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What is Gastroesophageal Reflux Disease (GERD)?

Gastroesophageal Reflux Disease (GERD) is a condition in which the contents of the stomach flow back into the esophagus, causing inflammation of the esophageal lining. Normally, the lower esophageal sphincter at the entrance of the stomach prevents this reflux, but when its function is weakened, stomach acid and digestive enzymes can flow back into the esophagus, leading to symptoms such as heartburn and regurgitation of sour liquid into the throat.

In recent years, GERD has been rapidly increasing in Japan and is recognized as a lifestyle-related disease. Factors contributing to this rise include Western-style diets (high-fat, high-calorie foods), increasing rates of obesity, aging, and a decline in Helicobacter pylori infection. According to reports from the Ministry of Health, Labour and Welfare and the Japanese Society of Gastroenterology, about 10–20% of Japanese people experience symptoms related to GERD, making it a fairly common condition.

The prevalence is even higher in Western countries; in the United States, approximately 30% of the population experiences heartburn at least once a week (Mayo Clinic, 2022). According to WHO statistics, the global prevalence of GERD is steadily increasing, particularly in Asian countries as lifestyles become more Westernized.

Although GERD is not immediately life-threatening, it can significantly reduce quality of life (QOL). Nighttime heartburn and coughing can disrupt sleep, daily dietary restrictions may be necessary, and concentration at work or school can be impaired. Therefore, early and appropriate diagnosis and treatment are important.

Main Symptoms of Gastroesophageal Reflux Disease (GERD)

The symptoms of Gastroesophageal Reflux Disease (GERD) are diverse, and their severity and perception can vary from patient to patient. In addition to typical symptoms, unexpected signs may also appear, so careful attention is needed. Below, we provide a detailed explanation of the common symptoms and their characteristics.

Heartburn

The most well-known symptom is heartburn. This is characterized by a burning sensation deep in the chest, often occurring after meals or during sleep, and tends to worsen when lying down. It is caused by stomach acid flowing back into the esophagus and irritating its lining. According to a survey by the Japanese Society of Gastroenterology, about 15% of the population experiences heartburn at least once a week.

Regurgitation

The sensation of sour liquid or bitter stomach juice rising into the throat or mouth is called regurgitation. This is a highly characteristic symptom of GERD and, along with heartburn, serves as an important clue for diagnosis. Regurgitation is especially likely to occur during sleep or when leaning forward, and it can also cause bad breath and discomfort in the throat.

Chronic Cough and Throat Clearing

When stomach acid affects the esophagus as well as the throat and airways, it can lead to persistent coughing or throat clearing. This is sometimes misdiagnosed as cough-variant asthma or chronic bronchitis and is known as a 'silent symptom' of GERD. According to research by the U.S. National Institutes of Health (NIH), approximately 30% of patients with chronic cough have symptoms related to GERD.

Throat Discomfort and Hoarseness

You may experience a sensation of something stuck in your throat or hoarseness. These symptoms are caused by stomach acid reaching the pharynx or vocal cords, leading to inflammation. Even after visiting an ENT specialist without finding a cause, GERD may eventually be suspected. Such symptoms are sometimes referred to as Laryngopharyngeal Reflux Disease (LPRD).

Swallowing Difficulties (Dysphagia)

Repeated inflammation of the esophageal lining can cause narrowing of the esophagus, leading to swallowing difficulties (dysphagia). This is considered a precursor to esophageal stricture and may indicate a more severe condition, so careful attention is needed. If you have trouble swallowing solid foods or feel food getting stuck in your throat, you should consult a doctor.

Sleep Disturbances and Impact on Daily Life

Nighttime heartburn and regurgitation can reduce sleep quality, affecting concentration and productivity during the day. Lying down often promotes reflux, leading to sleep deprivation and chronic fatigue. According to a large-scale U.S. study (Vakil N, 2006, Am J Gastroenterol), approximately 75% of GERD patients report sleep disturbances, which significantly impair their quality of life.

Atypical Symptoms

In addition to typical symptoms such as heartburn and regurgitation, GERD can present with a variety of atypical symptoms, including chest pain, palpitations, bad breath, enamel erosion, and ear discomfort. These symptoms can be easily mistaken for heart or ENT conditions, potentially delaying diagnosis, so careful attention is necessary.

