The most common symptom of GERD is a burning sensation in the chest.
What is GERD?
Gastroesophageal reflux disease (GERD) occurs when the lower esophageal sphincter relaxes involuntarily, allowing stomach acid to travel up into the esophagus. (24) The lower esophageal sphincter is the opening between the bottom of the esophagus and the stomach. During normal digestion, food travels down the esophagus, where the lower esophageal sphincter opens, allowing food and saliva to enter the stomach. In people with GERD, this sphincter doesn’t close properly, causing stomach acid and food contents to reenter the esophagus, which can cause pain and inflammation. (24) The most common symptom associated with GERD is heartburn. Heartburn occurs as a result of acid reflux, also called acid indigestion, acid regurgitation, and gastroesophageal reflux (GER). Acid reflux causes a burning sensation in the chest that can radiate toward the mouth, leading to a sour taste in the mouth. (2) Occasional acid reflux is normal in most people and not usually a cause for concern; however, persistent heartburn resulting from acid reflux is a hallmark sign of GERD. (12) Signs and symptoms of GERD include:- Belching and bloating
- Burning sensation in the chest (heartburn)
- Chest pain
- Chronic cough
- Halitosis (bad breath) (15)
- Hoarseness
- Nausea
- Regurgitation of stomach contents
- Swallowing issues or pain (2)(18)
What causes GERD?
Certain factors can influence how the lower esophageal sphincter functions, including:- Cigarette smoking or secondhand smoke exposure
- Certain medications (e.g., benzodiazepines, calcium channel blockers, non-steroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants)
- Hiatal hernia
- Obesity
- Older age (5)
- Pregnancy (18)
Complications of GERD
When left untreated, chronic GERD can lead to undesirable health effects such as dental erosion, respiratory issues, esophageal scarring, and even cancer. If you suspect you may have GERD, consult your integrative health care practitioner for a treatment plan customized to your needs.
Dental erosion
Dental erosion, or the loss of tooth structure, can result from the acid exposure caused by GERD and other factors such as consuming acidic foods and beverages, alcohol abuse, or eating disorders (e.g., bulimia). Studies demonstrate that dental erosion is more prevalent among patients with GERD. Dental erosion can present a host of concerns, such as difficulty chewing, tooth sensitivities, and dental caries (cavities). (24)Barrett’s esophagus
Persistent, long-term acid reflux can increase your risk of developing Barrett’s esophagus, a condition in which the lining of the esophagus becomes inflamed. In Barrett’s esophagus, the tissue of the esophagus lining thickens and becomes red, resembling tissue found in the small intestine. (17) Patients with Barrett’s esophagus have an increased risk of developing a rare form of cancer known as esophageal adenocarcinoma. (5)(17)Did you know? Approximately 1.6 to 3% of the global population has Barrett’s esophagus. (11)Esophageal stricture Long-term damage to the esophagus resulting from poorly controlled GERD can lead to scarring that can narrow the esophagus, a condition known as an esophageal stricture. Symptoms of an esophageal stricture include pain or difficulty swallowing, food impaction, chest pain, and weight loss. (6)
Respiratory conditions
Uncontrolled GERD may cause or worsen certain respiratory conditions. If stomach acid regurgitates into the mouth, it can also enter the lungs, causing recurrent cough, throat clearing, chest congestion, or lung inflammation, potentially leading to bronchitis or pneumonia. GERD may also exacerbate symptoms in patients with asthma. (10)Lifestyle tips for reducing symptoms of GERD
Making specific modifications to your lifestyle and diet can improve symptoms of GERD.Eat smaller meals and avoid eating before bedtime
Consuming smaller meals may help fend off symptoms of GERD. Large meals can contribute to increased gastric distension and may relax the lower esophageal sphincter, leading to heartburn. (20) Furthermore, it’s best to avoid reclining or going to bed shortly after a meal. Additionally, elevating the head of the bed (for example with additional pillows) during sleep may help. Research indicates that consuming a meal less than three hours before bedtime may worsen symptoms of GERD. (9)Identify food triggers
Some individuals with GERD may notice that specific foods trigger or worsen their symptoms. It can be helpful to keep a food and symptom diary to help track your symptoms and identify which foods cause you issues. Common food triggers include:- Acidic foods (e.g., citrus fruits, tomatoes)
- Alcohol
- Caffeine (e.g., coffee, tea, energy drinks)
- Carbonated beverages (e.g., soda, sparkling water)
- Chocolate
- Fried or fatty foods
- Spicy foods (13)(20)(29)
Spicy and fried foods are common triggers of GERD symptoms.
