Gastro-oesophageal reflux disease (GERD)

Overview

Gastro-oesophageal reflux disease, called GERD or GORD, happens when the contents of the stomach move back up into the oesophagus (the food pipe that joins the mouth to the stomach). A ring of muscle at the bottom of the food pipe normally closes after food passes. In GERD this ring opens at the wrong time or is weak, so acid rises and irritates the lining of the food pipe.

Almost everyone has a little reflux now and then, for example after a large meal. It becomes a disease when symptoms come often (about twice a week or more), when they trouble daily life, or when the acid has damaged the lining of the food pipe. Doctors describe two main forms: reflux with a normal-looking food pipe on endoscopy, and reflux with visible inflammation (oesophagitis).

GERD is one of the most common problems seen by family doctors and stomach specialists. It affects men and women roughly equally. Extra body weight, pregnancy, smoking and a hiatus hernia (part of the stomach slipping up into the chest) all make it more likely. Most people get good relief from simple lifestyle changes and a course of acid-lowering medicine, though some need treatment for a long time. A smaller number develop complications such as narrowing of the food pipe or Barrett's oesophagus, so persistent or worrying symptoms should always be checked.

Symptoms

• Heartburn: a burning feeling behind the breastbone, often within an hour of eating, and worse when lying down, bending or straining
• Regurgitation: sour or bitter fluid or food coming back up into the throat or mouth
• Chest pain that is not from the heart (the heart must always be checked first)
• A feeling of a lump in the throat or extra watery saliva (water brash)
• Nausea after meals, hiccups or bloating
• Dry cough, wheeze or asthma-like symptoms, especially at night
• Hoarse voice or sore throat in the morning
• Difficulty swallowing, which can mean the food pipe has narrowed
• Symptoms that get worse at night or when lying flat

Causes and risk factors

Causes

• The muscle ring at the lower end of the food pipe relaxes at the wrong time or stays weak, so stomach contents leak upwards
• A hiatus hernia, where the top of the stomach slides up through the diaphragm into the chest and weakens the barrier against reflux
• Raised pressure inside the belly from excess weight, pregnancy or fluid in the abdomen, which pushes stomach contents up
• Slow clearing of acid from the food pipe because of weak muscle movement or less saliva
• Slow emptying of the stomach, so food and acid stay in the stomach longer
• A weakened protective lining of the food pipe, so acid causes more damage

What makes it more likely

• Being overweight or obese
• Pregnancy (about half of pregnant women have reflux)
• Smoking, tobacco use or breathing in other people's smoke
• Alcohol use
• Hiatus hernia
• Age over 50
• Lying down soon after eating, large meals and late-night meals
• Regular painkillers such as aspirin and NSAIDs, and medicines that relax the muscle ring (for example some blood pressure tablets, nitrates, theophylline, anticholinergics and some antidepressants)

Complications

If acid keeps damaging the food pipe, it can become inflamed and ulcerated (reflux oesophagitis) and may bleed, which can lead to iron deficiency anaemia (low blood). Repeated scarring can narrow the food pipe (a stricture), so food feels stuck and swallowing becomes hard. In a small number of people the lining of the lower food pipe changes to a different type of cell, called Barrett's oesophagus; this raises the risk of cancer of the food pipe and needs follow-up endoscopy. Acid reaching the throat and airways can worsen asthma, cause long-term cough or hoarseness, and wear away tooth enamel. Severe oesophagitis heals more slowly and comes back more often, so it needs long-term treatment.

Diagnosis

For most people the doctor makes the diagnosis from the story: burning behind the breastbone and sour fluid coming up, with no warning signs. Examination is usually normal. If the symptoms are typical and there are no red flags, guidelines support starting lifestyle changes and a trial course of a proton pump inhibitor for about eight weeks; clear relief makes GERD very likely. Chest pain must first be checked for a heart cause.

Tests are used when the picture is not clear. An upper endoscopy (a thin flexible camera passed down the throat) is done first if there is trouble swallowing, bleeding, weight loss or anaemia, if medicine does not work, or if symptoms keep returning. It shows inflammation, ulcers, narrowing or Barrett's oesophagus, which are graded by what the doctor sees. If the endoscopy looks normal but reflux is still suspected, a pH or impedance study measures how much acid rises into the food pipe over a day or more, usually with medicine stopped for a while. Manometry (a pressure test of the food pipe) is mainly used before surgery. Barium X-rays and routine Helicobacter pylori tests are not used to diagnose GERD.

