Examining The Relationship Between “Heartburn”, “Acid Reflux” and “GERD”
“Heartburn”, “Acid reflux” and “GERD”. They’re terms that get tossed around a lot, not just in the reflux community but among regular people as well. Whether it’s a heartburn commercial on TV, an unasked for anecdote from Uncle Joe about the scope of his digestive issues, or a firsthand experience, chances are these three issues have in some way been a part of your life. So why is it that we still don’t understand what these terms mean?
Part of the problem is that there seems to be a common misconception about what heartburn, acid reflux and GERD really are. Many people view the three items as one. In fact, we often see the terms used interchangeably. It’s a bit disturbing because although heartburn, GERD and acid reflux can go hand in hand at times, at the end of the day they’re still three very distinctly different issues.
Heartburn is a symptom. More specifically, it’s the way that we "feel" acid reflux. It describes a burning sensation in the chest. Nobody is born knowing what heartburn is, but we lump all forms of burning chest pain and upper abdominal pain that typically occurs after eating as heartburn. The terms heartburn and indigestion are often used interchangeably as both are the name of a symptom. Symptoms do not confirm the presence of a disease, however, they just suggest that someone may have the disease. So in this case the symptom of heartburn suggests that a person may have the disease called acid reflux or GERD.
Acid reflux is technically described as “the backward flow of stomach acid into the esophagus”. It’s fairly common. In fact, everyone has acid reflux every day but usually they have no symptoms associated with it. Every time we burp, we have a quick, small acid reflux episode as the lower esophageal sphincter opens to let the air escape. If we study an individual who has no symptoms of heartburn, we will find that they will have 30-50 acid reflux episodes every day, each lasting only a few seconds. So you see, you can have acid reflux without heartburn, and it is possible that heartburn does not mean acid reflux. Also acid reflux is only one type of reflux, there can be bile reflux, non-acid reflux, etc.
Gastroesophageal Reflux Disease, on the other hand--more commonly referred to as “GERD”--is a chronic digestive disorder affecting the lower esophageal sphincter (that ring of muscle between your esophagus and your stomach). In patients with GERD, the lower esophageal sphincter is either weaker, shorter or has moved into a location that is other than normal causing it to relax inappropriately, allowing the stomach’s contents to flow back up into the esophagus and causing gastroesophageal reflux. When it does, this it can allow acid back up into the esophagus, bile back up into the esophagus or even undigested food can reflux into the esophagus. Ever burped after gorging yourself on Thanksgiving dinner and been able to taste that turkey you ate? That’s acid reflux.
This is where it can start to get confusing, because if “heartburn” is a symptom of “acid reflux” and “acid reflux” is technically a form of “gastroesophageal reflux” which is just another name for “GERD”, then doesn’t that mean that if you experience heartburn or acid reflux you have GERD? It’s a classic case of “yes, BUT no…”. GERD is characterized by frequent reflux, and although acid reflux can be included in that, GERD also encompasses other types of reflux such as non acid reflux and bile reflux.
In addition, whether or not you have GERD is completely dependent upon the frequency of your symptoms. If you experience heartburn or acid reflux on a weekly basis, most physicians would say that’s considered GERD. If you only get these symptoms a few times a year after a large meal or during the holidays, then it’s likely that you don’t actually have GERD, you simply had a couple episodes of heartburn. So although frequent heartburn or acid reflux can be categorized as GERD, the three don’t always go hand in hand. If you experience heartburn then you may suffer from acid reflux, but the frequency at which it occurs is what determines whether or not it’s GERD. At the end of the day, occasional acid reflux is just that: occasional acid reflux. It’s still heartburn, but it’s not GERD. Acid reflux that happens once or more a week, though? That’s something that should be evaluated and discussed with your physician as it may represent GERD.
Understanding the relationship between heartburn, acid reflux, and GERD can be difficult, and it’s ok to feel confused or admit that you don’t know all of the answers. That’s why we’re here. If you’re struggling with heartburn, acid reflux, or GERD, talk to your doctor and see how we can help!