Heartburn, acid reflux, and GERD, or gastroesophageal reflux disease, are terms that are often used interchangeably. Yet while they’re all closely related, they don’t necessarily mean the same thing. So if you’ve ever stopped and thought about heartburn vs. acid reflux vs. GERD and wondered what the difference is, we invite you to read on. We’ll talk about the differences—and the similarities—and how you can find relief from all three!
What Is Heartburn?
Heartburn refers to a burning sensation felt in the center of the chest, directly behind the breastbone. The condition is caused by relaxation of the lower esophageal sphincter (LES)—a band of muscle located at the bottom of the esophagus.
Under normal circumstances, the LES remains tight until it needs to allow food and liquids to pass from the esophagus into the stomach, at which point it relaxes. However, sometimes the LES becomes weak or malfunctions and relaxes when it should be tight. When this happens, stomach acid refluxes back up into the esophagus.
The two most common heartburn symptoms are:
- Burning chest pain after eating or while trying to sleep
- Worsening of pain when lying down or bending over
Many people have mistaken the sometimes excruciating pain of heartburn for something more sinister, like a heart attack, but occasional heartburn is actually quite common and not dangerous. In fact, the American College of Gastroenterology reports that more than 60 million Americans have the condition at least once a month.
Even though occasional episodes of heartburn are nothing to worry about, frequent heartburn can be a sign of a more serious condition.
What Is Acid Reflux?
Like heartburn, acid reflux occurs when the LES doesn’t tighten properly and allows stomach contents to flow back up into the esophagus. Yet heartburn is merely a symptom—albeit the most common one—of acid reflux.
In fact, aside from regurgitation and a bitter or sour taste in the mouth, you might not associate most symptoms of acid reflux with stomach acid. For example, symptoms may include:
What Is GERD?
As mentioned, everyone has acid reflux from time to time. However, if symptoms of acid reflux become chronic, the condition then becomes known as GERD. To be diagnosed with GERD, one of two situations must be present:
- Mild symptoms occur at least twice a week
- Moderate to severe symptoms occur at least once a week
Unlike occasional acid reflux, the chronic inflammation caused by GERD can lead to serious complications due to damage to the lining of the esophagus. Some of these complications include:
- Narrowing of the esophagus due to scar tissue (esophageal stricture)
- Erosion of areas of the esophagus (esophageal ulcers)
- Precancerous changes to the esophageal lining (Barrett’s esophagus)
- Esophageal cancer
In addition, frequent regurgitation of acid can lead to damage to the tooth enamel.
Risk Factors for Heartburn, Acid Reflux, and GERD
One thing heartburn, acid reflux, and GERD have in common is that they’re triggered by the same things. Risk factors associated with all three conditions include:
|Spicy foods||Fatty foods|
|Large meals||Garlic and onions|
|Alcohol||Caffeinated or carbonated beverages|
|Iron and potassium supplements||Nonsteroidal anti-inflammatory drugs (NSAIDs)|
|Aspirin||Antidepressant and anti-anxiety medications|
Diagnosing Heartburn, Acid Reflux, and GERD
Although your health care provider will probably be able to tell whether you have heartburn, acid reflux, or GERD based on your symptoms and a physical exam, they may choose to perform certain procedures to enable a more in-depth examination of the esophagus and stomach. These procedures may include:
- Upper endoscopy: This procedure uses a flexible, lighted tube, inserted through the mouth, to assess the esophagus and stomach for signs of damage. An endoscopy can also be used to perform a biopsy to evaluate for signs of Barrett’s esophagus.
- Esophageal manometry: This esophageal motility study assesses the strength and coordination of the esophageal muscles and LES during swallowing to measure the ability of the esophagus to move food to the stomach efficiently.
- Barium swallow: After drinking a chalky liquid, X-rays are taken to view the esophagus, stomach, and duodenum to assess for changes related to GERD.
