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Everyone gets heartburn now and again. It's an uncomfortable burning feeling that usually starts just below your breastbone and rises into your throat. You may also get a sour or bitter taste in your throat.

Most people get heartburn only once in a while, usually after drinking alcohol or eating rich or spicy food. But if you have heartburn often, you could have what doctors call GERD. This stands for gastroesophageal reflux disease.

• The most common symptom of GERD is heartburn. If you have heartburn at least twice a week, you probably have GERD.¹
• If you get heartburn several times a week, you'll probably need treatment to get better.
• Drugs called proton pump inhibitors are the best treatments for GERD.
• Drugs called H2 blockers also work but not as well as proton pump inhibitors. The advantage of H2 blockers is that you can buy them at the drugstore without a prescription.
• Surgery can help if you've had GERD for a long time and drug treatment hasn't worked.

To understand GERD and the best way to treat it, it helps to know something about your digestive system (the parts of your body that help break down food for cells to use).

The tube that carries food from your mouth to your stomach is called the esophagus. It's about 10 inches long and about an inch wide.² It's made of muscle and stronger supporting tissue (called connective tissue).

Your esophagus starts at the back of your throat and runs down to your stomach. It sits next to your windpipe (the tube that goes to your lungs).

When you swallow, your windpipe closes off and food or liquid is pushed from your throat into your esophagus. Muscles in the walls of your esophagus start to tighten and relax, making a squeezing movement (a wave-like action) that carries the food down to your stomach.

The lining of your esophagus is made of overlapping folds of tissue that let it stretch open so that larger pieces of food can pass through. The lining is pink and moist and looks a bit like the inside of your mouth.³

Underneath the surface of the lining are glands that make a thick fluid called mucus. This mucus helps food slip down more easily. And it also keeps the esophagus from getting damaged.

There is a ring of muscle at the lower end of your esophagus, where it joins your stomach. This ring of muscle separates your esophagus from your stomach. This muscle acts like a valve.

Usually the ring of muscle is closed. But when food reaches it, nerves trigger the muscle to open so food can pass into your stomach. Once food has passed into your stomach, the muscle tightens again and closes up. This stops the contents of your stomach from coming back up into your esophagus.

Your stomach makes acid and juices to help break down the food so that it can move on to the next part of your digestive system.

As you breathe, your chest presses downward onto the ring of muscle to make it close. This also helps keep acid out of your esophagus.

If you have GERD, the ring of muscle that sits between your esophagus and your stomach doesn't work properly. The muscle opens even when food is not passing through. And the muscle may stay open for too long. When this happens, acid from your stomach can flow back up into your esophagus. This backward flow is called reflux or acid reflux.

You get heartburn when the acid flows back into your esophagus. Heartburn is the burning feeling that runs up inside your chest to your throat. You get this feeling when acid from your stomach touches the lining of your esophagus. When you have heartburn you may also get a bitter acid taste in your mouth. And it may feel like food is coming back up into your throat or mouth.

Some people with GERD also have a problem getting rid of the acid in their esophagus. Normally, if stomach fluid flows into your esophagus, it quickly squeezes the fluid back into the stomach. And when there is acid in your esophagus, you tend to swallow extra saliva automatically to wash it down. But if you have GERD, the squeezing movement may be weak or you may make too little saliva.

Any acid that stays in your esophagus makes it sore. And this makes your heartburn worse.

If you get heartburn often and you don't get treatment for it, then over time the acid may make your esophagus sore. Doctors call this esophagitis. You may also get more serious problems, such as sores (called ulcers), patches of bleeding or a blocked esophagus.

About one-third to one-half of all people with GERD get damage or soreness (called inflammation) in their esophagus.^{1 4 5} If you have inflammation, it doesn't necessarily mean your symptoms will get worse. Some people with esophagitis have milder symptoms than people without this inflammation. Doctors don't know why this happens.

Researchers don't really know what causes GERD, so your doctor probably won't be able to tell you why you have it. Instead, your doctor may talk about risk factors. These are things that make it more likely that certain people will get a particular condition.

To find out more, see Risk factors for GERD.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.