Conditions & Treatments

Gastroesophageal Reflux Disease (GERD) / Heartburn

Gastroesophageal reflux disease (GERD) is a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus.

Gastroesophageal Reflux Disease (GERD)/Heartburn

What is GERD?

Illustration demonstrating  gastroesophageal reflux
Click Image to Enlarge

Gastroesophageal reflux disease (GERD) is a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus.

Gastroesophageal refers to the stomach and esophagus, and reflux means to flow back or return. Gastroesophageal reflux (GER) is the return of acidic stomach juices, or food and fluids, back up into the esophagus.

What are the symptoms of GERD?

The following is the most common symptom of GERD. However, each individual may experience symptoms differently.

Heartburn, also called acid indigestion, is the most common symptom of GERD. Heartburn is described as a burning chest pain that begins behind the breastbone and moves upward to the neck and throat. It can last as long as two hours and is often worse after eating. Lying down or bending over can also result in heartburn.

Most children younger than 12 years of age, and some adults, diagnosed with GERD will experience a dry cough, asthma symptoms, or trouble swallowing, instead of heartburn. Heartburn pain is less likely to be associated with physical activity.

The symptoms of GERD may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

What causes GERD?

GERD typically occurs when acid from the stomach backs up into the esophagus. The lower esophageal sphincter (LES), a muscle located at the bottom of the esophagus, opens to let food in and closes to keep it in the stomach. When this muscle relaxes too often or for too long, acid refluxes back into the esophagus, causing heartburn.

Other lifestyle contributors to GERD may include the following:

  • Being overweight

  • Overeating

  • Consuming certain foods, such as citrus,chocolate, fatty, and spicy foods

  • Caffeine

  • Alcohol

  • Smoking

  • Use of nonsteroidal anti-inflammatory (NSAIDs) drugs, such as aspirin and ibuprofen

Other conditions associated with heartburn may include the following:

  • Gastritis. This is inflammation of the stomach lining

  • Ulcer disease

How is GERD diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for GERD may include the following:

  • Upper GI (gastrointestinal) series (also called barium swallow). A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.

  • Esophagogastroduodenoscopy (also called EGD or upper endoscopy). An EGD (upper endoscopy) is a procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).

Illustration of an esophagogastroduodenoscopy procedure
Click Image to Enlarge

  • Bernstein test. A test that helps to confirm that the symptoms are a result of acid in the esophagus. The test is performed by dripping a mild acid through a tube placed in the esophagus.

  • Esophageal manometry. This test helps determine the strength of the muscles in the esophagus. It is useful in evaluating gastroesophageal reflux and swallowing abnormalities. A small tube is guided into the nostril, then passed into the throat, and finally into the esophagus. The pressure the esophageal muscles produce at rest is then measured.

  • pH monitoring. This measures the acidity inside of the esophagus. It is helpful in evaluating gastroesophageal reflux disease (GERD). A thin, plastic tube is placed into a nostril, guided down the throat, and then into the esophagus. The tube stops just above the lower esophageal sphincter, which is at the connection between the esophagus and the stomach. At the end of the tube inside the esophagus is a sensor that measures pH, or acidity. The other end of the tube outside the body is connected to a monitor that records the pH levels for a 24 to 48 hour period. Normal activity is encouraged during the study, and a diary is kept of symptoms experienced, or activity that might be suspicious for reflux, such as gagging or coughing. It is also recommended to keep a record of the time, type, and amount of food eaten. The pH readings are evaluated and compared to the patient's activity for that time period.

Treatment for GERD

Specific treatment for GERD will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

In many cases, GERD can be relieved through diet and lifestyle changes, as directed by your doctor. Some ways to manage heartburn include the following:

  • Monitor the medications you are taking--some may irritate the lining of the stomach or esophagus.

  • Quit smoking.

  • Watch food intake and limit fried and fatty foods, peppermint, chocolate, alcohol,citrus fruit and juices, tomato products, and caffeinated drinks, such as coffee, soda pop, and energy drinks. .

  • Eat smaller portions.

  • Avoid overeating.

  • Watch consumption of alcohol.

  • Do not lie down or go to bed right after a meal. Instead, wait a couple of hours.

  • Lose weight, if necessary.

  • Elevate the head of the bed 6 inches by placing bricks or cinderblocks under the legs of the bed.

  • Take an antacid, as directed by your doctor.

  • Ask your doctor about use of over-the-counter medicines called "H2-blockers" and "protein pump inhibitors". Formerly available only by prescription, these drugs can be taken before eating to prevent heartburn from occurring. Also, promotility medications, which help to empty food from the stomach, may be prescribed by your doctor.

  • Occasionally, a surgical procedure called fundoplication may be performed to help keep the esophagus in proper position and prevent reflux.

Treatment Programs


Massachusetts General Hospital understands that a variety of factors influence patients' health care decisions. That's just one reason why we're dedicated to ensuring patients understand their diagnosis and treatment options. Because a single option might not serve all patients, we offer a wide range of coordinated treatments and related services across the hospital. Patients should consult with their primary care doctor or other qualified health care provider for medical advice and diagnosis information.

