

3. Use of medications

Most of the time, the doctor will only prescribed reflux-related medications for "as-needed" use. That is, you can be prescribed medications to be used only when you experience reflux flare-ups situations, like after eating in excess.

However, these medication can also be used for longer periods of time, especially by people who have very intense and frequent symptoms. Some of the most common medications prescribed include:

  • Antacids, such as magnesium hydroxide or aluminum hydroxide. These neutralize stomach acidity and prevent the burning sensation in the esophagus
  • Proton-pump inhibitors, such as omeprazole, esomeprazole or pantoprazole. These inhibit the production of acid in the stomach, reducing the burning caused by reflux;
  • Prokinetic agents, such as metoclopramide and domperidone. These accelerate gastric motility and emptying, which decreases the time that food remains in the stomach
  • Stomach protectors, such as sucralfate. These form a protective barrier in the lining of the stomach and esophagus, reducing burning caused by stomach acid.

Symptoms and causes of reflux vary a lot from one person to another, and there medications should always be supervised by a doctor, who will evaluate your clinical history and indicate dosing and duration of drug treatment.

Learn more about the GERD medications that your doctor may consider prescribing.

4. Use of home remedies

In milder cases of reflux, home remedies can be an excellent way to relieve symptoms naturally. Some of the most suitable remedies include ginger tea, chamomile tea, and aloe vera juice, for example. Any of these can be used when the first heartburn symptoms appear. 

Also recommended: 13 Proven Home Remedies for Heartburn

Although they may be natural, home remedies should not substitute medication prescribed by the doctor. They should only be used as a complement to the treatment indicated. Learn more about ways you can treat acid reflux naturally at home.

5. Surgery

Surgery for GERD is usually only used as a last resort in more complicated cases where symptoms have not improved with lifestyle changes, dietary adjustments or medications.

In these cases, the surgeon performs a procedure to reinforce and  strengthen the esophageal sphincter, in order to prevent the rise gastric acid from rising into the esophagus. This surgery can be done with an incision to the abdomen, but it can also be done laparoscopically, in which small holes are made in the skin. The type of surgery most appropriate for you will be advised by your surgeon.