GERD (Acid Reflux / Heartburn) — NZ Condition Guide | KiwiMeds

What is GERD?

Gastro-oesophageal reflux disease (GERD), also called acid reflux, is a condition where stomach acid frequently flows back up into the oesophagus (the tube connecting your mouth to your stomach). This backwash (reflux) can irritate the lining of the oesophagus and cause symptoms. Almost everyone has occasional acid reflux, but when it happens regularly (more than twice a week) and causes discomfort or complications, it is called GERD. It is one of the most common gastrointestinal conditions in New Zealand.

Symptoms

The most common symptom of GERD is heartburn — a burning feeling in the chest, usually after eating or when lying down. Other symptoms include regurgitation of food or sour liquid, difficulty swallowing, a sensation of a lump in the throat, chronic cough, laryngitis, and disrupted sleep. Symptoms often worsen after large meals, fatty or spicy foods, alcohol, caffeine, or lying down. GERD can occur without heartburn (silent reflux) — causing mainly cough, hoarseness, or throat symptoms.

Causes and Risk Factors

GERD is caused by a weakened lower oesophageal sphincter (LOS) — the muscular valve between the oesophagus and stomach — that allows acid to escape upward. Risk factors include obesity (particularly abdominal obesity), pregnancy, hiatus hernia, smoking, certain foods (fatty foods, chocolate, caffeine, alcohol, spicy foods), and certain medications (NSAIDs, calcium channel blockers, antihistamines).

Diagnosis

GERD is often diagnosed based on symptoms alone, especially the characteristic heartburn. If symptoms are severe, atypical, or do not respond to treatment, your GP may refer for gastroscopy (camera examination of the oesophagus and stomach) to look for complications such as oesophagitis, Barrett’s oesophagus, or cancer. Alarm symptoms requiring urgent investigation include difficulty swallowing, unintentional weight loss, vomiting blood, or symptoms starting after age 50.

Treatment in New Zealand

Lifestyle modifications are important — maintaining a healthy weight, eating smaller meals, avoiding trigger foods, not eating within 3 hours of bedtime, and elevating the head of the bed. Medications include antacids for immediate relief, H2 blockers (ranitidine — note: has been withdrawn; famotidine available), and proton pump inhibitors (PPIs) such as omeprazole and pantoprazole — both funded by Pharmac and the most effective medicines for GERD. PPIs should be used at the lowest effective dose for the shortest time needed, and long-term use should be reviewed regularly with your GP.

NZ-Specific Information

Omeprazole and pantoprazole are among the most commonly prescribed medicines in New Zealand and are fully funded by Pharmac. Over-the-counter antacids (Gaviscon, Mylanta) are also widely available. Your GP or pharmacist can advise on the best approach for your symptoms.

Frequently Asked Questions

Are PPIs safe long-term? PPIs are generally safe but long-term use has been associated with small increases in risk of magnesium deficiency, bone fractures, and C. difficile infection. Regular review is recommended. Can GERD cause cancer? Chronic GERD can lead to Barrett’s oesophagus — a precancerous change — in a small proportion of people. Your GP will monitor for this if relevant. Can I take PPIs while pregnant? Some PPIs are considered safe in pregnancy — discuss with your GP or pharmacist.

Supplements That May Support Management

⚠️ Important: The supplements listed below have varying levels of clinical evidence. They are not a substitute for prescribed medications or professional medical care. Please consult your GP or pharmacist before starting any supplement, particularly if you are taking other medications or have existing health conditions.