Choose your carbohydrates wisely
Certain carbohydrate sources can either promote or improve symptoms of GERD. Simple carbohydrates (e.g., sugar, sugar-sweetened beverages and desserts, white rice, white bread), for example, are only partially absorbed in the small intestine before they are fermented in the colon. Research demonstrates that this fermentation process can promote lower esophageal sphincter relaxation, leading to heartburn. (20)(23) In contrast, fiber-rich complex carbohydrates (e.g., vegetables, whole grains, beans, legumes) have been shown to offer some symptom relief. Fiber may also exert similar benefits to over-the-counter antacid medications. According to one small study, patients with GERD who consumed a soluble fiber preparation for two weeks experienced identical improvements in their heartburn symptoms to the group given an antacid. (7)Avoid tight-fitting clothing
Did you know that what you wear can worsen symptoms of GERD? Tight, restraining clothing or belts can put unwanted pressure on the stomach, inducing gastric reflux. (16)Manage modifiable risk factors
It’s well understood that certain modifiable factors increase your risk or exacerbate symptoms of GERD. Weight reduction for patients who are overweight or obese can improve symptoms. Reducing your consumption of alcohol and avoiding cigarettes can help as well. (13)
Maintain or reach a healthy weight by eating a balanced diet and staying active.
Avoid post-meal exercise
Exercising shortly after eating can induce gastric reflux. (4) Vigorous exercise may slow gastric emptying, meaning acid and food remain in the stomach for extended periods, increasing risk of gastric reflux. (1) On the other hand, postprandial (post-meal) walking can reduce esophageal acid exposure. (1) It’s best to wait one to three hours after a meal before engaging in any vigorous exercise if you experience recurrent heartburn. (1)(28)Top supplements for heartburn
Research demonstrates that certain supplement ingredients may help relieve heartburn.Licorice (Glycyrrhiza glabra)
Licorice root has numerous health benefits and is known to enhance stomach mucus secretion and exert antiulcer activity. (25) In one randomized, double-blind, placebo-controlled study, participants with dyspepsia (i.e., indigestion) taking licorice extract experienced a significant decrease in total symptom scores compared to those taking a placebo. (25) Licorice may also cause small elevations in blood pressure, so talk to your integrative healthcare practitioner before taking licorice. (21)Probiotics
Probiotics are beneficial live bacteria that confer various health benefits, particularly for lower intestinal health. Emerging research suggests that probiotics may also be beneficial for relieving upper gastrointestinal symptoms. A 2020 systematic review demonstrated that probiotics significantly reduce symptoms of regurgitation and heartburn in patients with GERD. (3)Calcium carbonate
Calcium carbonate is a naturally-occurring compound used for the management of GERD. (8) Calcium carbonate works by acting as a buffer and neutralizer of stomach acid. Inhibiting acid can help reduce damage to the esophagus caused by GERD. Furthermore, calcium carbonate also stimulates peristalsis in the esophagus, helping acid move into the stomach and thus decreasing symptoms related to heartburn. (8) Calcium carbonate is available in various over-the-counter medications (e.g., Tums) and supplement forms, including chewable tablets, capsules, and liquids. (27)Melatonin
Melatonin is a hormone responsible for regulating the sleep-wake cycle and is most commonly regarded for its sleep benefits. However, studies indicate that melatonin may also be beneficial for patients with GERD. Melatonin has been shown to inhibit stomach acid secretion and decrease the production of nitric oxide, a compound that plays a role in transient lower esophageal sphincter relaxation. (22) In one study, administering melatonin before bed significantly reduced the signs and symptoms of GERD, most notably an increase in lower esophageal sphincter tone and a reduction in upper abdominal pain. This study also noted that taking melatonin and omeprazole (a proton pump inhibitor) in combination is more effective for improving the signs and symptoms of GERD compared to omeprazole alone. (14)The bottom line
Whether you experience occasional discomfort related to heartburn or have been diagnosed with GERD, you can manage your symptoms through various means ranging from diet modifications to supplements. If you’re a patient, speak to your integrative health care provider for guidance and recommendations.References
- Avidan, B., Sonnenberg, A., Schnell, T. G., & Sontag, S. J. (2001). Walking and chewing reduce postprandial acid reflux. Alimentary Pharmacology & Therapeutics, 15(2), 151–155.
- Badillo, R., & Francis, D. (2014). Diagnosis and treatment of gastroesophageal reflux disease. World Journal of Gastrointestinal Pharmacology and Therapeutics, 5(3), 105–112.
- Cheng, J., & Ouwehand, A. C. (2020). Gastroesophageal reflux disease and probiotics: A systematic review. Nutrients, 12(1).
- Clark, C. S., Kraus, B. B., Sinclair, J., & Castell, D. O. (1989). Gastroesophageal reflux induced by exercise in healthy volunteers. JAMA: The Journal of the American Medical Association, 261(24), 3599–3601.
- Clarrett, D. M., & Hachem, C. (2018). Gastroesophageal Reflux Disease (GERD). Missouri Medicine, 115(3), 214–218.
- Desai, J. P., & Moustarah, F. (2021). Esophageal stricture. In StatPearls. StatPearls Publishing.
- DiSilvestro, R. A., Verbruggen, M. A., & Offutt, E. J. (2011). Anti-heartburn effects of a fenugreek fiber product. Phytotherapy Research: PTR, 25(1), 88–91.