Select a treatment program for more information:



Digestive Healthcare Center

  • Weight Center
    The Massachusetts General Hospital Weight Center is a fully integrated center within the Digestive Healthcare Center that supports the spectrum of needs for people of all ages seeking help with obesity and weight loss.
  • Barrett’s Esophagus Treatment Center
    The multidisciplinary Barrett’s Esophagus Treatment Center at Massachusetts General Hospital provides comprehensive care, from endoscopic diagnosis to minimally invasive treatment, for Barrett’s esophagus.
  • Swallowing and Heartburn Center
    The Swallowing and Heartburn Center at the Massachusetts General Hospital Digestive Healthcare Center provides both primary treatment and second opinion evaluations for throat, esophagus and stomach disorders.
Imaging

  • Pediatric Imaging
    The Pediatric Imaging Program at Massachusetts General Hospital Imaging specializes in ensuring the safety and comfort of child patients while providing the latest technology and the expertise of specialized pediatric radiologists.
  • Adult Medicine Imaging
    The Adult Medicine Imaging Program at Massachusetts General Hospital Imaging offers a wide range of diagnostic exams and minimally invasive, image-guided treatments, all provided using leading-edge equipment and interpreted by specialty-trained radiologists.
MassGeneral Hospital for Children

  • Pediatric Anesthesia
    The Pediatric Anesthesia team at MassGeneral Hospital for Children specializes in caring for children before, during and after surgery and other procedures.
  • Pediatric Feeding Program
    The Pediatric Feeding Program at MassGeneral Hospital for Children diagnoses and treats feeding and swallowing disorders, or dysphagia, in infants, toddlers, children and adolescents.
  • Pediatric Surgery
    The Pediatric Surgery service at MassGeneral Hospital for Children is an international referral center for the complete spectrum of general and thoracic pediatric and neonatal surgical services.
Obstetrics and Gynecology

  • Midlife Women's Health Center
    The Massachusetts General Hospital Midlife Women’s Health Center brings together experts from more than 15 specialties to improve, promote and advance health care for women at menopause and beyond through research, collaboration and education.
Gastroenterology

  • Swallowing and Heartburn Program
    The Swallowing and Heartburn Program at the Gastroenterology Division of Massachusetts General Hospital provides both primary treatment and second opinion evaluations for disorders of the esophagus and stomach.
General and Gastrointestinal Surgery

  • Bariatric and Metabolic Surgery Program
    The Bariatric and Metabolic Surgery Program at Massachusetts General Hospital offers a full spectrum of safe and effective surgical procedures for obesity, weight disorders and metabolic disease.
  • Gastroesophageal Surgery Program
    Massachusetts General Hospital's Gastroesophageal Surgery Program offers advanced surgical options to treat the complete range of gastroesophageal conditions, including gastric and esophageal cancers and benign esophageal disease.

The following related clinical trials and research studies are currently seeking participants at Massachusetts General Hospital. Search for clinical trials and studies in another area of interest.

Relief from GERD, once and for all

Finally, good news for patients who have chosen not to have surgery to treat their gastroesophageal reflux disease (GERD) because they doubted surgery’s effectiveness. A new study reveals the benefits of a simple procedure that can vastly improve their quality of life. And, even better, the relief offered by this surgery is lasting and doesn’t require the hassle and expense of taking proton pump inhibitors (PPIs) and other prescription and over-the-counter drugs.

Barrett's esophagus: aggressive treatment helps prevent progression to cancer

Physicians can help stem the rising incidence of gastroesophageal cancers by aggressively treating patients with gastroesophageal reflux (GERD) and Barrett's esophagus.

Frequently asked questions: LINX® system

David Rattner, MD, chief of the Division of Gastrointestinal and General Surgery at the Mass General Digestive Healthcare Center, answers frequently asked questions (FAQ) about the LINX® Reflux Management System, a new treatment option for gastroesophageal reflux disease (GERD).

Three months after surgery, patient has new lease on life

The MGH was the first hospital in New England to offer a new procedure in which a flexible bracelet of magnetic titanium beads is laparoscopically implanted around the esophagus to help treat GERD.

Magnetic esophageal sphincter device benefits patients with GERD

The New England Journal of Medicine publishes the three-year results of a study of the safety and effectiveness of a new device for treatment of gastroesophageal reflux disease (GERD).

4th Annual Common Pediatric Hurdles: Advice and Updates from the Experts

New approaches to diagnosis and treatment of a number of problems encountered routinely in the office, including: child abuse and neglect; food allergies; pediatric pulmonary; pediatric orthopaedics; autism spectrum disorders; eating disorders; pediatric GERD.

Preview clip of Digestive Healthcare Center CME program

David Ryan, MD, explains the reasons for the current epidemic of esophageal cancer.

Preview clip of Digestive Healthcare Center CME program

David Rattner, MD, explains the management of gastroesophageal reflux, including indications for medical, endoscopy and surgical interventions to control this condition.

Preview clip of Digestive Healthcare Center CME program

Christopher Morse, MD, reviews minimally invasive treatments for esophageal cancer, including esophageal resections. Please note that this video contains images from a real procedure and may cause discomfort for some viewers.

David Rattner, MD, explains how screenings can prevent esophageal cancer

David Rattner, MD, Co-Chief of the Massachusetts General Hospital Digestive Healthcare Center describes how chronic heartburn can lead to other serious conditions, who is most at risk and how Barrett's esophagus and esophageal cancer can be diagnosed and treated.

Innovative care at the Digestive Healthcare Center

Learn more about the latest treatment options for this condition at the Digestive Healthcare Center