Causes of GERD and Associated Heartburn

Drinking beer can lead to GERD.
Justin Sullivan/Getty Images

Gastroesophageal Reflux Disease (GERD) is caused by reflux of stomach acid into the esophagus. In most sufferers, this is due to a relaxation of the lower esophageal sphincter (LES) that opens to allow food and liquids to pass into the stomach and closes to prevent food and stomach acid from flowing back into the esophagus. This relaxation of the LES happens a few times each day in people without GERD.

It's not known why it happens more frequently in GERD patients. The esophagus lining isn't the same as that of the stomach and isn't able to cope with acid as well as the stomach and is easily injured. It is this reflux of acid into the esophagus that produces the symptoms and potential damage to the esophagus.

Other Causes

A hiatal hernia may also contribute to acid reflux.

A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest. The diaphragm helps the LES keep acid from coming up into the esophagus. When a hiatal hernia is present, it is easier for the acid to come up. In this way, a hiatal hernia can cause reflux. A hiatal hernia can happen in people of any age; many otherwise healthy people over 50 have a small one.

Other factors that may contribute to GERD include the following:

  • Alcohol use
  • Overweight
  • Pregnancy
  • Smoking

Also, certain foods can be associated with reflux events, including the following:

  • Citrus fruits
  • Chocolate
  • Drinks with caffeine
  • Fatty and fried foods
  • Garlic and onions
  • Mint flavorings
  • Spicy foods
  • Tomato-based foods, like spaghetti sauce, chili, and pizza

How GERD Is Diagnosed

When a person complains of heartburn and other symptoms suggestive of GERD, such as a cough, sour taste in the mouth or hoarseness, a primary care physician will likely suspect GERD.

Typically, results from a history and physical exam are all that are needed to diagnose GERD and provide initial treatment for heartburn.

However, certain tests do exist that can diagnostically rule in the presence of GERD or rule out other diseases including the following:

  • Endoscopy (a flexible tube placed down your throat that can visualize the esophagus)
  • Manometry (a test that measures the motility or movement of the esophagus)
  • Barium swallow and upper GI series (x-ray)
  • Ambulatory acid probe to test the amount of pH in the esophagus


A variety of options exists to treat GERD. Some are non-prescription and some are prescription medications. Your physician may start you on prescription medications, to begin with, or tell you to take over-the-counter treatments first to see if they work. However, if your symptoms persist for more than 3 weeks on non-prescription medications, it's important to tell your physician so she can prescribe something for heartburn relief.

Here are some treatments for GERD:

  • Antacids (think Maalox, Mylanta, and Rolaids);
  • H2 blockers (think Tagamet or Pepcid);
  • PPI inhibitors (think Prilosec).

Both H2 blockers and PPIs are available in over-the-counter and prescription forms.

Prescription forms are stronger than over-the-counter alternatives. Both these medications decrease acid production by the stomach. Additionally, PPIs allow time for the esophagus to heal from injury due to acidic contents being refluxed, or passed into, the esophagus from the stomach.