• Deglycyrrhizinated Licorice (DGL): DGL — a processed form of liquorice root with glycyrrhizin removed — may help protect the oesophageal and gastric mucosa by stimulating mucus secretion and promoting healing of irritated tissue. Some trials support its use as an adjunct to standard therapy. Typical dose: 380–760 mg chewable tablet before meals. Not a substitute for proton pump inhibitors.
• Slippery Elm (Ulmus rubra): Slippery elm bark contains mucilage that forms a soothing gel coating along the oesophagus and stomach lining, potentially reducing irritation from reflux. Evidence is largely traditional/empirical. Dose: 1–2 tablespoons of powder in water before meals. Generally well tolerated.
• Melatonin: Melatonin plays a role in gastrointestinal motility and lower oesophageal sphincter (LES) tone. Preliminary clinical trials suggest 3–6 mg melatonin nightly may reduce reflux symptoms and heartburn, though evidence is preliminary. May be of particular interest for patients with coexisting sleep difficulties.
• Zinc L-Carnosine: This chelated compound has demonstrated mucosal-protective and anti-inflammatory properties in the gastric lining. Studied primarily for gastric ulcer healing, it may provide adjunctive benefit in GERD by supporting mucosal integrity. Typical dose: 75 mg twice daily. Consult a pharmacist if taking other zinc-containing supplements.
• Probiotic Supplements: Dysbiosis of the gut microbiome may contribute to reflux symptoms. Specific probiotic strains (e.g., Lactobacillus rhamnosus, Lactobacillus acidophilus) have shown modest benefit in some GERD trials, potentially reducing bloating and regurgitation. Choose a multi-strain product and consult your pharmacist for strain-specific guidance.
• Magnesium Glycinate: Magnesium plays a role in smooth muscle relaxation, including the lower oesophageal sphincter. Magnesium deficiency (which can occur with long-term proton pump inhibitor use) may worsen reflux. Supplementation at 200–400 mg/day may be appropriate, particularly for patients on long-term omeprazole or similar medicines.

Relevant Vaccinations

Certain vaccinations are recommended for individuals with GERD, particularly where complications such as aspiration risk or compromised respiratory health are a concern. Discuss your vaccination status with your GP or practice nurse, and refer to the New Zealand National Immunisation Schedule for funded vaccines.

• Influenza vaccine (annual): Acute respiratory illness and persistent coughing can significantly worsen GERD symptoms by increasing intra-abdominal pressure. Annual influenza vaccination is strongly recommended and is funded under the New Zealand National Immunisation Schedule for eligible groups including those aged 65+, pregnant women, and those with chronic health conditions.
• COVID-19 vaccine (as per current NZ schedule): COVID-19 infection and post-viral states can exacerbate gastrointestinal symptoms including reflux and dysmotility. Keeping up to date with COVID-19 vaccination in line with the Ministry of Health NZ recommendations supports overall recovery and reduces the risk of prolonged gastrointestinal complications.
• Pneumococcal vaccine: Chronic GERD increases the risk of aspiration, which in turn raises the risk of aspiration pneumonia — particularly in older adults. Pneumococcal vaccination (funded for adults aged 65+ and certain at-risk groups under the NZ schedule) provides important protection against pneumococcal pneumonia in this context.

Dietary Guidance

Diet plays a central role in GERD symptom management. The following evidence-based dietary recommendations may help reduce reflux frequency and severity. Individual tolerances vary, and a referral to a registered dietitian is recommended for personalised dietary planning.

• Low-acid, anti-reflux diet: A dietary pattern low in acidic, fatty, and spicy foods forms the cornerstone of non-pharmacological GERD management. Avoiding known triggers — including citrus fruits, tomato-based products, chocolate, caffeine, alcohol, carbonated beverages, and high-fat meals — can significantly reduce reflux frequency and symptom severity.
• Oatmeal and high-fibre foods: Oatmeal and other soluble fibre-rich foods (e.g., bananas, cooked vegetables, whole grains) are well tolerated in GERD and may help absorb excess stomach acid. Adequate dietary fibre also supports healthy gastrointestinal motility, reducing gastric stasis and bloating that can worsen reflux.
• Lean proteins (chicken, fish, legumes): Lean protein sources are less likely to relax the lower oesophageal sphincter compared to high-fat meats. Grilling, steaming, or baking proteins rather than frying further reduces the refluxogenic fat load of meals.
• Alkaline and low-acid fruits (melons, pears, bananas): Non-citrus fruits such as cantaloupe, watermelon, honeydew, pear, and banana are generally well tolerated in GERD and may help buffer gastric acidity. These provide important micronutrients while avoiding the acid load associated with citrus and berries.
• Ginger (fresh or as herbal tea): Ginger has anti-inflammatory and pro-motility properties that may help accelerate gastric emptying and reduce nausea associated with GERD. Up to 4 g of ginger per day (e.g., as fresh slices in hot water) is considered safe for most adults. Avoid ginger supplements in high doses.
• Portion control and meal timing: Large meals increase intragastric pressure and prolong gastric acid secretion, worsening reflux. Eating smaller, more frequent meals, avoiding eating within 2–3 hours of bedtime, and remaining upright after meals are evidence-based behavioural strategies that complement pharmacological treatment. A referral to a registered dietitian is recommended for individualised dietary planning.

Related Conditions & Medications

Related medications: Omeprazole. Related conditions: IBS.