Do you or someone you care for regularly experience heartburn, or an uncomfortable burning feeling in the upper chest that moves into the neck and throat? Can you usually pinpoint the cause of the discomfort—maybe late-night snacking or a favourite spicy recipe—or is it happening often and without clear cause? If the latter, you may be dealing with a more serious and chronic condition called gastroesophageal reflux disease (GERD).

Most adults experience heartburn, but there are many factors that can make it worse and more frequent as you age. Read on to learn about the differences between heartburn, acid reflux and GERD, how to manage your symptoms and when to talk to a doctor.

How are Heartburn, Acid Reflux and GERD different?

The terms heartburn, acid reflux and gastroesophageal reflux disease or GERD are often used interchangeably, but they aren’t the same thing.

• Acid reflux occurs when the lower esophageal sphincter (LES) muscle that joins the esophagus and stomach doesn’t tighten properly causing stomach acid to back up or ‘reflux’ into the esophagus.
• Heartburn, or a burning, tightening or discomfort that starts behind the breastbone and moves up to the neck and throat, is the most common symptom of acid reflux. Other symptoms include a sore throat, bitter or sour taste and the regurgitation of food or liquid back into the mouth.
• Gastroesophageal reflux disease, is a more severe and chronic form of acid reflux. It is usually diagnosed when reflux occurs more than twice a week over several weeks and isn’t relieved by over-the-counter antacids. GERD requires medical attention because symptoms can disrupt daily life and cause long-term damage to the esophagus, which can be related to esophageal cancer in extreme cases. GERD can also inflame and damage the throat and cause bronchitis, asthma or pneumonia. If you or a loved one have more than two episodes of acid reflux a week, you should talk to your doctor.

What are the symptoms of GERD?

People are affected in different ways, but the common signs and symptoms of GERD are:

• Heartburn
• Regurgitation
• Dry cough
• Asthma
• Sore throat and hoarseness
• Difficulty swallowing
• Chest pain
• Nausea
• Disrupted sleep
• Damage to tooth enamel

In most cases, older adults are able to communicate their pain or discomfort, but in other situations, caregivers may need to look for these signs in their loved ones. GERD symptoms can also signal other serious medical problems. Get immediate medical attention if stools are maroon or black, or blood or a material that resembles coffee grounds is vomited, as that could indicate internal bleeding in the stomach.

Why do these symptoms get worse with age?

There are several reasons why seniors experience more acid reflux and heartburn as they age. Just like other muscles, the sphincter that controls the passage between the esophagus and stomach naturally weakens over time. This means that it doesn’t shut as quickly or effectively as it used to, and stomach acid can enter the esophagus causing heartburn. Weight gain with age can also put pressure on the abdomen and stomach, pushing acid into the esophagus. Many people over 60 also have a hiatal hernia that can cause the upper part of the stomach to push up into the chest cavity and interfere with the esophageal tract. Additionally, some medications commonly prescribed to seniors including antidepressants, opioids, sedatives and blood pressure medicines can weaken the LES muscle creating increased reflux problems.

How can I treat and manage my symptoms?

Occasional acid reflux can usually be managed with lifestyle changes and over-the-counter medications. Avoiding caffeinated and alcoholic beverages, as well as acidic, fatty, fried and spicy food that may trigger symptoms can help. Keep a record of what you’re eating to figure out what is causing the discomfort. Other lifestyle changes including improving your diet overall, drinking more water, quitting smoking and increasing physical activity can also be beneficial.

If you’re diagnosed with GERD, your heartburn and other symptoms will not go away without treatment and it can lead to more serious problems. Many GERD cases can be improved with medication to reduce the amount of acid in the stomach. Along with positive changes to diet and physical activity, other adjustments like smaller, more frequent meals, staying upright for two hours after mealtime, elevating your head at night and avoiding tight clothing can all be helpful.

If your symptoms do not improve with drug therapy or lifestyle changes, you may be a candidate for surgery to strengthen the barrier between your stomach and esophagus. Sometimes this can be a good alternative to long-term medication use. Talk to your healthcare provider so you can develop the best treatment plan for you.

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