GERD (Acid Reflux)
GERD (gastroesophageal reflux disease) is chronic acid reflux causing troublesome symptoms or esophageal injury, managed per the ACG 2022 Clinical Guideline for the Diagnosis and Management of GERD.
Symptoms
Heartburn and acid regurgitation are the classic symptoms; chest pain, chronic cough, hoarseness, and a sensation of a lump in the throat can also occur.
Causes and risk
A weak or relaxed lower esophageal sphincter allows stomach acid to flow back into the esophagus; obesity, hiatal hernia, pregnancy, smoking, and certain foods (fatty meals, alcohol, caffeine) all raise risk.
How it is evaluated
Typical symptoms without alarm features are usually treated with an empiric trial of acid suppression rather than immediate endoscopy, per the ACG guideline; endoscopy is reserved for alarm features or symptoms that don't respond to treatment.
Treatment
An 8-week trial of a proton pump inhibitor (PPI), taken before a meal, is first-line per the ACG guideline, which also recommends weight loss as the lifestyle measure with the strongest evidence (trigger-food avoidance and head-of-bed elevation carry weaker evidence). The guideline specifically advises against routinely adding other medications for PPI non-responders without further workup.
When to seek care
New chest pain should always be evaluated to rule out a cardiac cause first. Difficulty or pain swallowing, unintended weight loss, vomiting blood, or black/tarry stools are alarm features requiring prompt evaluation.