Understanding acid reflux and GERD: What you need to know

⏱ 5 min video, 5 min read

While experiencing heartburn now and then is common, it’s estimated that about 20% of older adults have chronic acid reflux or gastro-esophageal reflux disease, also known as GERD.¹ This short video explores the causes of acid reflux and GERD, and offers practical, evidence-based tips for managing symptoms. Learn which lifestyle changes can make a real difference and when it’s time to speak with a healthcare provider.

View or download a transcript.

Download a handout from Choosing Wisely Canada that summarizes how to treat acid reflux.

Video highlights include:

• 0:31 What is acid reflux
• 1:56 How to improve your symptoms
• 3:26 When to see a healthcare provider

What is acid reflux?

When you eat, food passes from your mouth through a tube called the esophagus and into your stomach. Once food is in the stomach, a small valve called the lower esophageal sphincter prevents stomach acid from moving back into the esophagus. If this muscle doesn't close well or opens at the wrong times, food and stomach acid can go back up into your esophagus. This is called acid reflux. It can cause a burning sensation behind your breastbone or in the middle of your chest, commonly referred to as heartburn. It can result in a sour taste in the mouth. It often happens after eating or when lying down.

If symptoms occur more than twice a week or start affecting your daily life, you may have developed GERD. Other typical symptoms include regurgitation (bringing food back up) and excess saliva.

Risk factors for older adults

One of the risk factors for GERD is age.² As we get older, there may be several complicating factors that affect how the lower esophageal sphincter closes. These include weakened muscles and side effects from medications. For example, some medicines for blood pressure (such as calcium-channel blockers), asthma (such as anticholinergics or theophylline), certain sedatives/antidepressants, as well as medicines for motion sickness, can make GERD worse. They can relax the esophageal sphincter, making the seal less tight, resulting in food and stomach acid going back up into your esophagus.

Weight gain at any age can lead to acid reflux. Extra weight can put downward pressure on the stomach, which creates pressure to push food back up the esophagus.

Hiatal hernia is common and more prevalent in older adults. This condition causes the upper part of the stomach to push up against the chest cavity. Larger hernias are associated with an increased risk of heartburn.

Potential complications

Most people with GERD just have bothersome symptoms, but over time, acid reflux can sometimes cause complications. These can include:

• Esophagitis – inflammation of the lining of the esophagus, sometimes leading to sores (ulcers).
• Narrowing (stricture) of the esophagus – making it harder to swallow.
• Barrett’s esophagus – a change in the cells lining the lower esophagus, which slightly increases the risk of esophageal cancer.

These complications are less common but more likely if GERD goes untreated for many years, especially in people with severe or frequent symptoms. That’s why it’s important to talk to your healthcare provider if you have ongoing heartburn or other warning signs.

How to improve your symptoms

• Watch for triggers – Keep track of which foods or drinks cause your heartburn and try to avoid them. Everyone’s triggers are different. Common ones include:
  • fatty or fried foods
  • spicy foods
  • garlic and onions
  • citrus fruits
  • chocolate
  • peppermint
  • coffee and other caffeinated drinks
  • alcohol, and
  • tomato-based foods like pizza or pasta sauce.
• Eat smaller meals and avoid lying down for 2–3 hours after eating – This helps reduce pressure in your stomach.
• Quit smoking – Smoking weakens the valve between your stomach and esophagus and reduces saliva, making acid reflux worse.
• Lose extra weight – Even a modest weight loss can reduce pressure on your stomach and improve symptoms.
• Avoid tight clothing or belts that put pressure on your midsection.
• Raise the head of your bed by 15-20 cm (6–8 inches) using blocks or a wedge pillow to help prevent nighttime symptoms.

Treatment for GERD usually follows a step-by-step approach. If lifestyle changes aren’t enough, the next steps are occasional over-the-counter antacids, then longer-acting acid-lowering medicines if symptoms persist.

Treating GERD with medications

Antacids 

For symptoms that don’t happen often, antacids can give quick relief. They contain ingredients like calcium, aluminum, or magnesium that neutralize stomach acid. Relief can start within minutes but usually lasts about 30–60 minutes. Taking them after meals may make them work a bit longer. Some antacids with alginate (such as Gaviscon^®) may work best, as they form a protective layer that keeps acid away from the esophagus. Antacids don’t prevent future heartburn.

Acid-lowering drugs 

Two main types of medications reduce stomach acid: proton pump inhibitors (PPIs) and histamine-2 blockers (H2 blockers). Both make the reflux less acidic and less irritating. H2 blockers (such as famotidine) work within about 30–60 minutes and last longer than antacids, while PPIs are most useful for frequent symptoms and are taken daily for best effect.

A word about PPIs

Besides treating GERD, PPIs are also used for stomach/duodenal ulcers, to prevent stomach bleeding, and to protect the stomach when certain pain medicines (NSAIDs like ibuprofen) are needed. The most common PPIs available in Canada are omeprazole (Losec^®), esomeprazole (Nexium^®), lansoprazole (Prevacid^®), pantoprazole (Pantoloc^®), rabeprazole (Pariet^®), and dexlansoprazole (Dexilant^®). Some of these, like omeprazole and esomeprazole, are available over-the-counter in specific doses, while others require a prescription.

Are PPIs safe?

Yes, PPIs are effective and generally safe. Most people have no side effects, though some may notice mild symptoms such as headache, nausea, diarrhea, constipation, or stomach upset. 

Some studies have suggested possible long-term risks from taking PPIs, but these findings may not mean PPIs actually cause those problems. Many of these studies were observational, which means they looked at patterns in large groups of people rather than proving cause and effect. People who need PPIs often have other health issues, so the risks may be related to those conditions rather than the medication itself.^7,8 Rarely, especially with long-term use, PPIs have been linked to intestinal infections like C. difficile, and changes in nutrient levels such as low vitamin B12.

Thinking about stopping or lowering your dose?

Talk with your healthcare provider about:

• Whether you still need a PPI long term, or whether you can take it on an as-needed basis.
• A plan to reduce the dose or stop if it’s safe to do so (and what to do if symptoms return).
• Other ways to manage reflux (e.g., weight loss if needed, not smoking, avoiding late meals, and trigger foods).

Quick tips

• Take PPIs 30-60 minutes before breakfast (not at bedtime).
• If nighttime symptoms persist, tell your healthcare provider—sometimes the regimen can be adjusted.

Download a handout about PPIs from Choosing Wisely Canada.

When to see a healthcare provider

Speak with a healthcare provider such as your family doctor, pharmacist or nurse practitioner if:

• You have heartburn twice a week or more.
• Symptoms don’t improve after 2–4 weeks of treatment.
• You have trouble swallowing, pain when swallowing, or feel like food gets stuck behind the breastbone.
• You have unexplained weight loss, frequent nausea, persistent vomiting, or blood in your vomit.
• You have black, tarry stools or red blood in your stool.
• You’re over 60 with new symptoms, a history of Barrett’s esophagus, or a family history of esophageal cancer.
  

Seek urgent care if symptoms are severe.

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