Causes and Risk Factors of Gastroesophageal Reflux Disease (GERD)

The development of Gastroesophageal Reflux Disease (GERD) involves multiple factors, including a decreased ability to prevent stomach acid reflux, lifestyle habits, and individual susceptibility. Below, we outline and explain the common causes and risk factors.

Weakening of the Lower Esophageal Sphincter (LES)

At the junction of the stomach and esophagus, there is a muscle called the Lower Esophageal Sphincter (LES), which normally remains closed to prevent stomach acid from flowing back. When the LES weakens, it allows acid to reflux into the esophagus, causing inflammation of the esophageal lining. LES dysfunction is known to occur due to aging, obesity, pregnancy, or the effects of certain medications.

Impact of Dietary Habits

Modern dietary habits play a significant role in the development of GERD. The following foods and beverages are particularly likely to trigger reflux:

* Fatty foods (fried foods, meat dishes)
* Chocolate
* Coffee, tea, and carbonated drinks
* Alcohol (especially beer and wine)
* Spicy foods

These items can increase stomach acid secretion or relax the LES, so individuals who consume them frequently are at higher risk.

Obesity

Obesity is one of the strongest risk factors for GERD. Increased visceral fat raises abdominal pressure, compressing the stomach and making it easier for stomach acid to reflux into the esophagus. Epidemiological studies in the United States have shown that individuals with a higher BMI have a significantly higher incidence of GERD (El-Serag HB, 2014, Clin Gastroenterol Hepatol).

Aging

With aging, esophageal peristalsis—the movement that pushes food toward the stomach—declines, reducing the ability to clear stomach acid. Additionally, the closure strength of the LES weakens, making older adults more susceptible to GERD.

Pregnancy

During pregnancy, hormonal changes can weaken the LES, and the enlarging uterus can put pressure on the stomach, making reflux more likely. Approximately half of pregnant women experience heartburn, making it a common symptom observed in obstetric care.

Effects of Medications

Some medications can worsen GERD by relaxing the LES or increasing stomach acid production. Common examples include:

* Calcium channel blockers (for hypertension)
* Bronchodilators (for asthma)
* Certain antidepressants
* Hormonal medications

Patients taking these medications for chronic conditions should be aware that their reflux symptoms may worsen.

Impact of Helicobacter pylori Infection

In the past, many Japanese people were infected with Helicobacter pylori, but eradication therapy has reduced the infection rate. Since H. pylori suppresses stomach acid production, the decrease in infection may have led to increased acid secretion, contributing to the rise in GERD cases. In fact, studies have reported that H. pylori-negative individuals have a higher risk of developing GERD.

Posture and Lifestyle Habits

Slouching or prolonged desk work increases abdominal pressure, promoting acid reflux. Additionally, late-night meals, eating just before bedtime, and overeating can also trigger stomach acid reflux.

Stress

While psychological stress is not a direct cause, it is believed to worsen GERD by disrupting the autonomic nervous system, increasing stomach acid secretion, and contributing to unhealthy lifestyle habits.

Diagnostic Tests and Methods for Gastroesophageal Reflux Disease (GERD)

GERD can sometimes be diagnosed based solely on a symptom questionnaire, but various tests are essential for an accurate diagnosis and assessment of severity. Detailed examinations are especially recommended when symptoms persist, medications are ineffective, or complications are suspected. Here, we explain the common diagnostic methods.

Medical Interview and Symptom Scoring

The first step is a detailed medical interview. This includes assessing the frequency of heartburn and regurgitation, their relation to meals or posture, and the presence of nighttime symptoms. Additionally, questionnaires widely used in Japan, such as the F Scale (Frequency Scale for the Symptoms of GERD), may be employed to quantify symptom severity. The F Scale scores responses to 12 questions, and a total score of 8 or higher indicates a high likelihood of GERD. Interviews and symptom scoring are non-invasive, simple, and useful even in primary care settings.

Endoscopy (Upper Gastrointestinal Endoscopy)

Endoscopy is the most reliable method for diagnosing GERD. Using a gastroscope, the esophageal lining is directly examined to check for inflammation, erosions, or ulcers.

In Japan, endoscopic findings are evaluated using the **Los Angeles (LA) Classification**, which categorizes the extent of mucosal erosions from A to D, providing an objective assessment of disease severity.

Endoscopy is also crucial for the early detection of complications such as esophageal cancer or Barrett’s esophagus. For patients with persistent heartburn or older adults, endoscopy is recommended both for diagnosis and screening.

