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What is GERD and How Do You Know If You Have It?

How To Know When It’s GERD and When It Isn’t

Key Takeaways:

  • GERD is a chronic acid reflux that inflames your esophagus
  • Common GERD symptoms include heartburn, food regurgitation, belching, upper belly or chest pain, nausea, and difficult or painful swallowing
  • Unmanaged GERD may lead to complications like erosive esophagitis, esophageal cancer, stomach ulcers, and esophageal strictures
  • You can have occasional heartburn or acid reflux without having GERD
  • There are many gastrointestinal conditions, like eosinophilic esophagitis, functional dyspepsia, and gastroparesis that can mimic GERD
  • If you regularly have heartburn, acid reflux, regurgitation, chest pain, chronic coughing, or trouble swallowing, it’s important to speak with your doctor so the cause can be pinpointed and you can be treated quickly

We’ve all probably felt a burning sensation in our chest after eating a meal at some point. While it can be very uncomfortable, it’s not necessarily something to be overly concerned about [1]. But what if you’re experiencing heartburn and other gastrointestinal symptoms like nausea and abdominal pain pretty frequently? If this is the case, your body could be giving you some warning signs of a larger issue, like GERD, that needs to be addressed. 

GERD, which is just a short way of saying gastroesophageal reflux disease, is pretty common and impacts about 20% of adults in the Western world [2]. But there are a lot of other GI conditions that masquerade as GERD, so how do you know if that’s what it is or not? 

In this article, I’ll answer the question: what is GERD? I’ll also share some simple ways to help you distinguish between heartburn, GERD, and other GI conditions so you can get the right treatment. Let me start off with what GERD is and why it’s so important to identify and treat it right away. 

What is GERD?

Before we get into the specifics, let me share a brief lesson on your digestive system and digestion to help you better understand why it’s so important to identify and address GERD. 

I explain this in more detail in my book, Healthy Gut, Healthy You, but here’s the gist. When you chew and swallow food, it has to travel through your esophagus in order to reach your stomach.  Once the food passes through your lower esophageal sphincter (an area of high pressure that protects you from food refluxing backward), it enters your stomach. This kicks off hydrochloric acid (HCl) production to help begin the main digestive process. 

HCl has several important functions, including helping you digest proteins, absorb minerals, and control unwanted microbes like parasites, bacteria, and fungi. But HCl isn’t supposed to travel backward through your digestive system. This is what’s happening in GERD—the acidic contents of your stomach are chronically refluxing back into your esophagus, leading to inflammation and damaging the delicate tissues there. Think of it this way—if you’re driving on a one-way street and you suddenly start going in reverse, you could run into some serious consequences.

While occasional acid reflux isn’t much cause for concern, chronic, unmanaged GERD, can lead to complications like [2]:

  • Erosive esophagitis (inflammation that damages the tissue lining the esophagus)
  • Barrett’s esophagus, a condition where the cells in the lining of your esophagus change shape to resemble the cells lining the intestine that can eventually lead to cancer [3]
  • Esophageal stricture (scar tissue in the lining of the esophagus that causes it to narrow)
  • Esophageal cancer
  • Peptic ulcers (stomach ulcers)

GERD comes in three different forms [2]:

  1.  Non-Erosive Reflux Disease (NERD) affects 60–70% of GERD patients, more likely women
  1. Erosive Esophagitis (EE) affects 30% of GERD patients, more likely men
  2. Barrett’s Esophagus (BE) affects 6–12% of GERD patients, more likely men

NERD is less severe than both EE and BE, but it’s important to identify and get treatment quickly for any type of GERD. But how do you know if you have it? Let’s take a look at the symptoms.

Symptoms of GERD

Even if you haven’t experienced acid reflux personally, you can probably imagine how uncomfortable it would be to have the powerful acidic contents of your stomach move back up into your esophagus.  

