[6] Risk factors include obesity, pregnancy, smoking, hiatal hernia, and taking certain medications.

Medications that may cause or worsen the disease include benzodiazepines, calcium channel blockers, tricyclic antidepressants, NSAIDs, and certain asthma medicines.

Acid reflux is due to poor closure of the lower esophageal sphincter, which is at the junction between the stomach and the esophagus.

[6] The classic symptoms of GERD were first described in 1925, when Friedenwald and Feldman commented on heartburn and its possible relationship to a hiatal hernia.

GERD in children may cause repeated vomiting, effortless spitting up, coughing, and other respiratory problems, such as wheezing.

[27] Less common symptoms of GERD include difficulty in swallowing, water brash, chronic cough, hoarse voice, nausea and vomiting.

[29] GERD may lead to Barrett's esophagus, a type of intestinal metaplasia,[20] which is in turn a precursor condition for esophageal cancer.

Frequent acid reflux is due to poor closure of the lower esophageal sphincter, which is at the junction between the stomach and the esophagus.

A double-blind study, reported in 2004, found no clinically significant difference between these two types of patients with regard to the subjective or objective measures of disease severity.

It is the most objective test to diagnose the reflux disease and allows monitoring GERD patients in their response to medical or surgical treatment.

Short-term treatment with proton-pump inhibitors may help predict abnormal 24-hour pH monitoring results among patients with symptoms suggestive of GERD.

[44] Endoscopy, the examination of the stomach with a fibre-optic scope, is not routinely needed if the case is typical and responds to treatment.

[42] It is recommended when people either do not respond well to treatment or have alarm symptoms, including dysphagia, anemia, blood in the stool (detected chemically), wheezing, weight loss, or voice changes.

[42] Some physicians advocate either once-in-a-lifetime or 5- to 10-yearly endoscopy for people with longstanding GERD, to evaluate the possible presence of dysplasia or Barrett's esophagus.

Severity may be documented with the Johnson-DeMeester's scoring system:[47] 0 – None 1 – Minimal – occasional episodes 2 – Moderate – medical therapy visits 3 – Severe – interference with daily activities Other causes of chest pain such as heart disease should be ruled out before making the diagnosis.

Unlike GERD, LPR rarely produces heartburn, and is sometimes called silent reflux.

[48] Differential diagnosis of GERD can also include dyspepsia, peptic ulcer disease, esophageal and gastric cancer, and food allergies.

[49] The treatments for GERD may include food choices, lifestyle changes, medications, and possibly surgery.

[50] Some guidelines recommend trying to treat symptoms with an H2 antagonist before using a proton-pump inhibitor because of cost and safety concerns.

[56] The primary medications used for GERD are proton-pump inhibitors, H2 receptor blockers and antacids with or without alginic acid.

[9] The use of acid suppression therapy is a common response to GERD symptoms and many people get more of this kind of treatment than their case merits.

[66] In 2012 the U.S. Food and Drug Administration (FDA) approved a device called the LINX, which consists of a series of metal beads with magnetic cores that are placed surgically around the lower esophageal sphincter, for those with severe symptoms that do not respond to other treatments.

Improvement of GERD symptoms is similar to those of the Nissen fundoplication, although there is no data regarding long-term effects.

Contraindications that would advise against use of the device are patients who are or may be allergic to titanium, stainless steel, nickel, or ferrous iron materials.

[79] Instead, the occupational therapist would suggest rolling the child on the side, keeping the shoulders and hips aligned to avoid acid rising up the baby's esophagus.