Heartburn vs. Acid Reflux vs. GERD: How to Find Relief
Depending on the severity of your symptoms, your health care provider may recommend antacids to neutralize stomach acid or over-the-counter (OTC) or prescription medications to reduce the amount of acid produced by the stomach (histamine 2 blockers, or H2 blockers), decrease acid production and help heal the esophagus (proton pump inhibitors, or PPIs), or strengthen the LES (baclofen).
However, these medications aren’t without side effects. For example, several studies have shown that PPIs may cause severe rebound symptoms after withdrawal of the medication—and these symptoms can continue for weeks after stopping the PPI. Long-term use of PPIs is also associated with a risk of both dementia and kidney damage.
Moreover, a recent study found that long-term use of PPIs is associated with an increased risk of death. And H2 blockers and PPIs can both lead to vitamin B12 deficiency and fractures.
However, there’s no denying that GERD symptoms can lead to severe complications over time, and use of medications is certainly warranted in severe cases. But it’s important to note that most people can reduce or even eliminate symptoms by instituting simple lifestyle changes instead.
- Avoid tight clothing. Tight clothes and belts compress the abdomen and LES and can make symptoms worse, so avoid belts and choose loose clothing instead.
- Lose weight. If you’re overweight, commit to a program of healthy weight loss, as excess weight is a risk factor for heartburn, acid reflux, and GERD.
- Avoid overeating. Large meals overfill the stomach and put pressure on the LES. So instead of eating two or three large meals, try eating smaller, more frequent meals throughout the day. In addition to helping symptoms of acid reflux, this strategy has the added benefit of stabilizing blood sugar, which can make weight-loss goals easier to achieve.
- Stop smoking. The act of smoking weakens the LES and can increase symptoms of acid reflux.
- Sit up after eating. Waiting at least 3 hours after eating before lying down gives the body time to digest food and reduces the risk of reflux.
- Try baking soda. Baking soda neutralizes stomach acid and can prevent reflux symptoms. To get the benefits of this remedy, simply add a teaspoon of baking soda to 8 ounces of water and drink slowly. However, baking soda contains large amounts of sodium, which can lead to swelling and increased blood pressure in some people, so this method shouldn’t be used on a regular basis.
- Drink ginger tea. Ginger has long been used as a natural remedy for digestive tract issues such as nausea and heartburn and has been shown to decrease the production of stomach acid.
- Supplement with deglycyrrhizinated licorice (DGL). This special form of licorice has had its glycyrrhizin removed to prevent side effects like elevated blood pressure. DGL increases mucus production, which can protect the stomach and esophagus from excess stomach acid.
- Take probiotics. Taking a high-quality probiotic supplement daily can reduce levels of harmful bacteria in the gut and aid digestion, and some studies have indicated a link between improved digestion and decreased levels of reflux.
- Try magnesium. Experts estimate that between 50% and 80% of people in the United States are deficient in this important mineral. Yet over 300 enzymes require magnesium for their activation, including those involved in the digestion of food. Moreover, magnesium helps reduce the spasms in the LES that can lead to symptoms of reflux.
- Take melatonin. Several studies have found that melatonin supplementation is useful in the treatment of reflux symptoms. In fact, one recent study found that melatonin may exert a significant protective effect on esophageal mucosa.
- Reduce stress. Stress has a well-documented relationship with reflux and is known to affect both esophageal motility and LES function. Reducing levels of stress via techniques such as exercise, meditation, and deep breathing may help reduce symptoms of acid reflux as well.
- Take amino acids. A 2006 study found that supplementation with a formula that included the amino acids L-tryptophan (a precursor of melatonin) and methionine was more effective at relieving symptoms of GERD than omeprazole, a popular OTC medication for treatment of reflux symptoms. In addition, some studies indicate that L-glutamine may be beneficial in treating symptoms of reflux due to its role in supporting gastric mucosa.
If you have symptoms of heartburn, acid reflux, or GERD, these simple lifestyle changes should help you get back on the road to health. However, if you continue to experience severe or frequent symptoms, be sure to speak with your health care provider for further treatment options.