Here are some common symptoms of GERD [2]:

  • Heartburn—a burning sensation in your chest and throat that usually occurs after eating or when reclining, lying down, or bending over
  • Regurgitation—when stomach acid (with or without food contents) backs up into your esophagus and finds its way to the bottom of your throat, just above your windpipe, or into your mouth
  • Difficult or painful swallowing
  • Belching
  • Upper belly or chest pain
  • Nausea
  • Coughing, wheezing, or shortness of breath from acid getting into your airways through your windpipe

As you can see, none of these sound very pleasant, and symptoms can be made worse by lying down, bending over, or eating a large or fatty meal [1]. I want to point out here that you may experience some of these symptoms every now and then, but it doesn’t necessarily mean you have GERD

Unfortunately, there’s really no gold standard for diagnosing GERD. In general, GERD may be suspected when your reflux symptoms become chronic, meaning you have them at least twice a week for several weeks [1]. If this is the case, your provider may analyze your symptoms and assess how you respond to anti-reflux therapies like medications, diet-related changes, and lifestyle measures [2].

Now that you have an idea of what GERD is and what kind of symptoms it causes, let’s take a look at those who are most at risk.

GERD Risk Factors

Anyone can develop GERD, but it seems to impact men slightly more often and more severely than women [4]. Additionally, if you have any of the following conditions, you may also be at higher risk of developing GERD [2]:

  • Esophageal dysmotility (dysfunction of the muscles in the esophagus that move food toward the stomach) prevents the esophagus from clearing acid that may find its way there 
  • Weakened muscle tone of the lower esophageal sphincter (LES) makes it difficult to keep food and acid from moving back up into the esophagus  
  • Periodic relaxation of the LES allows acidic contents to move back up into the esophagus from the stomach 
  • Problems with stomach muscles and nerves that delay or compromise the stomach’s ability to empty its contents into the intestine. When food sits in the stomach for too long, there’s a higher chance it will move backward, especially as you bend over or lie down 
  • Weakened ability of the esophagus to defend itself against reflux. Prolonged or frequent exposure to stomach acid deteriorates the protective mucus barrier that lines the esophagus making it more susceptible to long-term damage.
  • Having a hiatal hernia (when part of the stomach is pushed up through the hole in the diaphragm to sit next to the esophagus) puts pressure on your stomach and can force its contents back into the esophagus
  • Excess abdominal fat/obesity puts pressure on your abdominal organs forcing stomach contents backward

In addition to physical conditions, other GERD risk factors include [2]:

  • Being over the age of 50
  • Having lower income and fewer resources
  • Smoking 
  • Drinking too much alcohol
  • Having connective tissue disorders, like scleroderma
  • Pregnancy (may cause temporary reflux that goes away after childbirth)
  • Lying down right after eating
  • Taking certain medications like benzodiazepines, NSAIDs or aspirin, nitroglycerin, albuterol, calcium channel blockers, certain antidepressants, or glucagon

I hinted earlier that many GI conditions could masquerade as GERD, so now I want to share what those conditions are and how you can distinguish them from each other. 

GERD Mimickers

There are several gut-related conditions that cause GERD-like symptoms which can sometimes make it tough to determine what you’ve got going on. The first and probably most commonly known is heartburn. 

Heartburn, aka acid reflux, is the hot, painful sensation you feel when stomach acid goes up into the part of your esophagus that’s close to your heart or throat [5]. If stomach acid only reaches the lower esophagus, you might have less of a heartburn sensation and instead feel indigestion. The good news here is that heartburn itself doesn’t always indicate a larger issue like GERD [1]. Examples of when you may experience occasional heartburn include:

  • Eating a large meal with spicy and fatty foods along with drinking alcohol
  • Eating too much before exercising
  • Eating a large meal before going to bed
  • Eating and then bending over to pick up something heavy

These situations are temporary and don’t suggest that you’ve got a major problem. However, people with coronary artery disease (CAD) can sometimes mistake the chest pain from CAD for GERD. If you have what seems like heartburn, plus crushing chest pain, you could be having a heart attack and need to get help right away [1]. 

