The Stages of GERD

The Stages of Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease, or GERD, occurs when the contents of the stomach flow back up into the esophagus (reflux). Although GERD is common, the condition is chronic and knowing what stage of GERD you have is important for ensuring you receive the proper treatment. The stage of GERD is determined by the frequency and severity of your symptoms.

Stage

Severity

Symptoms

Treatment Option

1

Mild

Heartburn and regurgitation occurring infrequently (less than once a week)

Lifestyle modifications;
antacids (as needed)

2

Moderate

Heartburn and regurgitation occurring a few times a week

Lifestyle modifications;
daily antisecretory therapy (histamine 2 receptor blockers or proton pump inhibitors)

3

Severe

Heartburn, regurgitation,
atypical GERD

Lifestyle modifications;
daily to twice daily antisecretory therapy (histamine 2 receptor blockers or proton pump inhibitors);
should be followed by a GERD specialist

4

Complications of GERD

Heartburn, regurgitation,
atypical GERD,
dysphagia,
endoscopic findings of strictures, Barrett’s esophagus, esophageal cancers

Lifestyle modifications;
twice daily antisecretory therapy (histamine 2 receptor blockers or proton pump inhibitors); must be followed by a GERD specialist

Receiving the appropriate treatment for your particular stage of GERD is important for keeping your condition from getting worse. GERD is considered a chronic disease and may not be entirely curable. Working with your doctor on a treatment plan that aligns with your stage of GERD will help manage your symptoms and halt the progression of the condition.

Stage 1: Mild

The majority of people who have GERD fall into stage 1, which is characterized by mild heartburn and/or regurgitation. This stage of GERD often leads to mild inflammation in the lower part of the esophagus.

The symptoms of stage 1 GERD may include:

  • Heartburn
  • Chest pain
  • Feeling like there is a lump at the back of your throat
  • Regurgitation of food or liquid

The best treatment options for this stage of GERD focus primarily on lifestyle changes. The symptoms of stage 1 GERD are often controlled by avoiding certain kinds of foods and beverages like coffee, alcohol, and spicy or fatty foods. Over-the-counter antacids and avoiding eating within 3 hours of bedtime are also generally effective in treating the symptoms of stage 1 GERD. In addition, you may consider elevating your head while sleeping or elevating the head of the bed by 6 inches to help prevent reflux.

Following a diet developed with a specialist will help treat symptoms and halt the progression of GERD.

Stage 2: Moderate

Stage 2 GERD occurs in about a third of people who have the condition and includes symptoms that occur several times a week. This increased frequency of acid reflux in this stage causes more significant inflammation in the lower part of the esophagus.

The symptoms of stage 2 GERD may include:

  • Heartburn
  • Chest pain
  • Feeling like there is a lump at the back of your throat
  • Regurgitation of food or liquid

Unlike with mild, or stage 1 GERD, the symptoms for stage 2 of the condition are not easily controlled with over-the-counter antacid therapy. Those who have stage 2 GERD may require a prescription for antisecretory therapy in the form of a proton pump inhibitor or a histamine 2 receptor blocker to control their GERD.  Those who have stage 2 GERD should consider consulting with a specialist who is knowledgeable about their condition.

Stage 3: Severe

Stage 3 presents a more significant problem both in the symptoms of GERD and the ongoing and severe inflammation in the esophagus. Approximately 15% of those who have GERD are in stage 3 and experience significant symptoms that may occur several times a week or even daily.

The symptoms of stage 3 GERD may include:

  • Heartburn
  • Regurgitation of food or liquid
  • Sore throat
  • Hoarse voice
  • Chronic cough

Stage 3 GERD is often not able to be controlled with medications. Those in this category are at risk of developing serious complications of GERD and should be cared for by a GERD specialist. The specialist may recommend advanced testing such endoscopy, esophageal manometry and pH studies in order to develop an appropriate treatment plan.

Stage 4: Esophageal Cancer or Precancerous Lesions

Stage 4 GERD represents the most serious consequence of long-term reflux, and approximately 10% of people who have GERD will progress to this stage if their reflux remains uncontrolled over time. 

The symptoms of stage 3 GERD may include:

  • Heartburn
  • Regurgitation of food or liquid
  • Sore throat
  • Hoarse voice
  • Chronic cough
  • Dysphagia (food getting stuck in the esophagus while eating)

Those who have stage 4 GERD may suffer from complications that result in esophageal strictures, Barrett’s esophagus or even esophageal cancers. This stage of GERD requires care by a GERD specialist who will perform diagnostic and/or surveillance endoscopy as well as advanced esophageal manometry and pH testing. Treatment may include surgery or cancer treatment if esophageal cancer is found. Be sure to make an appointment with a specialist immediately if you believe you may have stage 4 GERD.

Connect With Cooper Now

At Cooper University Health Care, our experts specialize in diagnosing and treating all stages of GERD. Our team of specialists uses state-of-the-art technology and advanced endoscopy to care for those who have GERD. 

While most acid reflux disease is benign, sometimes a person’s symptoms do not align with the degree of inflammation in their esophagus. Because GERD can worsen over time if not properly treated, an early evaluation by a specialist is recommended. A specialist will determine the stage of your GERD and work with you on an appropriate plan to treat your symptoms and minimize any risk of complications from long-term GERD.

To diagnose and treat GERD, Cooper specialists use the latest technology, including:

  • Esophagogastroduodenoscopy (EGD)
  • Esophageal dilation
  • Esophageal manometry (Medtronic)
  • Esophageal pH testing – 24- and 48-hour (Medtronic and Bravo systems)
  • Endoscopic mucosal resection
  • Endoscopic mucosal dissection
  • Argon plasma coagulation (APC)

Cooper provides comprehensive, patient-centered care for those who have GERD through the hospital’s Digestive Health Institute. Our nationally recognized and highly experienced specialists use state-of-the-art diagnostic procedures and an array of treatment options for general and complex gastrointestinal disorders.

In addition to our skilled experts and specially trained staff, the Digestive Health Institute features a state-of-the-art endoscopy center that uses the latest diagnostic and imaging technologies to ensure you receive a personalized treatment plan that works best for you.

To schedule an appointment with a GERD specialist at Cooper, please call 800.8.COOPER (800.826.6737) or use our online appointment request form.