GERD (Gastro-Oesophageal Reflux Disease)
Acid reflux causing heartburn, regurgitation and oesophageal irritation.
Overview
GERD occurs when the lower oesophageal sphincter allows stomach contents to reflux upward. Most people manage with lifestyle and acid-suppressing medication. Persistent symptoms despite treatment, or alarm features, need endoscopic assessment.
Symptoms
- • Burning chest discomfort after meals
- • Acid taste in mouth
- • Regurgitation
- • Cough at night
- • Hoarseness
Risk factors
- • Obesity
- • Pregnancy
- • Hiatus hernia
- • Smoking
- • Late evening meals
- • Alcohol and caffeine
Causes
- • Lower oesophageal sphincter dysfunction
- • Hiatus hernia
- • Delayed gastric emptying
🚨 Red flags — seek urgent care
- • Difficulty or pain swallowing
- • Unintentional weight loss
- • Vomiting blood or black stools
- • New symptoms after 55
When to seek care
- • Symptoms more than twice a week despite over-the-counter treatment
- • Any red flag
Diagnosis
- • Clinical diagnosis from typical symptoms — heartburn, regurgitation, response to acid suppression
- • Upper GI endoscopy if alarm features (dysphagia, weight loss, anaemia, vomiting, age >55 with persistent symptoms)
- • 24-h pH-impedance and high-resolution manometry for refractory or atypical cases
Treatment
- • Lifestyle: weight loss, head-of-bed elevation, avoid late meals, reduce triggers (alcohol, caffeine, fatty/spicy foods, smoking)
- • Step-up: antacids / alginates → H2 blocker → PPI (e.g. omeprazole 20–40 mg daily) for 4–8 weeks
- • Step-down to lowest effective dose after symptom control
- • Anti-reflux surgery (laparoscopic fundoplication) for refractory or PPI-intolerant disease with proven reflux
Prevention
- • Maintain healthy weight
- • Avoid known triggers and large late-evening meals
- • Stop smoking and limit alcohol
- • Avoid lying down within 3 hours of eating
Complications
- • Reflux oesophagitis
- • Peptic stricture
- • Barrett's oesophagus (precursor to oesophageal adenocarcinoma)
- • Asthma, chronic cough, laryngitis, dental erosion
Education & self-care
This guidance is reviewed by Dr. Handel Emery, MD, FRCP (UK) and last updated 2026-06-08. It is educational and not a substitute for professional medical advice.
Frequently asked questions
Are PPIs safe long-term?
PPIs are generally safe but should be used at the lowest effective dose. Long-term use has small associations with B12 deficiency and fracture risk.
How long should I take a PPI?
Use the lowest effective dose for the shortest necessary time. For uncomplicated reflux, an 8-week course is typical; longer treatment is appropriate for Barrett's oesophagus, severe oesophagitis or symptom relapse.
Will surgery cure GERD?
Fundoplication and newer endoscopic procedures can be effective for selected patients with proven reflux who respond to PPIs but want to come off them. Careful patient selection is critical.
Which foods make reflux worse?
Common triggers include fatty meals, chocolate, peppermint, citrus, tomato, coffee, alcohol and large late-evening meals. Personal triggers vary — keeping a food diary helps identify them.