- Fritz, K., Taylor, K., & Parmar, M. (2021). Calcium carbonate. In StatPearls. StatPearls Publishing.
- Fujiwara, Y., Machida, A., Watanabe, Y., Shiba, M., Tominaga, K., Watanabe, T., Oshitani, N., … & Arakawa, T. (2005). Association between dinner-to-bed time and gastro-esophageal reflux disease. The American Journal of Gastroenterology, 100(12), 2633–2636.
- Gaude, G. S. (2009). Pulmonary manifestations of gastroesophageal reflux disease. Annals of Thoracic Medicine, 4(3), 115–123.
- Gilbert, E. W., Luna, R. A., Harrison, V. L., & Hunter, J. G. (2011). Barrett’s esophagus: A review of the literature. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract, 15(5), 708–718.
- InformedHealth.org. (2018). Heartburn and GERD: Overview. Institute for Quality and Efficiency in Health Care (IQWiG).
- Kahrilas, P. J. (2008). Clinical practice. Gastroesophageal reflux disease. The New England Journal of Medicine, 359(16), 1700–1707.
- Kandil, T. S., Mousa, A. A., El-Gendy, A. A., & Abbas, A. M. (2010). The potential therapeutic effect of melatonin in Gastro-Esophageal Reflux Disease. BMC Gastroenterology, 10, 7.
- Marsicano, J. A., de Moura-Grec, P. G., Bonato, R. C. S., Sales-Peres, M. de C., Sales-Peres, A., & Sales-Peres, S. H. de C. (2013). Gastroesophageal reflux, dental erosion, and halitosis in epidemiological surveys: A systematic review. European Journal of Gastroenterology & Hepatology, 25(2), 135–141.
- Mitchell, D. R., Derakhshan, M. H., Wirz, A. A., Ballantyne, S. A., & McColl, K. E. L. (2017). Abdominal compression by waist belt aggravates gastroesophageal reflux, primarily by impairing esophageal clearance. Gastroenterology, 152(8), 1881–1888.
- National Institutes of Diabetes and Digestive and Kidney Diseases. Definition & facts for Barrett’s esophagus. (2017). https://www.niddk.nih.gov/health-information/digestive-diseases/barretts-esophagus/definition-facts
- National Institutes of Diabetes and Digestive and Kidney Diseases. (2020a). Symptoms & causes of GER & GERD. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes
- National Institutes of Diabetes and Digestive and Kidney Diseases. (2020b). Treatment for GER & GERD. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/treatment
- Newberry, C., & Lynch, K. (2019). The role of diet in the development and management of gastroesophageal reflux disease: Why we feel the burn. Journal of Thoracic Disease, 11(Suppl 12), S1594–S1601.
- Penninkilampi, R., Eslick, E. M., & Eslick, G. D. (2017). The association between consistent licorice ingestion, hypertension and hypokalaemia: A systematic review and meta-analysis. Journal of Human Hypertension, 31(11), 699–707.
- Pereira, R. de S. (2006). Regression of gastroesophageal reflux disease symptoms using dietary supplementation with melatonin, vitamins and aminoacids: Comparison with omeprazole. Journal of Pineal Research, 41(3), 195–200.
- Piche, T., des Varannes, S. B., Sacher-Huvelin, S., Holst, J. J., Cuber, J. C., & Galmiche, J. P. (2003). Colonic fermentation influences lower esophageal sphincter function in gastroesophageal reflux disease. Gastroenterology, 124(4), 894–902.
- Ramachandran, A., Raja Khan, S. I., & Vaitheeswaran, N. (2017). Incidence and pattern of dental erosion in gastroesophageal reflux disease patients. Journal of Pharmacy & Bioallied Sciences, 9(Suppl 1), S138–S141.
- Raveendra, K. R., Jayachandra, Srinivasa, V., Sushma, K. R., Allan, J. J., Goudar, K. S., Shivaprasad, H. N., … & Agarwal, A. (2012). An extract of Glycyrrhiza glabra (GutGard) alleviates symptoms of functional dyspepsia: A randomized, double-blind, placebo-controlled study. Evidence-Based Complementary and Alternative Medicine: eCAM, 2012, 216970.
- Sharp, L., Carsin, A.-E., Cantwell, M. M., Anderson, L. A., Murray, L. J., & FINBAR Study Group. (2013). Intakes of dietary folate and other B vitamins are associated with risks of esophageal adenocarcinoma, Barrett’s esophagus, and reflux esophagitis. The Journal of Nutrition, 143(12), 1966–1973.
- U.S. National Library of Medicine. (2015). Calcium carbonate. MedlinePlus. https://medlineplus.gov/druginfo/meds/a601032.html
- Wu, J., Liu, D., Feng, C., Luo, Y., Nian, Y., Wang, X., & Zhang, J. (2018). The characteristics of postprandial proximal gastric acid pocket in gastroesophageal reflux disease. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 24, 170–176.
- Yeh, A. M., & Golianu, B. (2014). Integrative treatment of reflux and functional dyspepsia in children. Children, 1(2), 119–133.