In addition to heartburn, there are a whole host of other conditions that can look like GERD. To make this easier, I’ve created a table showcasing each of these conditions along with the symptoms they share with GERD and the symptoms that aren’t typical of GERD to give you a side-by-side comparison [2]:

Condition Description GERD-Like Symptoms Non-GERD Symptoms
Achalasia A rare swallowing disorder that causes the lower esophageal sphincter to tighten, preventing food and liquids from entering the stomach
  • Chest pain
  • Heartburn
  • Coughing (mostly at night)
  • Regurgitation
  • Weight loss
  • Malnutrition
  • Hiccups
  • Difficulty belching
Eosinophilic Esophagitis Inflammation of the esophagus that involves immune cells called eosinophils reacting to food or environmental allergens
  • Chest pain
  • Heartburn
  • Upper belly pain
  • Trouble swallowing
  • Vomiting
  • Food getting stuck in the throat
Functional Dyspepsia Indigestion
  • Upper belly pain
  • Abdominal burning
  • Nausea
  • Bloating
  • Feeling overly full even when eating a small amount
  • Vomiting
Rumination Syndrome Repeated regurgitation of undigested or partly digested food from the stomach
  • Regurgitation
  • Unexplained weight loss
  • Feeling unreasonably full
  • Effortless regurgitation within a few minutes of eating that relieves abdominal pain or pressure
Esophageal Diverticulum An outpouching pocket on the inside of the esophagus that may or may not cause symptoms
  • Frequent cough
  • Difficulty swallowing
  • Regurgitation
  • Wheezing
  • Bad breath
  • Lump in the throat
Gastroparesis A nerve and muscle disorder that paralyzes the stomach, slowing and weakening stomach contractions
  • Acid reflux
  • Heartburn
  • Regurgitation
  • Upper abdominal pain
  • Nausea
Esophageal Cancer Cancer of the esophagus 
  • Heartburn
  • Chronic cough 
  • Pain in the throat or upper back
  • Vomiting or coughing up blood
  • Unintentional weight loss
Stomach Cancer Cancer of the stomach
  • Difficulty swallowing
  • Heartburn
  • Nausea
  • Bloating
  • Unreasonable fullness after eating a small amount
  • Loss of appetite
  • Vomiting
  • Unexplained weight loss
  • Fatigue
  • Black stools
Peptic Ulcer Disease A Helicobacter pylori infection or overuse of non-steroidal anti-inflammatory drugs (NSAIDs) causes sores called ulcers to develop in the stomach lining or duodenum (first part of the small intestine)
  • Heartburn
  • Nausea
  • Vomiting
  • Middle or upper belly pain that disappears for a time if you eat something or take an antacid
  • Dark or black stool
  • Weight loss
  • Severe middle or upper belly pain

This chart may seem overwhelming, but hopefully, you’ll be partnering with a trusted healthcare provider who can help you pinpoint what’s causing your symptoms. The main symptoms of GERD, recurring heartburn and regurgitation, are pretty easy to identify. As long as you don’t have any red-flag symptoms like painful or difficult swallowing, anemia, weight loss, or vomiting blood, your provider may give you an over-the-counter or prescription medication like a proton pump inhibitor (PPI) and monitor how your symptoms respond [2]. In addition to medications, there are many natural solutions for improving GERD symptoms, including [2]:

  • Healthy weight loss (if you’re overweight)
  • Avoiding food intake about 3 hours before bed
  • Elevating the head of your bed by 8–31 inches [6]
  • Trialing an elimination diet that excludes chocolate, caffeine, spicy foods, citrus, carbonated drinks, and fatty foods
  • Adding probiotics [7, 8, 9]
  • Trying breathing exercises [10, 11]
  • Adding acupuncture [12]
  • Trying one or more dietary supplements such as ginger, psyllium husk, melatonin, amino acids, and B vitamins [7]

If you do have any of the red flag symptoms, your provider will likely recommend an upper endoscopy—a procedure where a camera is placed on an endoscope (a flexible tube), allowing a gastroenterologist to view your esophagus, stomach, and duodenum (first part of the small intestine) for signs of GERD complications. Or, you may have a barium swallow test which can detect complications like moderate to severe esophageal inflammation, esophageal strictures, hiatal hernia, or tumors [2]. 

Don’t Ignore GERD Symptoms

GERD is a condition where your stomach contents are routinely backing up into your esophagus causing inflammation and damage. Aside from very uncomfortable symptoms like heartburn, belly pain, and regurgitation, GERD can cause serious complications like narrowing of your esophagus and even cancer if it’s left untreated.  

Anyone can develop GERD, but you’re more at risk if you have certain physiological conditions like dysmotility or a hiatal hernia. Smoking, drinking too much alcohol, and taking certain medications can also increase the likelihood that you’ll develop GERD.  

