Could your acid reflux be associated with heartburn or GERD?

Even the most pleasant meal can produce an unpleasant — even painful — aftermath with acid reflux. You may have heartburn, a burning sensation in your chest, or feel the need to repeatedly burp or clear your throat. Heartburn is common for many people, but it could be a sign of a more serious condition known as GERD.

Heartburn is a burning pain behind the breastbone. It is the most common gastrointestinal symptom, with more than 60 million Americans suffering from flare-ups at least once a month. Heartburn is triggered by certain foods and drinks, or from eating too much. It often goes away on its own after a few minutes, although it can last hours and require over-the-counter medication.

Occasional heartburn is nothing serious, but its symptoms can mimic gastroesophageal reflux disease, or GERD.

“These common digestive-related problems often get confused with each other because they share many of the same traits,” says Dr. Lawrence Friedman, assistant chief of medicine at Massachusetts General Hospital and medical editor of Harvard Health Publishing’s online guide Cooling Heartburn. “While they are connected, they are quite different.”

Severe and recurring heartburn is a symptom of frequent or persistent acid reflux, also known as GERD. For people with GERD, stomach acid rises from the stomach into the esophagus, much like water bubbling up into a sink from a plugged drain. When stomach acid reaches the esophagus, it can ignite heartburn.

Heartburn from GERD often extends from the bottom of the rib cage to the base of the neck and can last for hours. It may be accompanied by a stinging sensation in the throat and a sour taste in the mouth. “You should get checked for GERD if you have heartburn more than twice a week,” says Friedman.

Left alone, GERD can cause complications like esophagitis (inflammation of the esophagus) and occasionally precancerous changes in the lining of the esophagus (called Barrett’s esophagus).

While intense heartburn is the most common symptom of GERD, there are others, including:

• Nausea
• Difficulty swallowing
• Sore throat
• Regurgitation, which may come up as a “wet burp” or as vomit
• Coughing, wheezing or a constant need to clear your throat
• Hoarseness, especially after waking up

The most common cause of GERD is a malfunction of the lower esophageal sphincter (LES), the muscular ring that separates the esophagus from the stomach. Usually, it functions as a gate. The muscle relaxes when you swallow, which opens the passage between the esophagus and stomach and allows food to pass through.

When the sphincter tightens, it closes the route, keeping food and acidic stomach juices from flowing back up into the esophagus. However, with GERD, the LES relaxes when it shouldn’t, or it weakens and remains partially open. This allows stomach acid to rise into the esophagus.

For both heartburn and GERD, diet changes and medication can help you stay ahead of discomfort.

Cut back on trigger foods and drinks associated with heartburn, such as mint, fatty and spicy foods, tomatoes, onions, garlic, chocolate, coffee, tea, carbonated beverages and alcohol. Also, try eating smaller meals, sit upright for at least one hour after eating, and avoid eating two hours before bedtime.

Over-the-counter antacids or acid-blocking medications neutralize digestive acids in the stomach and esophagus; these work well for mild and occasional heartburn. Your doctor may recommend acid-reducers like H2 blockers or proton-pump inhibitors (PPI) for persistent or severe symptoms. These drugs are in many over-the-counter products, with stronger versions available by prescription.

Many of the self-help remedies for heartburn also help manage GERD. If these don’t provide relief, you may need to consider surgery to tighten your LES.

GERD is also associated with hiatal hernia, where your stomach pokes through a hole in your diaphragm and weakens the ligaments that hold your esophagus in place, making it harder for the LES to work properly.

Almost everyone with a large hiatal hernia has GERD, and hiatal hernias are commonly found in people with GERD who also have moderate or severe esophagitis.

Hiatal hernia usually doesn’t require treatment. “However, you may need surgery to repair the hernia if you have persistent reflux symptoms, you suffer from esophagitis that does not heal with medication, or the hiatal hernia is so large that part of the stomach becomes lodged above the diaphragm,” Friedman says.