Gastro-oesophageal reflux disease, or GERD, is when stomach contents flow back into the gullet often enough to cause troublesome symptoms or damage. Occasional heartburn after a large meal is normal. It becomes a disease when it happens twice a week or more or when it inflames the oesophagus.
Most people are controlled with changes in habits and acid-lowering medicine. A smaller group with proven reflux that persists, or who do not want lifelong tablets, can consider anti-reflux surgery. Long-standing reflux can change the lining of the lower gullet, known as Barrett's oesophagus, which needs surveillance.
Symptoms
- Burning behind the breastbone rising towards the throat, often after meals or lying down
- Sour or bitter fluid coming up into the mouth
- Symptoms worse on bending, at night or after fatty meals, alcohol or coffee
- Excess saliva, burping and bloating
- Chronic cough, hoarseness, throat clearing or a lump sensation in the throat
- Night-time wheeze or worsened asthma
- Eroded tooth enamel
Causes and risk factors
The valve between the gullet and stomach, the lower oesophageal sphincter, relaxes at the wrong times or is weak. A hiatus hernia, where part of the stomach slides up through the diaphragm, removes the diaphragm's support. Abdominal pressure from excess weight, pregnancy and tight clothing pushes contents upward. Large late meals, fat, chocolate, mint, alcohol, coffee and smoking make it worse. Medicines such as calcium channel blockers, nitrates, some antidepressants and anti-inflammatory painkillers contribute. Slow stomach emptying and scleroderma are less common causes.
How it is diagnosed
- Clinical diagnosis and trial of treatment: Typical heartburn and regurgitation in a younger person without alarm features is treated with 4 to 8 weeks of a proton pump inhibitor without tests.
- Upper endoscopy (gastroscopy): For alarm features, age over about 50 to 55 with new symptoms, symptoms persisting on treatment, or long-standing reflux. Shows oesophagitis, hiatus hernia and Barrett's, with biopsies.
- 24-hour pH and impedance monitoring: A thin tube through the nose, or a wireless capsule, measures reflux episodes and links them to symptoms. Essential before surgery if the endoscopy is normal.
- Oesophageal manometry: Measures the swallowing muscle pressures to exclude a motility disorder such as achalasia before any anti-reflux operation.
- Barium swallow: Outlines a large hiatus hernia or narrowing.
Treatment options
- Lifestyle measures: Weight loss if overweight is the most effective. Smaller meals, no food for 3 hours before bed, raising the head of the bed, and stopping smoking.
- Antacids and alginates: Quick relief for occasional symptoms. Alginates form a raft on the stomach contents and help after meals and at night.
- Proton pump inhibitors: Omeprazole and related drugs taken 30 to 60 minutes before breakfast. Heal oesophagitis in most people. The lowest dose that controls symptoms is used long term.
- H2 blockers: Famotidine as a milder alternative or for night-time symptoms.
- Laparoscopic fundoplication: The upper stomach is wrapped around the lower gullet and any hiatus hernia repaired through keyhole incisions. One or two nights in hospital.
- Magnetic ring and endoscopic procedures: A bead ring around the sphincter or endoscopic plication in selected patients. Long-term data are more limited than for fundoplication.
- Barrett's treatment: Surveillance endoscopy, with radiofrequency ablation or endoscopic resection if precancerous change is found.
When it is urgent
Chest pain that spreads to the arm, jaw or back, or comes with sweating or breathlessness, must be treated as a possible heart attack: call emergency services. Also seek urgent local care for vomiting blood or material like coffee grounds, black tarry stools, food sticking so that you cannot swallow fluids, or rapid unexplained weight loss.
Travelling to Türkiye for treatment
Ordinary reflux is managed with tablets by your own doctor. A visit is useful if symptoms persist despite treatment and you need endoscopy, pH monitoring and manometry, which can be completed in 2 to 3 days, or for planned laparoscopic anti-reflux surgery. For surgery allow about 7 to 10 days, and expect a soft diet for several weeks afterwards. Bring any previous endoscopy reports.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Are proton pump inhibitors safe long term?
For people who need them the benefits outweigh the risks. Associations with low magnesium or B12, fractures and gut infections are small. Review the need and dose with your doctor every year or so.
Will I be able to stop tablets after surgery?
Most people can in the first years, but some return to medication over time. Temporary difficulty swallowing, bloating and being unable to belch are recognised after-effects.
Does reflux cause cancer?
Long-standing reflux can lead to Barrett's oesophagus, which carries a small yearly risk of oesophageal cancer. The absolute risk for an individual is low, and surveillance finds changes early.
Which foods should I avoid?
There is no universal list. Large, fatty and late meals matter more than any single food. Cut out only the items that reliably trigger your own symptoms.