Barium Swallow Examination (X-ray Test)

This examination involves drinking barium followed by X-ray imaging to assess the shape of the esophagus and the presence of acid reflux. It is useful for detecting hiatal hernias; however, it cannot directly observe inflammation of the mucosa, making it insufficient for a definitive diagnosis. It is mainly used as an auxiliary diagnostic tool.

24-Hour pH Monitoring

Considered the gold standard for diagnosing GERD, 24-hour esophageal pH monitoring involves placing a thin tube or capsule-type sensor in the esophagus to continuously measure acidity (pH) over a 24-hour period.

This test provides detailed information on the frequency of acid reflux and its correlation with symptoms. It is especially useful for diagnosing non-erosive reflux disease (NERD), where no inflammation is observed on endoscopy.

Impedance-pH Combined Monitoring

Recently, esophageal impedance-pH combined monitoring has been introduced, allowing the measurement of not only acid reflux but also non-acid reflux (such as bile or food). This enables a more precise assessment of the type and extent of reflux and its correlation with symptoms. It is particularly useful for evaluating medication-resistant GERD.

Helicobacter pylori (H. pylori) Testing

Although not directly linked to GERD, testing for Helicobacter pylori infection can be useful, as it affects the regulation of stomach acid secretion. There have been cases where GERD symptoms appear after H. pylori eradication due to increased acid production, making this test helpful for comprehensive evaluation in gastroenterology.

Blood Tests and Breath Tests

There are no blood markers to directly diagnose GERD itself, but blood tests may be performed to assess complications or to differentiate from other conditions. Additionally, breath tests (urea breath tests) are used to determine the presence of H. pylori infection.

Summary of the Diagnostic Process

* For mild cases with typical symptoms (heartburn and regurgitation): diagnosis is made via medical interview and F Scale → initiate medication therapy.
* For severe or persistent symptoms: perform endoscopy to assess the esophageal lining.
* If symptoms persist despite a normal endoscopy: conduct 24-hour pH monitoring or impedance testing.
* Additional tests (barium swallow, H. pylori testing, etc.) are performed based on background factors and risk.

In this way, the diagnosis of GERD is conducted in a stepwise and comprehensive manner.

Treatment Methods for Gastroesophageal Reflux Disease (GERD)

Treatment for GERD aims to relieve symptoms, prevent recurrence, and avoid complications. The foundation of therapy consists of medication and lifestyle modifications, while surgical intervention may be considered in severe cases. Below, we provide a detailed explanation of each treatment approach.

Medication Therapy

Proton Pump Inhibitors (PPIs)

Proton pump inhibitors (PPIs) are the first-line treatment for GERD. They strongly suppress stomach acid secretion, rapidly improving symptoms such as heartburn and regurgitation. Common PPIs include omeprazole, lansoprazole, and esomeprazole.

According to the Japanese Gastroenterological Association guidelines, PPIs are central to GERD treatment. Typically, a 2–8 week course is expected to relieve symptoms and promote mucosal healing.

H2 Receptor Antagonists (H2 Blockers)

H2 receptor antagonists (H2 blockers) inhibit histamine H2 receptors to reduce stomach acid secretion. Famotidine is a common example. While not as potent as PPIs, they act quickly and can be used on an as-needed basis for mild cases or nighttime symptoms.

Antacids and Mucosal Protective Agents

Antacids containing aluminum or magnesium neutralize already-secreted stomach acid, providing symptom relief. Mucosal protective agents, such as sucralfate, help protect the esophageal lining and promote healing of inflammation. Both are commonly used as adjunctive treatments.

Other Medications

Gastrointestinal motility agents, such as domperidone, promote gastric emptying and help reduce reflux. Additionally, potassium-competitive acid blockers (P-CABs) have recently emerged as a promising alternative to PPIs.

Lifestyle Modifications

In parallel with medication therapy, reviewing and improving lifestyle habits is essential to prevent recurrence. The following measures are recommended:

Dietary Adjustments

Avoid fatty foods, chocolate, alcohol, caffeinated beverages, and spicy foods.

Meal Timing

Finish meals 2–3 hours before bedtime. Avoid late-night snacks and alcohol before sleeping.

Portion Control

Instead of eating large meals at once, have smaller portions spread over multiple meals.

