GERD

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

Dr Chad OkayFounder, Suna Health

4 min read. Updated .

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

  1. Eat smaller, earlier evening meals. The single biggest lever for night-time reflux.
  2. Stop eating 3 hours before bed. Walk for 10 minutes after dinner.
  3. Raise the head of the bed by about 20 cm, using risers under the bedposts rather than extra pillows. Pillows bend you at the waist and make reflux worse.
  4. Sleep on your left side. Anatomy puts the stomach below the oesophagus on this side and reduces acid contact.
  5. Lose 5 to 10% of body weight if you carry it around the middle. Reduces pressure on the stomach.
  6. Cut alcohol and reduce coffee for a fortnight to see if symptoms shift. Then reintroduce at smaller doses.
  7. Try an alginate-based liquid after meals. A pharmacist can point you to one. The alginate forms a raft that floats on the stomach contents and physically blocks reflux for a short period after meals.

When medication enters the picture

Proton pump inhibitors (omeprazole, lansoprazole) are the standard medical treatment. They strongly reduce stomach acid production, by around 80% or more. Many people notice symptoms improving within the first couple of weeks, though NICE recommends judging the full response over a defined course rather than an open-ended one, then stepping down to the lowest dose that keeps symptoms away. The dose and the length of the course are your prescriber's decision, not ours.

When reflux needs more than habits

Reflux that answers to the changes above needs nothing else. Vomiting blood or black tarry stools is an emergency: 999 in the UK, 911 in the US, and do not drive yourself. Difficulty or pain on swallowing, weight going down on its own, or new reflux from the mid-fifties deserve a prompt appointment, and reflux that returns every time treatment stops is one for a routine conversation with your doctor.

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 means refluxed acid sits in the oesophagus for longer at night, which is why night-time reflux can be more damaging.

Sources

Written by Dr Chad Okay. Contributor: Dr Parisah Hussain, MBChB, BSc (Hons), DRCOG, MRCGP. Last updated 17 September 2026. From Digests.

Digests explains how the body works in general, everyday terms. It is not medical advice. It is not a substitute for someone who can examine you and knows your history, and we do not tell you what dose of any medicine to take.

Where we describe how something is checked or looked after, we follow UK guidance from NICE and the NHS. If you are reading this outside the UK, the same concerns are worth taking to your own doctor, though the tests and routes where you live may differ.

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