Heartburn (GERD)

Gastroesophageal reflux disease (GERD) is a disorder in which contents of the stomach or small intestine repeatedly move back up into the esophagus (tube connecting the throat to the stomach). This regurgitating action is called reflux. Reflux causes heartburn, and although most people have an attack of heartburn at some point in their lives, persistent reflux and severe heartburn may indicate GERD.

Normally when a person swallows, the muscular walls of the esophagus move in waves to push the food down into the stomach. Right after the food enters the stomach, a band of muscle (the lower esophageal sphincter) closes off the esophagus. If the muscle fails to close tightly enough, the stomach contents can back up into the esophagus causing heartburn and other symptoms of GERD.

Substances in the digestive juices from the stomach (namely, acid, pepsin, and bile) can damage the inner lining of the esophagus, causing inflammation ulcers (open sores), and, possibly, precancerous changes to cells (called Barrett's esophagus).

Signs and Symptoms

Heartburn — a burning sensation under the sternum in the chest — is the primary symptom of GERD. Heartburn often occurs after a meal and worsens at night, when you are lying flat. It is more likely to occur following a heavy meal, or if you bend, lift, or lie down just after eating.

Other symptoms of GERD include: GERD is common in infants and young children, but is generally mild. If an infant has the following symptoms, however, call a physician as soon as possible.


GERD can often be traced to the malfunctioning of the lower esophageal sphincter (LES). The LES is a muscle responsible for opening and closing the lower end of the esophagus, which it accomplishes by relaxing and contracting at appropriate times. The LES may weaken or lose tone, allowing the contents of the stomach to escape back up the esophagus. Any of the following may compromise the LES: Children with the following conditions are at particular risk for GERD:


GERD is generally not difficult to diagnose. Your symptoms, what you eat and drink, medications you are taking, and your lifestyle are usually enough to make a clear diagnosis. If the diagnosis is unclear to your doctor, one or more tests may be performed:

Treatment Approach

The primary goals of treatment are to reduce the reflux (regurgitation), stop the harmful effect of the stomach's materials by reducing its acid content, improve the clearance of food through to the stomach, and protect the walls of the esophagus.

For mild cases, these goals can be accomplished by making lifestyle changes (such as avoiding certain foods) and by taking over-the-counter medication. An herbalist may suggest licorice or other herbs for their soothing properties. Prescription medicines may be recommended as needed.

For moderate to severe cases, prescription medication may be used more regularly and the condition monitored more closely. If these measures fail, surgery may ultimately be required.


Making changes to or avoiding certain habits can go a long way to relieving or preventing your symptoms of GERD.

The following are typical suggestions for people with GERD: If you experience more frequent symptoms at night, you may be relieved by: Stress may worsen symptoms. Therefore, relaxation, such as yoga, tai chi, and meditation are worth considering, as part of your whole, comprehensive treatment plan.


The main aim of drug treatment is to control the acidity of the stomach. This can be achieved with either nonprescription or prescription drugs, depending on the severity and frequency of your reflux. Your doctor will determine which medicine is best for you.

There are several different types of medications used for GERD, and each works in a different way. Over-the-counter antacids neutralize the stomach acids; histamine H2 blockers interfere with the production of acid; and proton pump inhibitors suppress molecules in the glands responsible for the release of acid. Avoid taking other medications within three hours of an antacid because antacids may limit the absorption of other drugs.

Surgery and Other Procedures

For a small number of people, diet, medication, and lifestyle changes are not enough to relieve symptoms of GERD. In such cases, a surgical procedure called fundoplication may be performed to prevent reflux and repair a hiatal hernia (a condition that may cause GERD). As many as 90% of people who have had this operation report no longer having heartburn.

Nutrition and Dietary Supplements

Nutritional therapy is one of the first treatments recommended for GERD. Generally, this entails avoiding foods that cause heartburn. These may include: Although more study is needed for all of the following, supplements or specific food ingredients that may prove to be helpful for the treatment of GERD symptoms or prevention of its complications include:

Bromelain (Ananas comosus)
Bromelain is an enzyme found in the pineapple plant. It contains protein-digesting enzymes, which help promote and maintain proper digestion. These enzymes may also relieve symptoms of stomach upset or heartburn, particularly when used with other enzymes such as amylase (which digests starch) and lipase (which digests fat). Studies in people are needed.

Gamma Linolenic Acid (GLA)
This omega-6 fatty acid comes from evening primrose, black currant, borage, and fungal oils. There is very early evidence from test tube and animal studies that GLA from evening primrose oil (EPO) may have anti-ulcer properties. It is premature to know how this might apply to people.

Selenium, which is found in large quantities in whole grain products, may have some protection against Barrett's esophagus (precancerous cellular changes along the lining of the esophagus which can result from GERD) becoming cancerous. Again, more research is required.


Herbs, like medications, may produce side effects or interact with other substances including drugs. They should, therefore, be used with caution and only under the guidance of a professionally trained and qualified herbalist.

Licorice (Glycyrrhiza glabra)
An herbalist may recommend that you try licorice. Licorice is a demulcent (soothing, coating agent) often used to prevent and treat stomach ulcers. Animal studies and early trials in people support this use for licorice. For example, preparations containing glycyrrhizin (an active compound in licorice) may be as effective as leading anti-ulcer medications in relieving pain associated with stomach ulcers and preventing the ulcers from recurring. So far, however, there are no studies on licorice specifically as a treatment for GERD. Herbalists may consider it for this purpose, however, because of the similarity in symptoms.

Turmeric (Curcuma longa)
Turmeric has long been used in both Ayurvedic and Chinese medicine to treat digestive disorders. Scientific research is beginning to test the merit of this traditional use. In an animal study, for example, extracts of turmeric root reduced the release of acid from the stomach and protected against injuries such as inflammation and ulcers, both of which are potential complications from GERD. Further studies are needed to know to what extent these protective effects apply to people as well. (Note: at very high doses, turmeric may induce ulcers. It is very important to stick with the dose recommended by an herbal specialist.)

Other herbs that might be considered by an herbal specialist because of traditional use include: Homeopathy
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of GERD symptoms based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Other Considerations


GERD is quite common during pregnancy, particularly in the third trimester.

Warnings and Precautions

People with high blood pressure, obesity, diabetes, or kidney, heart, or liver conditions should avoid licorice. This herb should also not be used by pregnant or breastfeeding women or by men with decreased libido or other sexual dysfunctions. Use of any licorice product is not recommended for longer than four to six weeks.

Contact your health care provider if the medication recommended does not help or if you experience side effects, such as cramping or diarrhea.

Prognosis and Complications

The acidic contents of the stomach can damage the esophagus, causing narrowing, ulcers, erosion , and precancerous changes to cells known as Barrett's esophagus. GERD can also result in respiratory diseases, ear, nose, throat conditions, and tooth decay. Most people can effectively manage their symptoms with lifestyle modifications and medications.


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