Posture Improvement

Avoid slouching and prolonged positions that increase abdominal pressure. During sleep, elevate the upper body using a pillow or an inclined bed.

Weight Management

Since obesity is a major risk factor, maintaining a healthy body weight is recommended.

Smoking and Alcohol Cessation

Smoking relaxes the lower esophageal sphincter (LES), and alcohol increases stomach acid secretion; therefore, limiting both is effective.

These lifestyle modifications not only enhance the effectiveness of medication therapy but also help prevent recurrence.

Surgical Treatment

Surgery may be considered when medication therapy and lifestyle modifications are insufficient or when severe complications are present.

Fundoplication (Nissen Procedure)

The most common procedure is Nissen fundoplication. In this surgery, a portion of the stomach is wrapped around the lower esophagus to reinforce the LES and prevent reflux. It is often performed laparoscopically and has a high success rate.

Endoscopic Treatment

In recent years, endoscopic treatments to prevent reflux have been explored. These include techniques such as applying laser or radiofrequency energy to the gastroesophageal junction to induce tissue contraction, or using specialized devices to create a valve-like structure. While not yet widely adopted, these minimally invasive approaches hold promise.

Treatment Selection Pathway

1. Mild cases → Lifestyle modifications, H2 blockers, or antacids
2. Moderate to severe cases → Pharmacotherapy primarily with proton pump inhibitors (PPIs)
3. If symptoms do not improve with medication → Further evaluation (pH monitoring, impedance-pH testing)
4. Severe or medication-resistant cases → Consideration of surgical treatment

Treatment for gastroesophageal reflux disease is selected step by step according to symptom severity.

Prevention and Self-Care

Gastroesophageal reflux disease (GERD) often recurs if lifestyle habits are not improved, even after treatment. Therefore, it is important to be mindful of self-care and preventive measures in daily life. Here, we focus on methods that have been medically proven to be effective.

Dietary Habits and Adjustments

* Avoid eating before bedtime
Lying down soon after eating can make acid reflux more likely, so it is recommended to finish meals at least 2–3 hours before going to bed.

* Limit fatty foods
Fats delay gastric emptying and relax the LES, so fried foods and meals high in meat should be consumed in moderation.

* Restrict stimulants
Alcohol, caffeine, carbonated drinks, chocolate, and spicy foods can increase stomach acid secretion and worsen reflux.

Improving the Sleep Environment

* Adjusting the angle of the pillow or bed
Raising the upper body by about 15–20 cm while sleeping can help prevent acid reflux. This is especially effective for those who suffer from nighttime heartburn or regurgitation.

* Sleeping on the left side
Due to the anatomical shape of the stomach, lying on the left side makes it less likely for stomach acid to flow back into the esophagus.

Lifestyle Modifications

* Weight management
An increase in visceral fat raises intra-abdominal pressure and increases the risk of reflux. Maintaining an appropriate body weight contributes to prevention.

* Smoking cessation
Smoking has a relaxing effect on the LES and is directly linked to the onset and worsening of GERD. Quitting smoking is one of the most effective forms of self-care.

* Stress management
Stress disrupts the autonomic nervous system and increases gastric acid secretion. Sufficient rest and the adoption of relaxation techniques help in prevention.

Avoiding Self-medication

Over-the-counter antacids or H2 blockers may provide temporary relief, but long-term self-treatment can be dangerous. It may mask the progression of esophagitis or the risk of esophageal cancer. Therefore, if symptoms persist, it is essential to consult a physician.

The Importance of Preventing Recurrence

GERD is known for its high recurrence rate, with many cases experiencing a return of symptoms after treatment. Lifestyle modifications are not only a part of treatment but also the key to preventing recurrence.

Risks of leaving GERD untreated

Gastroesophageal reflux disease (GERD) is often perceived as a condition that is unlikely to be life-threatening. However, if left untreated, it can lead to serious complications and a significant decline in quality of life (QOL). Even mild symptoms, if persistent over a long period, warrant medical evaluation. Below is a summary of the potential risks associated with leaving GERD untreated.

Chronic esophagitis

Repeated gastric acid reflux causes chronic inflammation of the esophageal mucosa. Prolonged inflammation weakens the mucosa, increasing the risk of bleeding and ulcer formation. Chronic inflammation not only worsens symptoms such as heartburn and pain in daily life but also serves as a risk factor for tissue changes.

