Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a condition in which acid reflux, the back flow of stomach contents into the esophagus (the tube connecting the throat to the stomach), causes distress and/or complications.


Gastroesophageal reflux disease (GERD) is a condition in which acid reflux, the back flow of stomach contents into the esophagus (the tube connecting the throat to the stomach), causes distress and/or complications. ​

What is Gastroesophag​​eal Reflux Disease (GERD) and what causes it? ​​

Acid reflux is a normal process which occurs in all individuals. However, constant irritation to the lining of the esophagus, with frequent reflux, can give rise to GERD. 

GERD occurs when a circular ring of muscle that connects the lower end of the gut to the stomach is weak and/or relaxed or if the stomach pushes up through a hole in the diaphragm (large flat muscle at the base of the lungs) muscle. The following factors may increase your risk of getting GERD: 

  • Ageing
  • Pregnancy
  • Obesity 
  • Cigarette smoking
  • Over-eating and having a dietary intake of spicy/fatty/tomato-based foods, chocolate, orange juice, caffeinated/carbonated drinks, alcohol, peppermint and onions  
  • Use of certain medications like codeine, nifedipine, salbutamol, prazosin, ibuprofen, iron salts and alendronate
  • Medical conditions like anxiety, depression, peptic ulcer disease and irritable bowel syndrome​

​​What are the symptoms?

Heartburn. A burning sensation that rises from the stomach or lower chest towards the neck, commonly occuring after food.  Non-cardiac (not related to the heart) chest pain may also be experienced. 

Acid regurgitation. Acidic stomach contents rise into the throat or mouth. 

Other symptoms of GERD include swallowing difficulty, nausea, cough, sore throat, shortness of breath, hoarseness, wheezing, teeth erosion and ear infections. ​


What are the treatment options?

A number of medications are available in various forms (tablets, capsules, suspensions) to relieve GERD symptoms that are mild and occur ≤2×/week with minimal impact on quality of life. However, always consult a doctor or pharmacist before starting on any medications.

Antacids and Alginates​​

Antacids neutralise stomach acid while alginates form a barrier to protect the gut from gastric acid. Antacids such as aluminium hydroxide, magnesium hydroxide, calcium carbonate and sodium bicarbonate in various combinations with or without alginates can be bought over-the-counter and be used if GERD symptoms are ​not predictable. These medications are usually taken after food and before bedtime, not exceeding four times a day. It is to be noted that calcium and aluminium may cause constipation while magnesium may cause diarrhoea.

Some antacids and/or alginates may be used during pregnancy, breastfeeding and in children older than the age of one year.



Histamine-2 receptor antagonists (H2RAs)

H2RAs reduce gastric acid production and are available without a prescription at pharmacies, under the advice of a pharmacist. Cimetidine and famotidine (taken once a day) and ranitidine (taken twice a day), 30-60 minutes before a meal may be used if GERD symptoms are predictable e.g. after eating a large meal. Side effects of H2RAs include nausea, diarrhoea, constipation, abdominal pain, headache and dizziness. 


Proton pump inhibitors (PPIs)

PPIs like omeprazole and pantoprazole are used to inhibit gastric acid secretion and allow healing of the gut. They can be bought without a prescription at pharmacies, on the advice of a pharmacist.  They are usually given if your symptoms persist despite taking antacids and/or alginates and/or H2RAs for two weeks. PPIs are taken once a day, 30 minutes before food for two weeks. Both PPIs are equally effective for the treatment of GERD but may cause side effects like nausea, diarrhoea, abdominal pain and headache. ​



The following methods may also relieve symptoms of GERD:

  • Elevate the head of the bed by using six to eight inch blocks or foam wedges.
  • Avoid tight fitting clothes around the waist. 


Do I need to see a doctor?

The vast majority of patients with GERD will not develop serious complications if reflux is adequately treated. However, severe GERD may give rise to complications. Additionally, other conditions may mimic the symptoms of GERD. It is thus important to consult a doctor if you:

  • Experience shortness of breath, hoarseness, wheezing, teeth erosion and ear infections​
  • Have alarm features like pain on swallowing, swallowing difficulty, bleeding, chest pain, vomiting, unintended weight loss, bloody stools and jaundice (yellowing of the skin and whites of the eyes)
  • Have GERD symptoms that are moderate or severe, occurring ≥3×/week, with significant impact on quality of life
  • Have heartburn accompanied with fever, headache, nausea or vomiting (especially if the vomit has blood in it)
  • Have heartburn for over three months, with severe or night time heartburn, regardless if you have tried self-treatment or not
  • Are over 40 years old and experiencing GERD symptoms for the first time
  • Have symptoms which persist for more than two weeks despite self-treatment
  • Take more than one course of PPI treatment every four months
  • Are a child in whom the use of antacids are not indicated and/or require the use of H2RAs or PPIs​


What can I do to prevent recurrence of GERD?​

Weight management. Obesity is linked to a 1.5 to 2 times increase in the risk of GERD symptoms. Reaching and maintaining a healthy weight through appropriate exercise regimens and dietary choices is thus recommended.  

Smoking cessation. Smoking increases the amount of stomach acid and reduces and/or ​​damages your body's natural defense mechanisms to acid reflux. Smoking cessation is thus recommended for smokers who suffer from persistent heartburn. If smoking cessation is not possible, smokers should at least refrain from smoking immediately after meals. 

Diet. Avoid over-eating by eating small frequent meals. Avoid eating within 3 hours of bedtime. Recognise specific foods which trigger your symptoms and avoid them. For infants and young children, thickened feeds may be tried. 

Posture. Avoid lying down immediately after meals. For infants and young children, position them upright after feeding for 20 to 30 minutes.  

Medications. Certain medications have a direct irritant effect on the gut. Take plenty of liquid if you need to take doxycycline, aspirin, ibuprofen, naproxe​​​n, iron salts, quinidine, potassium chloride, alendronate and risedronate. ​



Information provided by this patient information leaflet is solely for informational purposes only and is not intended as a substitute for the advice provided by your physician, pharmacist or other healthcare professional. You should not use the information for diagnosis or treatment of a health problem or disease. Always speak with your physician, pharmacist or other healthcare professional before taking any medicine or supplement, or adopting any treatment for a health problem. Under n​​​​​o circumstances will Pharmaceutical Society of Singapore be liable to any person for damages of any nature arising in a way from the use of such information.​​


Prepared by the Pharmaceutical Society of Singapore, updated on 2016.


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