Gastroesophageal Reflux Disease (GERD) has become an increasingly common chronic digestive disorder, affecting millions worldwide. This condition, characterised by persistent and troublesome symptoms of acid reflux, is often a byproduct of modern, fast-paced lifestyles. To effectively manage GERD, it is crucial to understand its mechanics, recognise its symptoms, and be aware of the serious complications that can arise if it is left untreated.
Mechanics of GERD
At the heart of GERD is the lower oesophageal sphincter (LES), a muscular ring that acts as a valve between the oesophagus and the stomach. In a healthy individual, the LES opens to let food into the stomach and then closes tightly to prevent stomach acid from flowing back up. GERD occurs when this sphincter weakens or relaxes inappropriately. This allows stomach contents, including highly acidic digestive juices, to reflux into the oesophagus. This backward flow causes the classic burning sensation known as heartburn and can lead to damage of the oesophageal lining.
The key distinction between occasional acid reflux and GERD is a matter of frequency and severity. While many people experience reflux from time to time, a GERD diagnosis is made when symptoms are persistent and negatively impact a person’s quality of life. The global rise of GERD is significantly influenced by factors such as obesity, sedentary lifestyles, and poor dietary habits.
Symptoms and diagnosis
GERD symptoms can be categorised into two groups:
Typical symptoms: The most common signs include heartburn, the regurgitation of food or sour liquid, and difficulty swallowing.
Extra-oesophageal symptoms: These are often less recognised and can include chronic cough, hoarseness, asthma, and dental erosion. These symptoms highlight how GERD’s effects can extend beyond the digestive system.
For many individuals, a GERD diagnosis begins with a clinical assessment of symptoms. If classic heartburn and regurgitation are present, a doctor may prescribe a trial of acid-suppressing medication, such as proton pump inhibitors (PPIs). If the symptoms resolve, it is a strong indication of GERD. However, for more complex cases, advanced diagnostic tools are necessary. These include:
Endoscopy: This procedure uses a flexible tube with a camera to be able to see the oesophagus, stomach, and small intestine. It helps doctors assess the severity of any damage to the oesophageal lining, such as esophagitis, and rule out other conditions.
24-hour impedance pH monitoring: For unclear cases or when symptoms persist despite medication, this study involves placing a thin tube through the nose into the oesophagus to measure the amount and acidity of reflux events over a 24-hour period. This provides a detailed picture of the patient’s reflux patterns and helps differentiate GERD from conditions that may mimic its symptoms.
The dangers
Ignoring GERD can have severe consequences. The constant exposure of the oesophageal lining to stomach acid can lead to inflammation and ulceration. Over time, this chronic inflammation can cause the formation of scar tissue, resulting in oesophageal strictures—narrowing of the oesophagus that makes swallowing difficult and painful.
A more serious complication is Barrett’s oesophagus, a precancerous condition where the cells lining the oesophagus are replaced by cells similar to those found in the intestine. While not all cases of Barrett’s oesophagus progress to cancer, the condition significantly increases the risk of developing oesophageal adenocarcinoma, a particularly aggressive form of cancer. The risk of bleeding from oesophageal ulcers is also a serious concern.
These potential complications emphasise the critical importance of seeking medical advice and effectively managing GERD.
Management and treatment
The good news is that GERD is a highly manageable condition. In many cases, lifestyle modifications are the first and most effective line of defence.
Diet and eating habits: Have small, frequent meals (5–6 times a day). Avoid excessive consumption of tea, coffee, and especially soda. Leave a three-hour gap between dinner and sleep. Avoid too much water with food. Avoid fried fatty foods, particularly at dinner. Avoid large portions foods and sweets. Avoid excess juices, soups, and other liquid items.
Lifestyle adjustments: Weight management is crucial, as excess abdominal fat puts pressure on the stomach and can force acid back into the oesophagus. Avoid wearing tight clothes immediately after eating. Elevate the head of the bed during sleep to use gravity to prevent nighttime reflux. Sleep on your left side while lying down. Avoid stress, smoking, and NSAID pain killers.
For individuals whose symptoms do not respond adequately to lifestyle changes or medication, there are alternative treatment options. Surgical procedures, such as laparoscopic fundoplication, involve wrapping a part of the stomach around the lower oesophagus to reinforce the LES. Less invasive endoscopic procedures, such as radiofrequency ablation, use heat to create scar tissue and tighten the LES.
In conclusion, GERD is not a condition to be ignored. It is a signal from the body that something is out of balance. By making informed lifestyle choices, seeking timely medical advice, and exploring the full spectrum of treatment options, individuals can successfully manage their symptoms and prevent long-term complications, moving from the discomfort of a burn to a life of balance.
This article was first published in The Hindu’s e-book Care and Cure
(E. Rabindranath is consultant gastroenterologist, Naruvi Hospitals, Vellore. rabindranath.e@naruvihospitals.com; Jacob Raja A. S. is consultant gastroenterologist, consultant in infectious diseases, Naruvi Hospitals, Vellore. jacobraja.as@naruvihospitals.com)
Published – January 14, 2026 01:00 pm IST