Treatment

1. Start with lifestyle changes: lose weight if overweight, stop smoking, eat smaller meals, avoid food within two to three hours of bedtime, cut back on personal trigger foods and drinks, and raise the head of the bed if symptoms are worse at night.
2. Review your medicines with your doctor or pharmacist, because some painkillers and heart or asthma medicines can make reflux worse. Do not stop any medicine on your own.
3. For occasional mild symptoms, an antacid or alginate from the pharmacy gives quick, short-lived relief.
4. For frequent or troublesome symptoms, the doctor usually prescribes a proton pump inhibitor (PPI) for a set course of several weeks, taken before a meal. Your doctor decides the dose and length.
5. If a PPI does not help enough, the doctor may change the PPI, adjust how it is taken, or add an H2 blocker at night. If symptoms are still not controlled, you will be referred for endoscopy and acid tests.
6. Once symptoms settle, the aim is to step down to the lowest amount that keeps you well, use medicine only when needed, or stop altogether. People with severe oesophagitis or Barrett's oesophagus usually need long-term treatment and yearly review.
7. Surgery (laparoscopic fundoplication) or newer endoscopic procedures are options for people with proven reflux who do not want lifelong medicine, cannot tolerate it, or have a large hiatus hernia.

Medicines in Pakistan

Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.

Also used (not yet in our price list): Pantoprazole, lansoprazole and rabeprazole (other proton pump inhibitors), Famotidine (H2 blocker), Sodium alginate preparations (alginate antacids that form a protective layer on top of stomach contents), Vonoprazan (a newer potassium-competitive acid blocker, used when PPIs fail), Sucralfate (only used for reflux during pregnancy)

Self-care and prevention

Self-care

• Keep to a healthy weight; even a small weight loss can reduce symptoms
• Eat smaller meals and finish your evening meal two to three hours before lying down
• Raise the head of your bed on blocks or use a wedge pillow if symptoms wake you at night
• Note which foods and drinks set off your symptoms (common ones are fatty or spicy food, coffee, tea, chocolate, citrus, mint and fizzy drinks) and cut back on them
• Stop smoking and limit alcohol
• Avoid bending over, stooping or heavy lifting straight after meals
• Take your acid medicine as the doctor told you, usually before a meal, and ask before stopping it
• Tell your doctor or pharmacist about all your other medicines, including painkillers bought without a prescription

Prevention

• Stay at a healthy body weight
• Do not smoke
• Avoid large, late meals and do not lie down soon after eating
• Limit alcohol and your own trigger foods
• Use painkillers such as NSAIDs only when needed and as advised

Common questions

Is heartburn the same as GERD?

Heartburn is a symptom: a burning feeling in the chest. Many people get it now and then after a big meal. GERD is the disease that is diagnosed when reflux happens often, about twice a week or more, or when it has damaged the food pipe.

How long do I need to take a PPI?

Most people take a set course of several weeks and then try to step down or stop. If symptoms come back, the doctor usually suggests the lowest amount that keeps you comfortable, or taking it only when needed. People with severe oesophagitis or Barrett's oesophagus usually need long-term treatment and should have a yearly review.

Are PPIs safe to take for a long time?

PPIs are the most effective medicine for GERD and side effects are usually mild. Some studies have linked long-term use to problems such as gut infections, fractures or kidney disease, but higher-quality studies have not confirmed most of these, apart from a small rise in gut infections. Guidelines say the benefits outweigh the risks when there is a real need, and routine blood tests are not required for most people.

Can reflux cause chest pain or cough?

Yes. Acid can cause chest pain that feels like heart pain, and it can irritate the throat and airways causing cough, hoarseness or wheeze. Because heart disease is dangerous, chest pain must be checked by a doctor before it is blamed on reflux. Cough and hoarseness have many other causes too, so the doctor will look for those first.

When will I need an endoscopy?

Not everyone needs one. It is done first if you have trouble swallowing, bleeding, weight loss or anaemia, and also if medicine does not work, symptoms keep coming back, or you have had reflux for many years. It checks for inflammation, narrowing and Barrett's oesophagus.

Sources

1. NICE. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management (CG184) - Recommendations (2019).
2. American College of Gastroenterology. ACG Clinical Guideline: Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease - PMC (2022).
3. American College of Gastroenterology. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease (ACG Virtual Grand Rounds slide deck) (2022).
4. StatPearls (NCBI Bookshelf). Gastroesophageal Reflux Disease (GERD) - StatPearls - NCBI Bookshelf (2025).
5. MedlinePlus. GERD | Gastroesophageal Reflux Disease | MedlinePlus (2025).
6. MedlinePlus. Gastroesophageal reflux disease: MedlinePlus Medical Encyclopedia (2025).

Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.

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