Acid reflux (GERD): symptoms, complications, and modern management

Gastroesophageal reflux disease (GERD) is a chronic condition where stomach contents irritate the esophagus, producing heartburn, regurgitation, and other symptoms. Diagnosis may include endoscopy and pH monitoring. Treatment begins with lifestyle changes and over-the-counter remedies, progresses to acid-suppressing medications when needed, and for refractory cases may include surgical or device-based interventions. Consult a clinician for persistent or severe symptoms to reduce risk of complications such as strictures or Barrett's esophagus.

What is acid reflux (GERD)?

Acid reflux happens when stomach contents flow back into the esophagus. When this material contains stomach acid, pepsin, or bile it can irritate and inflame the esophageal lining. When symptoms are frequent or cause damage, clinicians call the condition gastroesophageal reflux disease (GERD). GERD is often chronic and typically requires ongoing management.

Common symptoms

• Heartburn: a burning or pressure-like discomfort behind the breastbone. It often follows meals and can worsen when lying down or bending.

• Regurgitation: a sour or acidic fluid that reaches the throat or mouth, sometimes leaving an unpleasant taste.

• Chest pain: can mimic cardiac pain; any new or severe chest pain should be evaluated promptly.

• Less obvious symptoms: chronic cough, hoarseness, sore throat, or dental enamel erosion can be caused by long-standing reflux.

Possible complications if untreated

• Esophagitis: inflammation and ulceration of the esophagus can cause pain and bleeding.

• Strictures: repeated injury and healing can scar and narrow the esophagus, making swallowing difficult.

• Barrett's esophagus: a change in esophageal cells after long-standing reflux that increases the risk of esophageal adenocarcinoma. Because of this risk, doctors may recommend surveillance endoscopy for some patients.

Diagnosis today

Doctors diagnose GERD from symptoms, but they also use tests when the diagnosis is uncertain or complications are suspected. Common tests include upper endoscopy (esophagogastroduodenoscopy), ambulatory pH monitoring, and esophageal manometry. These tests help assess inflammation, measure acid exposure, and evaluate esophageal function.

Treatment options

Start with lifestyle measures: avoid late or large meals, reduce weight if overweight, stop smoking, and elevate the head of the bed at night. Over-the-counter antacids can relieve occasional symptoms.

For frequent or damaging reflux, medications are the mainstay. H2 receptor blockers and proton pump inhibitors (PPIs) reduce acid production and allow healing. Long-term PPI use should be reviewed with your clinician to balance benefits and possible risks.

When medication and lifestyle changes are insufficient, procedural options exist. Laparoscopic fundoplication remains a standard surgical repair. Newer approaches, including magnetic sphincter augmentation (LINX) and less-invasive endoscopic procedures, are options for selected patients and should be discussed with an experienced specialist.

When to see a doctor

See a healthcare provider for frequent heartburn, difficulty swallowing, unexplained weight loss, persistent vomiting, or any new chest pain. Early evaluation reduces the chance of long-term complications.