Causes and Diagnoses

Causes and Diagnoses of GERD


The exact cause of GERD is unknown. In individuals with GERD, the lower esophageal sphincter tends to relax while the rest of the esophagus is working. In individuals who have a hiatal hernia (in which the upper part of the stomach moves into the lower esophagus), GERD is likelier to develop.

Risk factors

There are certain factors that increase an individuals risk of developing GERD, including: 

  • Obesity
  • Pregnancy
  • Smoking

Some foods may also worsen reflux symptoms, including:

  • Citrus fruit
  • Chocolate
  • Caffeinated drinks
  • Alcoholic beverages
  • Fatty and/or fried foods
  • Garlic and/or onions
  • Mint
  • Spicy foods
  • Tomato-based foods such as chili, spaghetti cause, pizza or salsa


If GERD symptoms do not resolve from changes in lifestyle and medications, additional tests may need to be performed, including:

  • Barium swallow radiograph: This test involves drinking a barium solution that will allow an X-ray image to spot abnormalities such as an ulcer or a hiatal hernia or stricture (narrowing) in the esophagus.
  • Upper endoscopy: This test may be performed in a physician’s office or in a hospital. Your physician will lightly sedate you and numb your throat before sliding a thin, flexible plastic tube with a light and a lens at the end of it (an endoscope) down your throat. This tiny camera lets the physician see the surface of your esophagus to confirm GERD. The physician may, if necessary, perform a biopsy (obtain small tissue samples) by using tiny tweezers (forceps) that are passed through the endoscope. This will then be examined by a pathologist to determine if the tissues are abnormal.
  • pH monitoring examination: This test uses a small tube inserted in the esophagus for 24 to 48 hours that monitors how and when acid enters the esophagus. If used in conjunction with a food diary (a log indicating the amounts and types of food eaten at specific times), this allows your doctor to find a correlation between symptoms and reflux. This test may be used to determine whether respiratory symptoms are caused by reflux.