Esophageal Ulcer

As inflammation progresses, deep sores (ulcers) can form in the esophageal lining. Ulcers may cause bleeding and severe chest pain, and can lead to anemia. Healing is slower in elderly individuals or those with underlying conditions, increasing the risk of chronic complications.

Esophageal Stricture

Repeated ulcers and inflammation can lead to scarring of the esophageal tissue, causing the lumen to narrow. This condition is called esophageal stricture. As the narrowing progresses, it becomes difficult for food to pass, resulting in swallowing difficulties. In severe cases, even liquids may be hard to ingest, increasing the risk of malnutrition and dehydration.

Barrett's Esophagus (Pre-malignant Lesion)

If gastroesophageal reflux disease (GERD) is left untreated for a long time, the esophageal lining can be replaced by epithelium resembling that of the stomach or intestines. This condition is called Barrett’s esophagus and is known as a precancerous lesion for esophageal adenocarcinoma.

According to U.S. studies, about 10% of GERD patients develop Barrett’s esophagus, and a portion of these cases may progress to esophageal cancer (Vakil N, 2006).

Risk of Esophageal Cancer

In patients with Barrett’s esophagus, the risk of developing esophageal adenocarcinoma is reported to be 30–40 times higher than in healthy individuals (El-Serag HB, 2014).

While esophageal squamous cell carcinoma is more common in Japan, the incidence of GERD-related esophageal adenocarcinoma has become a significant public health issue in Western countries. With the westernization of lifestyle advancing in Japan, an increase in such cases is also a growing concern.

Significantly Reduced Quality of Life (QOL)

In addition to the medical risks, persistent heartburn and sleep disturbances can negatively affect overall quality of life, including reduced concentration at work or school, dietary restrictions, and psychological stress. Some patients report concerns such as “being afraid to eat out” or “having work performance affected due to lack of sleep.”

Summary

If left untreated, gastroesophageal reflux disease (GERD) can lead not just to “heartburn” but to serious complications such as ulcers, strictures, Barrett’s esophagus, and esophageal cancer. Persistent symptoms should prompt early consultation with a healthcare provider.

Introducing the Latest Research and Papers

Gastroesophageal reflux disease (GERD) is a widely studied condition globally, and in recent years, numerous papers have been published on its treatment and pathophysiology. Here, we introduce several reliable international studies.

Studies on the Long-term Use of PPIs

Proton pump inhibitors (PPIs) are the first-line treatment for GERD, but there are concerns regarding their long-term safety. A study from Harvard University (Harvard Health Publishing, 2021) reported that long-term PPI use may be associated with changes in the gut microbiota and an increased risk of kidney dysfunction. However, the absolute risk is low, and clinical guidelines recommend using the shortest effective duration of therapy.

Barrett's Esophagus and Esophageal Cancer Risk

A review article published on PubMed (El-Serag HB, 2014, Clin Gastroenterol Hepatol) analyzed the relationship between GERD and Barrett's esophagus. The study showed that patients with GERD have a significantly higher risk of developing esophageal adenocarcinoma compared to healthy individuals. This provides scientific evidence for the importance of early treatment and continuous management of GERD.

Lifestyle and GERD

A report published by the WHO in 2020 explicitly stated that Western-style diets (high in fat and calories) and obesity are major risk factors for GERD. Furthermore, the recent increase in GERD cases in Asian countries has been largely attributed to changes in lifestyle habits.

Development of New Medicines

In recent years, a new drug developed in Japan, the potassium-competitive acid blocker (P-CAB), has been introduced. It acts faster than conventional PPIs and can suppress gastric acid secretion continuously, making it a promising treatment for PPI-resistant GERD. Since 2020, multiple clinical trials have been conducted, drawing international attention.

Research on Non-cid Reflux

Until now, the cause of GERD has been considered to be “gastric acid reflux,” but recently, the involvement of non-acidic reflux, such as bile and digestive enzymes, has gained attention. A study by the European Society of Gastroenterology (Vakil N, 2006, Am J Gastroenterol) demonstrated, using impedance–pH monitoring, that non-acidic reflux may contribute to chronic cough and throat discomfort.

Summary

Recent research indicates that GERD is not merely a “disease of gastric acid reflux” but a complex condition influenced by multiple factors, including lifestyle, drug resistance, and non-acidic reflux. Going forward, the development of new medications and diagnostic methods is expected to enable more individualized treatment approaches.

