---
title: "Frequently Asked Questions about GERD / Acid Reflux / Heartburn"
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---

One of the most common conditions I see in our Scottsdale clinic -- and the one I get the most questions  about -- is gastroesophageal reflux (GER), which is more commonly called ["acid reflux,"](/acid-reflux) "acid indigestion" or "heartburn" though these also can describe common symptoms. 

There are many causes of GER (and its chronic form GERD) and many reasons why it can occur. Here is a primer on this common and literally irritating condition and answers to the most frequently asked questions.

## Acid Reflux General FAQ

### What is GER or Acid Reflux? How does it happen? 

Gastroesophageal Reflux (GER) is a disorder that occurs when the Lower Esophageal Sphincter (LES) --- the muscle at the opening to the stomach from the esophagus -- relaxes at the wrong time, resulting in stomach contents regurgitating into the esophagus and sometimes into the mouth or windpipe (LPR).

### What is the difference between GER and GERD? 

GER tends to describe reflux that is temporary, transient or episodic. GERD is the chronic form of GER where symptoms are persistent and longer lasting, possibly leading to other complications. 

### What causes Acid Reflux?

- Dietary habits - Spicy, acidic, fatty and processed foods; carbonated beverages; food sensitivities, overeating, eating too fast.
- Medications - Chronic use of NSAIDs (Advil, Motrin, Aleve, etc), aspirin, calcium channel blockers, etc. 
- Lifestyle habits - Alcohol, smoking, sedentary lifestyle, obesity, lying down after eating
- Chronic stress  - being in "fight or flight" or sympathetic nervous system mode when you should be in parasympathetic or "rest and digest" mode.
- Physical conditions - Pregnancy : the stomach, small intestine push upward as fetus grows. Hiatal hernia:  the stomach pouches up the esophageal hiatus and temporarily sticks above diaphragm. Gastroparesis:  extremely slow motility where food remains in the stomach too long. Hypochlorhidia,  a condition of too little stomach acid. Hypermobility syndromes such as Ehlers-Danlos, or   scleroderma,  an autoimmune hardening of tissue. 

### Who is at risk for GERD? 

Anyone can get GER, even children and babies. Risk factors for GERD in adults includes age (over 50 years old), obesity (body mass index (BMI) >30) or those with sedentary lifestyle; smoking and alcohol use.[1] Diet and lifestyle factors also contribute to GERD risk (I would say the most), including eating frequent consumption of large meals and/or fatty, spicy, and acidic foods.[2] People taking certain medications such as calcium channel blockers also can be at risk for GERD.

### How common is GERD? 

Researchers estimate that GERD affects up to 20% of people in the United States (as of 2014)[3] and up to 25% of people worldwide (as of 2017)[4], with trends not changing dramatically in the last 20 years.

### When does acid reflux (GER) become chronic (GERD)?

If start experiencing acid reflux regularly -- two or more times a week -- or all the time -- this should be a cause for concern and you should consult your physician. It might mean that you have gastroesophageal reflux disease (GERD) is a more serious form of acid reflux. Longstanding GERD can lead to tissue changes at the gastroesophageal junction called [Barrett's esophagus](/blog/barrett-s-esophagitis-causes-symptoms-treatments-and-when-to-seek-medical-help). 

So treating only the painful and unpleasant symptoms of acid reflux is not enough. It can be a symptom of other underlying conditions and can also put you at risk of esophageal damage, increased chances of developing ulcers, narrowing of the esophagus, or even cancer, if left untreated

### What are the different types of Acid Reflux?

- Gastritis - irritation of the stomach lining, creating heartburn symptoms and possibly pressure laxity of the Lower Esophageal Sphincter (LES) causing symptoms of reflux; 
- GER/GERD - Gastroesophageal reflux of contents rom the stomach into the esophagus. GER is episodic,  GERD is the chronic form.
- Hiatal hernia - a common condition where the stomach slides or pouches through the opening where the esophagus goes through the diaphragm, causing abdominal discomfort, heartburn and reflux symptoms until it drops back to its normal position. 
- LPR - Laryngopharyngeal Reflux (a/k/a "Silent Reflux") - when contents of the stomach regurgitate high enough to affect the throat (pharynx and larynx); usually comes on at night with positional change and starts with throat tickle, lump sensation at top of throat, or cough; different symptoms than traditional acid reflux. 
- Reflux esophagitis - Acid reflux that irritates the esophagus and causes symptoms; can be caused by GERD, [eosinophilic esophagitis,](/blog/eosinophilicesophagitis) hiatal hernia or certain medications. 
- [Barrett's ](/blog/barrett-s-esophagitis-causes-symptoms-treatments-and-when-to-seek-medical-help) [esophagus](/blog/barrett-s-esophagitis-causes-symptoms-treatments-and-when-to-seek-medical-help) - Longer-term reflux esophagitis where the tissue changes from squamous (normal) to columnar (abnormal) in response to chronic exposure to stomach acid. 

