Gastroesophageal reflux disease

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 6 Feb 2026

Last updated: 19 Dec 2025

Gastroesophageal reflux disease (GERD) is a clinical diagnosis. The classic symptoms are heartburn and regurgitation. A therapeutic trial of a proton-pump inhibitor (PPI) can serve for both diagnosis and initial treatment.

Upper endoscopy is indicated to evaluate for complications; for atypical, persistent, or relapsing symptoms; or for alarm features (e.g., weight loss, anemia).

Rate of relapse is high upon stopping treatment.

Serious complications of GERD include stricture, Barrett esophagus, or esophageal carcinoma.

Definition

Gastroesophageal reflux disease (GERD) is defined as "the condition in which the reflux of gastric contents into the esophagus results in symptoms and/or complications''.[1][2][3]

Typical symptoms are heartburn and acid regurgitation. Extraesophageal symptoms include cough, laryngitis, asthma, or dental erosion.[1][4][5][6] Atypical symptoms include dyspepsia, epigastric pain, nausea, bloating, and belching.[7]

GERD may occur with or without esophageal inflammation (esophagitis). If erosions are present on endoscopic examination, the condition is called erosive reflux disease (ERD); if there are no erosions, it is called nonerosive reflux disease (NERD).[1]

History and exam

Key diagnostic factors

heartburn
acid regurgitation

Full details

Other diagnostic factors

dysphagia
bloating/early satiety
laryngitis
globus
enamel erosion
halitosis
dyspepsia

Full details

Risk factors

family history of heartburn or GERD
older age
hiatal hernia
obesity
use of lower esophageal sphincter (LES) tone-reducing drugs
psychological stress
asthma
use of nonsteroidal anti-inflammatory drugs (NSAIDs)
smoking
alcohol consumption
peroral endoscopic myotomy (POEM)
dietary factors
pregnancy

Full details

Diagnostic investigations

1st investigations to order

proton-pump inhibitor (PPI) trial

Full details

Investigations to consider

esophagogastroduodenoscopy (EGD)
ambulatory pH monitoring
esophageal manometry
combined impedance-pH testing
barium swallow
esophageal capsule endoscopy

Full details

Emerging tests

endolumenal functional lumen imaging probe

Treatment algorithm

ACUTE

initial presentation

ONGOING

nonpregnant: proton-pump inhibitor-responsive

nonpregnant: incomplete response to proton-pump inhibitor

pregnant: intractable symptoms or complicated reflux disease

Contributors

Authors

Marc J. Zuckerman, MD

Professor of Medicine

Chief of Division of Gastroenterology

Texas Tech University Health Sciences Center

El Paso

Disclosures

MJZ has been reimbursed and is on the speakers bureau for Phathom Pharmaceuticals, the manufacturer of vonoprazan.

Andres F. Carrion, MD

Gastroenterologist

GastroMed Miami

Miami

Disclosures

AFC declares that he has no competing interests.

Acknowledgements

Dr Marc J. Zuckerman and Dr Andres F. Carrion would like to gratefully acknowledge Dr Sheila Feit and Dr Mohamed Othman, previous contributors to this topic.

Disclosures

SF declares that she has no competing interests. MO has acted as a consultant for Olympus.

Peer reviewers

Lars Aabakken, MD

Professor of Medicine

Chief of GI Endoscopy

Rikshospitalet University Hospital

Oslo

Norway

Disclosures

LA declares that he has no competing interests.

Lise Lotte Gluud, MD, DMSc

Consultant

Department of Internal Medicine

Copenhagen University Hospital

Hellerup

Denmark

Disclosures

LLG declares that she has no competing interests.

Gary W. Falk, MD, MS

Professor of Medicine

Department of Gastroenterology & Hepatology

Center for Swallowing & Esophageal Disorders

Cleveland Clinic

Cleveland

Declarações

GWF has received fees from: AstraZeneca (consultant, speakers bureau, grant support); Takeda (grant support); Pentax (speaker, travel); Wyeth (consultant); and C2 Therapeutics (consultant).

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Referências

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Principais artigos

Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56.Texto completo Resumo

ASGE Standards of Practice Committee, Desai M, Ruan W, et al. American Society for Gastrointestinal Endoscopy guideline on the diagnosis and management of GERD: summary and recommendations. Gastrointest Endosc. 2025 Feb;101(2):267-84.Texto completo Resumo

Freedberg DE, Kim LS, Yang YX. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology. 2017 Mar;152(4):706-15. Resumo

Ness-Jensen E, Hveem K, El-Serag H, et al. Lifestyle intervention in gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2016 Feb;14(2):175-82.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Acute coronary syndrome
- Stable angina
- Functional esophageal disorder/functional heartburn
Mais Diagnósticos diferenciais
Guidelines
- Guideline on the diagnosis and management of GERD: summary and recommendations
- ACR practice parameter for the performance of esophagrams and upper gastrointestinal examinations in adults
Mais Diretrizes
Patient information
GERD: questions to ask your doctor
Acid reflux, heartburn, and gastroesophageal reflux disease (GERD)
More Patient information
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Gastroesophageal reflux disease

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Emerging tests

Treatment algorithm

initial presentation

nonpregnant: proton-pump inhibitor-responsive

nonpregnant: incomplete response to proton-pump inhibitor

pregnant: intractable symptoms or complicated reflux disease

Contributors

Authors

Marc J. Zuckerman, MD

Disclosures

Andres F. Carrion, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Lars Aabakken, MD

Disclosures

Lise Lotte Gluud, MD, DMSc

Disclosures

Gary W. Falk, MD, MS

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice