What Is GERD, Actually? A Gastroenterologist Explains

Here’s why your favorite meals are giving your esophagus grief.

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You knew that late-night pizza was going to spell trouble later, but you just couldn’t resist; the smell was incredible. And right on schedule, at 2:45 AM, the pizza came back to haunt you with burning pain in your chest. Yep…  It’s heartburn.

Contrary to popular belief, heartburn is not a medical condition all by itself, and it has nothing to do with your heart. Heartburn is actually a symptom of acid reflux, and it occurs in the esophagus (not your ticker).

“[Heartburn is] a burning sensation that occurs in the chest that is usually due to acid coming up from the stomach into the esophagus causing irritation,” says Roshini Raj, MD, a gastroenterologist at NYU Langone Health in New York City and co-founder of healthy living brand Tula.

What Causes Heartburn?

When food gives you upset stomach, it makes more intuitive sense. You know your stomach and intestines are in your midsection, so it’s logical that the cramping would happen there.

Heartburn, then, seems a tad confusing. Why would that spicy burrito cause pain in your chest?

What you’re actually feeling is irritation in your esophagus—not your heart or lungs, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). This dyspepsia (pain in the chest) may occur as far down as the middle of your abdomen, since your esophagus stretches from your stomach to your throat.

Between the stomach and esophagus, you have something called an esophageal sphincter. It’s like a valve that separates the two organs.

Your esophageal sphincter allows food to pass through to the stomach, but its job is to keep it there. That’s because the stomach contains potent acids that help digest food. The lining of the stomach is designed to withstand that acid, but your esophagus is not.

“When someone feels heartburn, acid is coming backward up into the esophagus, and it’s causing irritation or burning in the lining of the esophagus,” says Dr. Raj. If the acid comes up far enough, you may also taste the stomach acid in your mouth.

Certain foods, eating habits, and health conditions can alter the effectiveness of the esophageal sphincter, causing it to relax or loosen. This causes backward flow of stomach acid, known as acid reflux. Some triggers of acid reflux include:

  • Being pregnant

  • Carrying extra weight, especially in the abdominal area

  • Eating late at night and/or before lying down

  • Eating spicy, fatty, or acidic foods

  • Drinking alcohol

Here are more factors that may trigger acid reflux.

What Is Gastroesophageal Reflux Disease (GERD)?

When acid reflux occurs frequently, your doctor may diagnose you with gastroesophageal reflux disease, commonly known as GERD. This condition is pretty common; it affects some 20 percent of the U.S. population, according to NIDDK. Learn more about the difference between heartburn or GERD here.

“There are people with acid reflux who don’t experience heartburn,” says Dr. Raj. Instead, they may experience other symptoms of GERD caused by acid in the esophagus, such as:

  • Nausea

  • Trouble swallowing

  • Throat clearing

  • Bad breath

  • Dry, scratchy throat

  • Changes in your voice

“I think heartburn is so common that many people assume it’s a normal part of life,” says Dr. Raj. “The truth is, it’s not, and it could be a sign of something more serious going on in your body.”

If you experience heartburn (or other symptoms like nausea and trouble swallowing) more than twice a week, talk to your doctor about acid reflux. Not only can you doctor help you treat the GERD symptoms, but you may also figure out the underlying source of the problem to nix heartburn for good.