### Are Acid Reflux and Heartburn the same thing? 

Acid reflux (from the stomach back up the esophagus) may cause a heartburn sensation, so the terms are often used interchangeably, though mean different things. 

### Are Acid Reflux and GERD the same thing?

While the terms are often used interchangeably, they actually mean different things. Acid reflux is the primary reason why patients have gastroesophageal reflux, stomach contents regurgitating into he esophagus and causing discomfort. GERD is the official diagnosis stemming from longer-lived symptoms of acid reflux or heartburn.

### Are Acid Reflux and Indigestion the same thing? 

The terms are often used interchangeably because acid reflux is often referred to as acid indigestion.  Acid reflux is where stomach contents regurgitate up through a lax Lower Esophageal Sphincter (LES, the stomach's "lid") and into the esophagus, causing discomfort, usually a burning sensation. Indigestion (minus the "acid") is a catch-all for abdominal discomfort that can be caused by a number of things including reflux, gas, irritable bowel syndrome (IBS) and various abdominal pains (not just burning). 

### Can Acid Reflux go away (on its own)?

As a one-off episode, yes (though can be uncomfortable). As a chronic condition - GERD - defined as acid reflux more than 2 days per week - the answer is no. With GERD, some intervention is recommended to reduce symptoms, promote healing and halt progression of any tissue damage.

### When is Acid Reflux considered serious? 

Acid reflux episodes that occur more than twice per week are considered serious, the chronic form called gastroesophageal reflux disease GERD). When it becomes chronic, it is important to seek help from a doctor to ease the symptoms and halt the progression of any tissue damage.

### What should you do if Acid Reflux won't go away?

When Acid Reflux becomes chronic, it is important to seek help from a doctor - especially one who treats the root cause - to ease the symptoms and halt the progression of any tissue damage. 

### What are Acid Reflux alarm signs?

Alarm signs for acid reflux include chest pain or pressure (like an elephant sitting on your chest), which could be a heart attack. If heartburn symptoms are accompanied by arm, neck, jaw or back pain; nausea, pale skin, sweating (diaphoresis), lightheadedness fast pulse, you should call 9-1-1 or go to the ER.

Another set of alarm signs include regurgitating/vomiting blood or a coffee grounds-like material or having tarry, black stools - these are all signs of gastrointestinal bleeding and should be investigated at the ER.

### Why does Acid Reflux occur after eating?

Eating fills the stomach, causing contents to rise toward the top or "lid" called the Lower Esophageal Sphincter (LES). If the muscle is lax, stomach contents can reflux into he esophagus and cause symptoms.  

The stomach pumps a commensurate amount of Hydrochloric Acid (HCl) for what has been eaten. If you consume a large meal, it will take up more space in the stomach, it will pump out more acid and you may feel the effects of more acid regurgitation into the esophagus

### Can you get Acid Reflux on an empty stomach (fasting)?

Yes. Neurotransmitters that signal hunger (such as ghrelin) will initiate the production of stomach acid in preparation for a meal. This can irritate the stomach lining and/or relax the LES, leading to acid reflux.

## Acid Reflux Symptom FAQs

### What does Acid Reflux feel like? What are the symptoms of GERD?

Acid reflux affects the stomach and esophagus and very often feels like a burning sensation in your mid-chest near the sternum (this is why it's often referred to as “heartburn”). Other people might describe it as a feeling not dissimilar to indigestion i.e. burning, sour stomach, pain and discomfort - low down in the stomach between the ribs.

### Does Acid Reflux cause stomach pain?

Typically, yes. Pain is usually described as a burning sensation behind the sternum (breast bone) or in the upper-center of the abdomen underneath it. 

### Can Acid Reflux cause shortness of breath?

Yes. First, though shortness of breath is an alarm sign for heart attack. If it is accompanied by arm, neck, jaw or back pain; nausea, pale skin, sweating (diaphoresis), lightheadedness, or fast pulse, you should call 9-1-1 or go to the ER.

That said, the stomach is located under the diaphragm, which regulates breathing and the two organs can interact. A full stomach after a meal or pregnancy can push the stomach up against the diaphragm and cause discomfort. In these cases, it may be hard to get a deep breath.

Some people also can have a hiatal hernia, a condition where the stomach can slide through the esophageal hiatus after eating and stick above the diaphragm until contents digest and the stomach relaxes back through the opening. While happening, this can cause shortness of breath as the pouch takes up space above the diaphragm and presses up near the pericardium (the sack that protects the heart). In many cases, a hiatal hernia can be manually adjusted.

### Can Acid Reflux cause chest tightness or chest pain? 

Yes. It should first be said though that chest pain or pressure is an alarm sign for heart attack. If it is accompanied by arm, neck, jaw or back pain; nausea, pale skin, sweating (diaphoresis), lightheadedness fast pulse, you should call 9-1-1 or go to the ER.

Chest pain is the primary symptom of "heartburn," the most common cause of non-cardiac chest pain and sends an estimated 9 million people to the doctor annually.[5]

### Where does Acid Reflux chest pain occur? 

Acid reflux pain is usually described as a burning sensation behind the sternum (breast bone) or in the soft tissue in the upper-center of the abdomen just underneath it.

### Can Acid Reflux cause lightheadedness / dizziness? 

Yes. First, it is very important to differentiate these symptoms from a heart attack, which can also include chest, neck, jaw or back pain; nausea, sweating, pale skin and rapid heartbeat.

That said, acid reflux can irritate the vagus nerve, our primary calming nerve, which is involved in digestion and runs directly from the brain near the ears down to the center of our chest, touching most of the organs and structures along the way. When the esophagus gets irritated it can refer up the vagus nerve and affect the balance center in our ears. It also can affect blood pressure, which can go high (sympatchtic activation) and cause symptoms of dizziness or lightheadedness.

### Can Acid Reflux cause higher blood pressure?

Yes. When the esophagus gets irritated it can cause activation of our sympathetic ("fight or flight") nervous system which can increase blood pressure. It is very important to differentiate these symptoms from a heart attack, which also can include chest, neck and jaw pain; nausea, sweating, pale skin and rapid heartbeat.

### Can Acid Reflux cause heart palpitations? 

Heart palpitations are not a common symptom of GERD. However, it can occur in about the 10% of people with GERD who have gastroparesis (slow stomach emptying)due to vagal neuropathies.[7] Acid reflux also can activate the sympathetic ("fight or flight") nervous system which can cause blood pressure fluctuations. 

### Can Acid Reflux cause nausea or vomiting? 

Acid reflux can cause a symptom of nausea or a feeling of sour stomach. Nausea as an acid reflux symptoms tends to be stronger in my patients who also have [gastritis or peptic ulcer](/blog/peptic-ulcer-disease-pud-conventional-and-natural-treatments) . It doesn't cause vomiting per se; that usually comes from being nauseous enough you want to throw up.

### Can Acid Reflux cause coughing? 

Acid reflux can cause coughing. This is usually more prevalent in the Layngopharangeal Reflux (LPR) variety, where stomach contents may travel as far as the windpipe or oral cavity. For more "run of the mill" acid reflux, the activation of sympathetic ("fight or flight") nervous system from acid in the esophagus may cause referral symptoms higher up, leading to symptoms of tight/hoarse voice, pit at top of the throat or wheezing, which may precipitate the need to cough. 

### Is Acid Reflux related to constipation?

Maybe. It's hard to say if acid reflux causes constipation. The consensus is that the symptoms overlap, that GI tract symptoms up high can affect function below. It also is believed that acid reflux medications such as proton pump inhibitors (PPIs) can contribute to constipation due to poor digestion of food. [9] A bloated belly from more severe constipation could put upward pressure on the stomach and make acid reflux more likely.

### Does Acid Reflux cause diarrhea? 

The consensus is that the symptoms are separate but could overlap. GERD affects the upper GI and IBS/diarrhea/loose stool is a lower GI symptom.

PPIs are more likely to cause diarrhea that acid reflux itself. A 2019 Mexican study looked at how the use of proton pump inhibitors (PPIs) as part of acid reflux treatment might influence the development of IBS. Treatment of heartburn with PPIs affect stomach acidity, which can increase the risk of small intestinal bacterial overgrowth (SIBO). People with SIBO often experience IBS-type symptoms, including diarrhea and constipation. [10]

The body has a primitive response to invaders or irritants in the gut -- flood it out. While stomach irritation could cause the body to react this way, this is usually triggered where nutrients start to get absorbed -- in the small intestine.

### Can Acid Reflux cause sore throat? 

Yes, but it depends. Most acid reflux will stay low in the esophagus; this may irritate the local nerves, creating a "burning" chest sensation and/or referral sensations up the esophagus into the throat and ears. However, some types of reflux such as Lanyngopharangeal Reflux (LPR) - where acid rises as high as the voice box and oral cavity - can more directly cause sore throat, hoarse voice and sensation of pit or lump in the throat. 

