Acid reflux causes heartburn, a burning sensation that happens when some of the acid content of the stomach flows up into the esophagus. Frequent acid reflux may be a sign of GERD.

Although people may use the terms interchangeably, heartburn is a symptom of acid reflux, also known as gastroesophageal reflux (GER). Despite the name, heartburn has nothing to do with the heart.

Gastroesophageal reflux disease (GERD) is a more serious form of GER. Doctors will diagnose GERD when acid reflux becomes a recurrent complaint about an individual, usually more than twice a week for several weeks at a time.

GERD is most common in Western countries, affecting an estimated 20% of the population in these regions.

About 20% of Americans also have GERD, and it is the most common gastrointestinal condition diagnosed in the outpatient setting.

About 60% of people who have GERD are women. Among people living with GERD, African Americans account for the second-largest group after people who are white.

The stomach contains hydrochloric acid, which is a strong acid that helps break down food and protect against pathogens such as bacteria.

The lining of the stomach is specially adapted to protect it from the powerful acid, but the esophagus is not protected.

A ring of muscle, the gastroesophageal sphincter, normally acts as a valve that lets food into the stomach but not back up into the esophagus.

When this valve fails, stomach content regurgitates back into the esophagus. This is acid reflux. A person will feel a burning sensation in their esophagus as the acid rises up. This is heartburn.

Acid reflux can affect people of all ages, sometimes for unknown reasons. It may happen due to a lifestyle factor, but also due to causes that cannot always be prevented.

Risk factors for getting acid or GERD reflux include:

  • obesity
  • smoking (active or passive)
  • low levels of physical exercise
  • medications, including drugs for asthma, calcium-channel blockers, antihistamines, painkillers, sedatives, and antidepressants
  • pregnancy

Food and dietary habits that have been linked to acid reflux include:

  • caffeine
  • alcohol
  • fatty foods
  • spicy foods
  • tomatoes and tomato sauces
  • onions and garlic
  • eating large meals
  • lying down within 2-3 hours of eating a meal
  • consuming chocolate, carbonated drinks, and acidic juices

Heartburn is the most recognizable symptom of acid reflux. It is the uncomfortable, burning sensation that occurs in the esophagus.

A person will feel it behind the breastbone area. It tends to get worse when lying down or bending over. It can last for several hours and often worsens after eating food.

The pain of heartburn may move up toward the neck and throat. Stomach fluid can reach the back of the throat in some cases, producing a bitter or sour taste.

Acid reflux and heartburn are common and relatively easy to diagnose, however, it is possible to confuse them with other chest complaints such as:

A doctor will often diagnose GERD simply by finding improvement in heartburn symptoms in response to lifestyle changes and acid reflux medication.

Gastroenterologists may also arrange the following investigations:

  • endoscopy: camera imaging
  • biopsy: taking a tissue sample for laboratory analysis
  • barium X-ray: imaging the esophagus, stomach, and upper duodenum after swallowing a chalky liquid that helps provide contrast on images
  • esophageal manometry: pressure measurement of the esophagus
  • 24-hour pH impedance monitoring: measuring the amount of acidity within the esophagus

Without treatment, persistent acid reflux or GERD can lead to serious complications in the long term. This includes:

  • Esophagitis: the lining of the esophagus is inflamed, causing irritation, bleeding, and ulceration in some cases
  • Strictures: damage caused by stomach acid leads to scar development and difficulties swallowing, with food getting stuck as it travels down the esophagus
  • Barrett’s esophagus: a serious complication where repeated exposure to stomach acid causes changes in the cells and tissues lining the esophagus with the potential to develop into cancer cells

When a person has acid reflux, their stomach content is rising back up into their esophagus. This causes heartburn, which is the burning sensation a person feels from the acid that comes up from the stomach. People who get acid reflux frequently may have GERD.

A variety of treatments are available for acid reflux and GERD. There are over-the-counter antacids a person can buy, though in more severe cases prescription medications are available. Lifestyle modifications such as eating a healthful diet, exercising, and sleeping in an elevated position may help relieve symptoms.

What are other symptoms of GERD?

When acid reflux progresses to GERD, other symptoms can include asthma, nausea and vomiting, laryngitis, pain when swallowing, dental erosion, and bad breath.

What is the difference between heartburn and indigestion?

People may use the terms heartburn and indigestion to mean the same thing, but they are different. Indigestion is also known as dyspepsia. It describes the feeling of being uncomfortable full or in pain in the upper abdomen. It can occur with bloating, burping, and gas. A person may have both heartburn and indigestion at the same time, or they may experience them separately.

Why does pregnancy cause heartburn?

As many as 45% of women experience heartburn during pregnancy. Pregnancy can cause acid reflux due to an increase in the hormone progesterone, which relaxes the gastroesophageal sphincter between the stomach and the esophagus.

Learn more about acid reflux during pregnancy.

Can heartburn lead to cancer?

In rare cases, acid reflux could lead to cancer. Both esophagitis and Barrett’s esophagus, which are complications of acid reflux, are associated with a higher risk of cancer. About 30% of esophageal cancer cancers are also linked to GERD.

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