Are heartburn and GERD the same thing?

Heartburn is the symptom. GERD is the diagnosis when heartburn (or other reflux symptoms) happens chronically. Occasional heartburn after a big meal is normal. Heartburn that wakes you, happens twice a week or more, or stops you eating things you used to enjoy is GERD.

Mild GERD often resolves with the lifestyle changes above and a short course of medication. Moderate to severe GERD is usually a long-term pattern that needs ongoing management. Surgical options (fundoplication, LINX) exist for cases that do not respond to lifestyle and medication, but most people never need them.

Is GERD dangerous long term?

Untreated chronic GERD can lead to oesophagitis, strictures, and Barrett's oesophagus, which carries a small but increased risk of oesophageal cancer. The reason endoscopy is offered to long-term reflux sufferers, especially men over 50 with persistent symptoms, is to catch this early.

Why is reflux worse at night?

Lying down removes the help gravity gives during the day in keeping acid in the stomach. Saliva production drops at night so less acid gets neutralised. The combination is why night-time reflux causes more damage to the oesophagus per minute than daytime reflux.

Digestive symptoms

GERD

Also called: GORD, acid reflux, gastro-oesophageal reflux disease, heartburn

GERD (gastro-oesophageal reflux disease, written GORD in the UK) is when stomach contents repeatedly flow back into the oesophagus, causing symptoms or damage. The classic feeling is burning behind the breastbone after meals or when lying down. Occasional heartburn is normal. GERD is when it happens at least twice a week, or interferes with sleep or eating.

What is happening

A muscular ring at the top of the stomach (the lower oesophageal sphincter) usually opens to let food in and closes to keep acid down. In GERD that ring leaks. Stomach acid, bile and partially digested food rise into the oesophagus, which is not designed to handle them. The oesophagus inflames and over time can scar. The classic symptom is a burning behind the breastbone, but reflux can also present as cough, hoarseness, sour taste in the mouth, dental erosion, or chest pain.

What triggers reflux

Large meals: more food in the stomach raises pressure on the sphincter.
Eating within 3 hours of bed: gravity stops helping when you lie down.
Specific foods that relax the sphincter: chocolate, mint, coffee, alcohol, fatty fried meals.
Specific foods that increase acid: tomato, citrus, spicy meals.
Pregnancy: progesterone relaxes the sphincter, the bump compresses the stomach.
Hiatus hernia: part of the stomach pushed up through the diaphragm, present in around half of people with reflux.
Smoking and being overweight: both reliably worsen reflux.
Some medications: ibuprofen, aspirin, certain blood pressure drugs.

What actually helps

Eat smaller, earlier evening meals. The single biggest lever for night-time reflux.
Stop eating 3 hours before bed. Walk for 10 minutes after dinner.
Raise the head of the bed by 10 to 15 cm using risers (not extra pillows). Pillows bend you at the waist and make reflux worse.
Sleep on your left side. Anatomy puts the stomach below the oesophagus on this side and reduces acid contact.
Lose 5 to 10 percent of body weight if you carry it around the middle. Reduces pressure on the stomach.
Cut alcohol and reduce coffee for a fortnight to see if symptoms shift. Then reintroduce at smaller doses.
Try alginate-based liquids (Gaviscon Advance) after meals. They form a raft that physically blocks reflux for an hour or two.

When medication enters the picture

Proton pump inhibitors (omeprazole, lansoprazole) are the standard medical treatment. They reduce stomach acid production by 80 to 95 percent. Most reflux symptoms settle within 2 weeks. NICE recommends a 4 to 8 week course, then a step-down. Long-term daily use is increasingly questioned because of effects on nutrient absorption (B12, iron, magnesium, calcium) and gut microbiome. They are not addictive but rebound acid production after sudden stopping is real, so taper rather than stop.

Red flags worth a GP visit

Difficulty or pain on swallowing.
Unintentional weight loss.
Vomiting blood or stools that look black and tarry.
New reflux starting after age 55.
Reflux that does not improve on a full proton pump inhibitor course.

Common questions

Are heartburn and GERD the same thing?: Heartburn is the symptom. GERD is the diagnosis when heartburn (or other reflux symptoms) happens chronically. Occasional heartburn after a big meal is normal. Heartburn that wakes you, happens twice a week or more, or stops you eating things you used to enjoy is GERD.
Can GERD be cured?: Mild GERD often resolves with the lifestyle changes above and a short course of medication. Moderate to severe GERD is usually a long-term pattern that needs ongoing management. Surgical options (fundoplication, LINX) exist for cases that do not respond to lifestyle and medication, but most people never need them.
Is GERD dangerous long term?: Untreated chronic GERD can lead to oesophagitis, strictures, and Barrett's oesophagus, which carries a small but increased risk of oesophageal cancer. The reason endoscopy is offered to long-term reflux sufferers, especially men over 50 with persistent symptoms, is to catch this early.
Why is reflux worse at night?: Lying down removes the help gravity gives during the day in keeping acid in the stomach. Saliva production drops at night so less acid gets neutralised. The combination is why night-time reflux causes more damage to the oesophagus per minute than daytime reflux.