Gut Health Series: GERD

GERD (gastroesophageal reflux disease, or chronic acid reflux) is a condition in which acid-containing contents in your stomach persistently leak back up into your esophagus, the tube from your throat to your stomach.

Acid reflux happens because a valve at the end of your esophagus, the lower esophageal sphincter (LES), doesn’t close properly when food arrives at your stomach. Acid backwash then flows back up through your esophagus into your throat and mouth, giving you a sour taste.

Acid reflux happens to nearly everyone at some point in life. Having acid reflux and heartburn now and then is totally normal. But, if you have acid reflux/heartburn more than twice a week over a period of several weeks, constantly take heartburn medications and antacids yet your symptoms keep returning, you may have developed GERD.1

Symptoms of GERD2

The main symptom of GERD is heartburn, often described as a fiery feeling in one’s chest, and regurgitating sour or bitter liquid to the throat or mouth. The combination of heartburn and regurgitation is such a common characteristic of GERD that formal testing may be unnecessary.

Other symptoms of GERD include:

  • Non-burning chest pain, which is usually located in the middle of the chest and radiates to the back is the most common symptom of GERD is heartburn (acid indigestion). It usually feels like a burning chest pain that starts behind your breastbone and moves upward to your neck and throat. Many people say it feels like food is coming back into the mouth, leaving an acid or bitter taste3
  • Difficulty swallowing (dysphagia)
  • Atypical reflux symptoms relating to the throat, larynx or lungs:
    • Sore throat
    • Coughing
    • Increased salivation
    • Shortness of breath

Causes of GERD:4

  • Have a hiatal hernia: This occurs when part of your stomach moves above your diaphragm toward your chest. If your diaphragm is compromised, it may prevent your LES from functioning properly.
  • Frequently eat large meals: This may cause distension of the upper part of your stomach. This distension sometimes means there isn’t enough pressure on the LES, and it doesn’t close properly.
  • Lie down too soon after meals: This might not create enough pressure for the LES to function properly.

Other factors, including those listed below, may also contribute to having heartburn more than twice a week.

Lifestyle factors

Lifestyle factors that may contribute to persistent reflux with esophageal inflammation include:

Health factors

Health factors such as the following may contribute to GERD:

Other conditions

Other health conditions that can worsen the symptoms of GERD include:


Studies suggest that drinking alcohol may increase the risk of GERD. The greater the quantity of alcohol and frequency of consumption, the greater the correlation.

If you’ve received a diagnosis of GERD, limiting or stopping alcohol intake may provide symptom relief.

Dietary triggers

Some foods may trigger GERD symptoms more than others, including:

  • high fat foods such as fried and fast foods
  • spicy foods
  • Chocolate
  • certain fruits and vegetables, such as pineapple, tomato, and citrus
  • certain liquids, such as coffee, tea, and carbonated drinks

What tests do doctors use to diagnose GERD?5

Your doctor may order one or more of the following tests to help diagnose GERD and check for GERD complications or other health problems.

Upper gastrointestinal (GI) endoscopy

Upper GI endoscopy is a procedure in which a doctor uses an endoscope—a flexible tube with a camera—to see the lining of your upper GI tract, including your esophagusstomach, and duodenum. During upper GI endoscopy, a doctor may obtain biopsies by passing an instrument through the endoscope to take small pieces of tissue from the lining of your esophagus. A pathologist will examine the tissue under a microscope. Doctors may order an upper GI endoscopy to check for complications of GERD or problems other than GERD that may be causing your symptoms.

Esophageal pH monitoring

Esophageal pH monitoring is the most accurate way to detect stomach acid in the esophagus. Two types of esophageal pH monitoring are.

  • catheter monitoring, in which a health care professional passes one end of a catheter—a thin, flexible tube—through your nose and into your esophagus to measure acid and non-acid reflux.
  • capsule monitoring, in which a health care professional uses an endoscope to place a small, wireless capsule on the lining of your esophagus to measure acid reflux.

During esophageal pH monitoring, you’ll wear a monitor that receives information from the catheter or capsule and tracks information about your diet, sleep, and symptoms. Your doctor will use this information to see how your diet, sleep, and symptoms relate to acid reflux in your esophagus. Doctors may order this test to confirm the diagnosis of GERD or to find out if GERD treatments are working.

Diet and Lifestyle Changes3

There are several changes that doctors suggest you make in your lifestyle to help lessen your symptoms of GERD.

  • Avoid foods and beverages triggers: Stay away from foods that can relax the LES, including chocolate, peppermint, fatty foods, caffeine, and alcoholic beverages. You should also avoid foods and beverages that can irritate a damaged esophageal lining if they cause symptoms, such as citrus fruits and juices, tomato products, and pepper.
  • Eat smaller servings: Eating smaller portions at mealtime may also help control symptoms. Also, eating meals at least 2 to 3 hours before bedtime lets the acid in your stomach go down and your stomach partially empty.
  • Eat slowly: Take your time at every meal.
  • Chew your food thoroughly: It may help you remember to do this if you set your fork down after you take a bite. Pick it up again only when you’ve completely chewed and swallowed that bite.
  • Stop smoking: Cigarette smoking weakens the LES. Stopping smoking is important to reduce GERD symptoms.
  • Elevate your head: Raising the head of your bed on 6-inch blocks or sleeping on a specially designed wedge lets gravity lessen the reflux of stomach contents into your esophagus. Don’t use pillows to prop yourself up. That only puts more pressure on the stomach.
  • Stay at a healthy weight: Being overweight often worsens symptoms. Many overweight people find relief when they lose weight.
  • Wear loose clothes: Clothes that squeeze your waist put pressure on your belly and the lower part of your esophagus.
  • AcupunctureIn one study, treatment with acupuncture stopped reflux in the test group better than PPIs, with results that lasted longer. We need more large studies to confirm this, but early results are promising.

Read part 3 of our Gut Health Series


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Nada Eltom

Nada Eltom (Hungary), CNP, CFMP worked as a physician (laboratory medicine specialist) in Hungary before immigrating to Canada where she earned her Certified Nutritional Practitioner, and a Certified Functional Medicine Practitioner, designations. She completed her Bachelor of Medicine and Surgery in Semmelweis University, Hungary, her Holistic Nutrition Diploma from the Institute of Holistic Nutrition, Canada and her Functional Medicine Certificate from the Functional Medicine University, USA.