There’s no gold standard test for diagnosing GERD, and there are many other gastrointestinal conditions, like gastroparesis and eosinophilic esophagitis, that masquerade as GERD. This overlap can muddy the waters a bit when you’re trying to get an accurate diagnosis. 

Occasional heartburn or acid reflux isn’t necessarily a cause for concern. If your symptoms become more routine, for example, at least twice a week for several weeks, you’ll want to see a doctor. Additionally, regularly having regurgitation, chest pain, coughing, or trouble swallowing can all indicate GERD or another serious condition, so it’s best to get checked out right away. 

Fortunately, there are many natural ways to address the root causes of GERD. You may want to work your way through my Great-in-8 Action Plan in Healthy Gut, Healthy You to restore robust gut health. And we’re always available in the clinic to support you along your healing journey. 

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References
  1. Acid Reflux & GERD: Symptoms, What It Is, Causes, Treatment [Internet]. [cited 2023 Nov 29]. Available from:
  2. Antunes C, Aleem A, Curtis SA. Gastroesophageal Reflux Disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. PMID: 28722967.
  3. Khieu M, Mukherjee S. Barrett Esophagus. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. PMID: 28613697.
  4. Chhabra P, Ingole N. Gastroesophageal reflux disease (GERD): highlighting diagnosis, treatment, and lifestyle changes. Cureus. 2022 Aug 29;14(8):e28563. DOI: 10.7759/cureus.28563. PMID: 36185857. PMCID: PMC9517688.
  5. Heartburn | Pyrosis | MedlinePlus [Internet]. [cited 2023 Dec 1]. Available from:*d9orvn*_ga*MTQ0ODcwNzg0NS4xNjk1MTU1NjIy*_ga_7147EPK006*MTcwMTQ3NDk1NS4xNi4wLjE3MDE0NzQ5NTUuMC4wLjA.*_ga_P1FPTH9PL4*MTcwMTQ3NDk1NS4xNi4wLjE3MDE0NzQ5NTUuMC4wLjA.
  6. Albarqouni L, Moynihan R, Clark J, Scott AM, Duggan A, Del Mar C. Head of bed elevation to relieve gastroesophageal reflux symptoms: a systematic review. BMC Fam Pract. 2021 Jan 19;22(1):24. DOI: 10.1186/s12875-021-01369-0. PMID: 33468060. PMCID: PMC7816499.
  7. Martin Z, Spry G, Hoult J, Maimone IR, Tang X, Crichton M, et al. What is the efficacy of dietary, nutraceutical, and probiotic interventions for the management of gastroesophageal reflux disease symptoms? A systematic literature review and meta-analysis. Clin Nutr ESPEN. 2022 Dec;52:340–52. DOI: 10.1016/j.clnesp.2022.09.015. PMID: 36513474.
  8. Cheng J, Ouwehand AC. Gastroesophageal reflux disease and probiotics: A systematic review. Nutrients. 2020 Jan 2;12(1). DOI: 10.3390/nu12010132. PMID: 31906573. PMCID: PMC7019778.
  9. Singh G, Haileselassie Y, Briscoe L, Bai L, Patel A, Sanjines E, et al. The effect of gastric acid suppression on probiotic colonization in a double blinded randomized clinical trial. Clin Nutr ESPEN. 2022 Feb;47:70–7. DOI: 10.1016/j.clnesp.2021.11.005. PMID: 35063245.
  10. Qiu K, Wang J, Chen B, Wang H, Ma C. The effect of breathing exercises on patients with GERD: a meta-analysis. Ann Palliat Med. 2020 Mar 17;9(2):405–13. DOI: 10.21037/apm.2020.02.35. PMID: 32233626.
  11. Zdrhova L, Bitnar P, Balihar K, Kolar P, Madle K, Martinek M, et al. Breathing exercises in gastroesophageal reflux disease: A systematic review. Dysphagia. 2023 Apr;38(2):609–21. DOI: 10.1007/s00455-022-10494-6. PMID: 35842548. PMCID: PMC9888515.
  12. Zhu J, Guo Y, Liu S, Su X, Li Y, Yang Y, et al. Acupuncture for the treatment of gastro-oesophageal reflux disease: a systematic review and meta-analysis. Acupunct Med. 2017 Oct;35(5):316–23. DOI: 10.1136/acupmed-2016-011205. PMID: 28689187.

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