Almost everyone has had heartburn after a big dinner. When it happens often, wakes you at night, or needs a pill most days, it may be gastroesophageal reflux disease, or GERD. Most of the time GERD is very manageable. A few symptoms, though, should never be written off as indigestion.

Reflux versus GERD

Reflux happens when stomach contents come back up into the esophagus, the tube that carries food to the stomach. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) explains that many people have reflux once in a while, and that GERD is a more severe, long-lasting form that causes repeated symptoms or leads to complications. It can develop when the muscle at the bottom of the esophagus weakens or relaxes when it should not.

The classic symptoms are heartburn, a burning feeling behind the breastbone rising toward the throat, and regurgitation, a sour taste of food or acid in the mouth. The NIDDK also lists chest pain, nausea, trouble or pain swallowing, and a chronic cough or hoarseness. Being overweight, pregnancy, smoking and a hiatal hernia raise the risk, and so can some medicines, including NSAIDs, certain blood pressure pills (calcium channel blockers), some asthma medicines, sedatives and tricyclic antidepressants.

Chest pain: rule out the heart first

Heartburn and a heart attack can feel alike. The American College of Gastroenterology’s 2022 guideline on GERD advises that people with chest pain have an adequate evaluation to exclude heart disease before it is attributed to reflux. Call 911 for chest pain or pressure, especially with shortness of breath, sweating, lightheadedness, or pain in the jaw, neck, back, arms or shoulders. The CDC notes that women are more likely to have less obvious symptoms, such as unusual tiredness, nausea or vomiting.

What helps

The NIDDK and the ACG guideline both start with daily habits:

  • Avoid eating within 2 to 3 hours of bedtime.
  • For nighttime symptoms, raise your head 6 to 8 inches with a foam wedge or extra pillows under your head and upper back.
  • Lose weight if you are overweight.
  • Stop smoking.
  • Notice and limit the foods and drinks that set off your symptoms.

For medicines, the NIDDK describes three main options. Antacids relieve mild, occasional heartburn but are not meant for daily use without talking to a doctor. H2 blockers such as famotidine lower acid production. Proton pump inhibitors (PPIs), such as omeprazole, are the strongest and can heal an inflamed esophagus in most people.

The ACG guideline recommends that people with classic heartburn and no warning signs try a PPI once daily for 8 weeks, taken 30 to 60 minutes before a meal rather than at bedtime. If symptoms resolve, the guideline recommends trying to stop the PPI. People who need long-term treatment should use the lowest dose that controls symptoms. When medicines and habit changes are not enough, or someone wants to stop long-term medicine, the NIDDK notes that surgery is an option; the most common operation, fundoplication, usually brings long-term relief. Any long-term acid medicine belongs on your medication list for review; see our article on medication reviews.

Warning signs that need a doctor

See a doctor if heartburn does not improve with over-the-counter medicines and habit changes, or if you need them for more than a couple of weeks. The NIDDK lists these as reasons to be seen promptly:

  • Trouble swallowing or pain when swallowing
  • Persistent vomiting or loss of appetite
  • Vomit with blood or that looks like coffee grounds
  • Black, tarry or bloody stools
  • Weight loss you cannot explain

The ACG recommends an upper endoscopy, a camera exam of the esophagus and stomach, as the first test for trouble swallowing, weight loss or bleeding, and for people with several risk factors for Barrett’s esophagus, a change in the esophageal lining caused by long-standing reflux. Vomiting large amounts of blood or feeling faint is a 911 call.

Heartburn that keeps coming back is the kind of problem that gets better with a doctor who knows your medicines and history. Legacy Medical offers same or next business day visits, and Dr. Shtern can arrange specialist care when an endoscopy is needed. If you take NSAIDs regularly, our article on NSAID risks is worth a read. To meet Dr. Shtern first, the first visit is a complimentary meet and greet.

This article is general information, not advice for your situation. Members can call the office with questions about their own care.