### Can GERD / Acid Reflux cause hoarse voice? 

Yes. Chronic acid reflux can cause a hoarse voice due to acid  regurgitating into the esophagus; this irritates the nerves (including the vagus nerve) that run the length of the esophagus, creating a sympathetic nerve state, tightening the vocal chords, which can affect voice. Sometimes, as in LPR, it can be a result of direct injury - acid rising to the level of the larynx (voice box) and affecting the nerves and vocal cords. 

### Can I get acid reflux when I'm sleeping?  Why is Acid Reflux worse at night? 

Acid reflux tends to be worse at night because we slow our movement and change into a horizontal position when we lay down to sleep. We're essentially turning the stomach container on its side and if the lid (LES) is lax, contents can spill and contribute to symptoms. Regular upright movement during the day aids the digestive process and gravity helps with the rest, keeping food in the bottom of the stomach after it's eaten. Some people can have "silent reflux" (laryngopharangeal reflux or LPR) where stomach contents are more likely reach up the esophagus to the windpipe and oral cavity, which can irritate the larynx and trachea when breathing; this is often enough to produce a cough and/or wake someone up. 

## Acid Reflux Causes FAQ

### Does too much stomach acid cause Acid Reflux or GERD? 

Maybe. "Too much acid" causing reflux is a myth perpetuated by the advertisers of popular acid reflux medications. It's a half-truth: the stomach pumps a commensurate amount of Hydrochloric Acid (HCl) for what has been eaten. If you consume a large meal, it will take up more space in the stomach, it will pump out more acid and you may feel the effects of more acid regurgitation into the esophagus. But true hyperchlorhydria (too much acid) is rare, usually from a condition like Zollinger-Ellison syndrome (ZES), where one has a gastrin tumor (gastrin promotes stomach acid) or similar condition; these can cause GERD. 

### Can too little stomach acid cause GER? 

Yes, ironically, too little stomach acid, hypochlorhydria, can cause symptoms of reflux. Hypochlorhydria can create tissue irritation from undigested food and changes in stomach pressure that can cause the Lower Esophageal Sphincter (LES) to relax inappropriately and regurgitate contents into the esophagus.

Chronic use of certain medications such as proton pump inhibitors (PPIs) can cause low stomach acid and sometimes cause the very condition they seek to remedy. Physical conditions such as achlorhydria and autoimmune gastritis can cause this as well and should be addressed by a gastroenterologist.

### Do food sensitivities cause GERD? 

Yes. I find that GERD is almost always related to food sensitivity or eating habits. A gastroenterologist will sooner send an endoscope down your throat than ask what's on the end of your fork. Food sensitivities as well as spicy, fatty, ultra-processed or fast foods can start or exacerbate GERD. Many people with GERD find that it can resolvewith these minor, temporary alterations to their diet. 

Can stress cause GERD?

Yes. I would say that stress is the most common cause of GERD due to the nervous system mismatch. We are meant to eat in a parasympathetic (or "rest and digest") nervous system mode. When we are stressed, the body is in "fight or flight" or sympathetic nervous system mode. Your nervous system halts digestion under stress. Then, the bolus of food is like a car stuck in the car wash when the power goes out -- everything stops and the car sits. Over time, this creates indigestion, inflammation and sometimes more stress -- and what we ingest (sometimes background stress of its own) can run over the inflamed areas and make them worse.

### Can a hiatal hernia cause Acid Reflux?

Yes. About 20% of the population have a hiatal hernia, a condition where the stomach pushes through the diaphragmatic opening into the chest, compromising the Lower Esophageal Sphincter (LES), the muscle that serves as a "lid" for the stomach. The inappropriately relaxed LES can enable gastric contents and acid to regurgitate into the esophagus, leading to GERD.[8] 95% of hiatal hernias are the "sliding" variety so acid reflux symptoms can occur with position changes such as lying down at bedtime.

### Can ibuprofen (NSAIDs, Advil, Motrin, Alleve, etc.) cause Acid Reflux? 

Technically, yes. Non-steroidal anti-inflammatory drugs (NSAIDs) can contribute to the relaxation the Lower Esophageal Sphincter (LES), the main cause of acid reflux.[6] However, in normal doses, for temporary use and when taken with food, NSAIDs don't often cause GI issues.

NSAIDs reduce an inflammation-signaling neurotransmitter called COX-1, which inhibits prostaglandins, which help to protect the gut lining and drain acids from the stomach. As a…