GERD (Heartburn and Reflux)

Gastroesophageal reflux disease (GERD) is a condition where stomach contents and acid go backward into the esophagus. While this happens to everyone occasionally, when this happens frequently it is called GERD. GERD may also be called “acid reflux” or “acid indigestion.”¹

GERD is very common, and many people with asthma also have GERD. It may worsen asthma and make symptoms harder to control. The most common symptoms of GERD are heartburn and regurgitation. Treating GERD can help improve asthma symptoms and outcomes. Talk to your doctor if you notice symptoms.^2,3

What causes GERD?

The esophagus carries foods and liquids from your throat to your stomach. The lower esophageal sphincter (LES) is a group of muscles at the bottom of the esophagus. The LES opens to let food through. It then tightens to keep food and stomach acid in the stomach.¹

GERD happens when the LES muscles are too weak or relaxed. When this happens, stomach contents can back up into the esophagus. These contents can include fluid, food, and digestive juices. Other problems with the stomach and esophagus can also cause GERD.¹

What are the symptoms of GERD?

Common symptoms of GERD include:¹

• Heartburn
• Chest pain
• Dry cough
• Trouble swallowing (dysphagia) or painful swallowing (odynophagia)
• Nausea
• Sense of something stuck in the throat (globus)
• Sore throat
• Hoarseness

Some of these GERD symptoms are also symptoms of asthma. This can make it hard for people with asthma to notice GERD symptoms.⁴

How does GERD affect asthma?

Asthma and GERD often happen together. People with asthma have a higher risk of GERD. In fact, about half of children and adults with asthma have GERD. People with GERD also have a higher risk of asthma. But many people who have both asthma and GERD do not show typical GERD symptoms.^3-8

GERD can worsen asthma symptoms. In GERD, the esophagus is exposed to stomach acid. This can make the airways more reactive, meaning they overreact to things in the environment and swell up more easily. GERD can also cause small amounts of stomach contents to enter the lungs (micro-aspiration). This can lead to airway constriction and blockage.^4,5

Asthma can also worsen GERD symptoms. Airway obstruction causes pressure changes in the chest and diaphragm. This can promote reflux of stomach contents. Some drugs prescribed to treat asthma can cause GERD by relaxing the LES.⁵

Other shared risk factors may also link asthma and GERD. For example, obesity and obstructive sleep apnea (OSA) are common among people with asthma. Obesity and OSA can lead to GERD by causing the LES to relax and open.⁹

How do doctors determine if GERD is an asthma trigger?

Doctors often ask people with asthma about GERD symptoms. Signs that GERD is causing or worsening asthma symptoms include:⁵

• Asthma symptoms starting as an adult
• Trouble controlling asthma symptoms with typical medicines
• Asthma symptoms that start right after a GERD episode

If your doctor suspects GERD as an asthma trigger, they may refer you to a gastroenterologist. This is a doctor who specializes in the care of your stomach and intestines.^4,10

A gastroenterologist can perform tests to diagnose GERD. These tests may include endoscopy, imaging, or testing acid levels. They may also ask you to try different medicines to see whether your symptoms improve.⁴

How is GERD treated?

Lifestyle changes are the main treatment strategies for GERD. Common changes you can make to reduce GERD symptoms include:^2,3

• Eating small meals
• Avoiding triggers, such as high-fat or spicy foods, caffeine, alcohol, chocolate, carbonated beverages, and acidic foods
• Staying upright after eating for 2 to 3 hours
• Using blocks to lift the head of your bed 6 to 8 inches
• Losing weight if you are overweight
• Quitting smoking

If GERD symptoms continue after lifestyle modifications, your doctor may recommend over-the-counter and prescription drugs. Drugs that can reduce GERD symptoms include:^3-5

• Histamine receptor antagonists such as Pepcid® (famotidine) and Tagamet® (cimetidine)
• Proton pump inhibitors (PPIs) such as Prilosec® (omeprazole), Prevacid® (lansoprazole), Nexium® (esomeprazole), Protonix® (pantoprazole), Dexilant® (dexlansoprazole), and Aciphex® (rabeprazole)

PPIs are often effective in reducing symptoms and healing the esophagus. If medicines do not work or are not an option for you, your doctor may recommend surgery. The most common surgery for GERD is called laparoscopic Nissen fundoplication or anti-reflux surgery.^4,11

A laparoscopic surgery uses small cuts and small tools (minimally invasive). Laparoscopic Nissen fundoplication is used to “wrap” the stomach around the LES to help the LES work better.¹¹

How does treating GERD affect asthma?

Treating GERD can improve asthma symptoms. It is most effective in people with severe asthma. Clinical trials have shown benefits for people with asthma who do have symptoms of GERD. Taking a PPI drug can reduce nighttime asthma symptoms and improve quality of life. Surgical treatments for GERD may also improve asthma symptoms.^3,4

If treating GERD symptoms does not improve asthma, GERD may not be what is triggering asthma. In this case, GERD may be managed separately. GERD treatments will not improve asthma for people who do not have GERD symptoms. This is why GERD treatments are not recommended for everyone with asthma.⁴