Trends in the World and Japan

Gastroesophageal reflux disease (GERD) is a gastrointestinal disorder that is increasing worldwide. It was once thought to be common in Western countries and rare in Japan and other parts of Asia, but recent changes in lifestyle have significantly altered this trend.

Current Situation in Japan

According to surveys by the Ministry of Health, Labour and Welfare and reports from the Japan Gastroenterological Association, the prevalence of GERD in Japan has risen rapidly over the past 20 years. It was once estimated at around 1–2%, but it is now thought to affect 10–20% of the population. Contributing factors include Westernized dietary habits, an increase in obesity, and a decline in Helicobacter pylori infection rates.
Additionally, as Japan has an aging population, age-related decline in LES function and esophageal motility is also believed to contribute to the rising incidence.

Comparison with Europe and America

In the United States and Europe, GERD is already considered a common disease. According to the American Gastroenterological Association (AGA), about 30% of American adults experience heartburn at least once a week. Moreover, the increasing incidence of esophageal adenocarcinoma has become a social concern, with GERD and Barrett's esophagus identified as major contributing factors.
In Japan, while esophageal squamous cell carcinoma remains more prevalent, the proportion of adenocarcinoma has been gradually rising in recent years. This trend is believed to be closely associated with the increasing prevalence of GERD.

Reports from WHO and International Organizations

The World Health Organization (WHO) has recognized GERD as part of lifestyle-related diseases, warning that obesity and the Westernization of diets are driving its prevalence worldwide. International epidemiological studies also indicate a common trend of increasing GERD cases in Asian countries, suggesting that this condition will become an increasingly important focus in healthcare in the future.

Future Prospects

In the future, GERD management in Japan is expected to focus on:

* Promoting lifestyle modifications (addressing obesity, diet, smoking, and alcohol consumption)
* Expanding the use of endoscopic examinations for early detection
* Clinical application of new drugs (such as P-CABs)
* Establishing long-term follow-up systems to prevent complications

Conclusion

Gastroesophageal reflux disease (GERD) begins with symptoms such as heartburn and acid regurgitation, and if left untreated, can lead to ulcers, strictures, and even an increased risk of esophageal cancer.

Its development is influenced by multiple factors, including diet, obesity, aging, posture, medications, and *Helicobacter pylori* infection, making it a condition that can affect anyone in modern society.

The cornerstone of treatment is medication—primarily proton pump inhibitors (PPIs)—combined with lifestyle modifications. Even after symptoms improve, GERD tends to recur, so ongoing self-care and regular check-ups at medical facilities are recommended.

The number of GERD patients in Japan is increasing year by year, and awareness of it as a “national health issue,” similar to Western countries, is growing. Recent research has also highlighted the role of non-acid reflux, and new drugs are being developed, expanding future treatment options.

If symptoms such as heartburn, persistent cough, or throat discomfort continue, it is important not to ignore them or self-manage, but to seek evaluation at a specialized medical facility.

◼️ Editor
Takafumi Suzuki
Anesthesiologist
Director of Yasashii Clinic Hiroo Shirokane
Member of the Japan Society of Anesthesiologists

◼️ Management body
Yasashii Clinic Hiroo Shirokane
Internal Medicine, Dermatology, Allergy Clinic, Pain Management
O-KA building 3F, 2-31-3, Ebisu, Shibuya-ku, Tokyo 150-0013
https://yasashii-clinic.jp

◼️ Last updated date
September 2, 2025

◼️ References
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国立がん研究センター「バレット食道と食道がん」
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日本消化器内視鏡学会「食道疾患における内視鏡診断」
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Mayo Clinic."GERD (Gastroesophageal reflux disease)."
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National Institutes of Health (NIH). "GERD Research."
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World Health Organization (WHO). "Digestive diseases burden."
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Harvard Health Publishing. "Lifestyle changes for GERD."
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Vakil N, et al. "The Montreal definition and classification of GERD." Am J Gastroenterol. 2006.
https://pubmed.ncbi.nlm.nih.gov/16928254/

El-Serag HB. "Epidemiology of GERD." Clin Gastroenterol Hepatol. 2014.
https://pubmed.ncbi.nlm.nih.gov/24267409/

◼️ Disclaimer
This article is intended to provide general medical information and is not a substitute for professional diagnosis or treatment. If you have any symptoms, please consult a physician. The content of this article is based on the latest information available at the time of writing and supervision.