GERD can lead to anemia over time due to impaired iron absorption or chronic blood loss from erosions or ulcers in the esophagus.

Gastroesophageal reflux disease (GERD), also known as chronic acid reflux, is a condition characterized by the backward flow of stomach acid into the esophagus. It causes symptoms such as heartburn, a sour or bitter taste in the mouth, and difficulties swallowing.

In some cases, GERD can contribute to anemia, as it can cause ongoing blood loss through erosions or ulcers in the esophagus.

Certain treatments for GERD, such as long-term use of proton pump inhibitors (PPIs), can further interfere with iron absorption and increase the risk of anemia.

GERD can contribute to anemia by disrupting your body’s ability to absorb iron. When stomach acid rises into the esophagus, it can damage the lining and result in erosions or ulcers.

These lesions can lead to chronic blood loss and, when combined with impaired iron absorption, can result in iron deficiency anemia.

Esophagitis and ulcers

Severe or untreated GERD can lead to chronic inflammation of the esophagus (esophagitis) and ulcers. In some cases, these conditions may lead to slow, chronic bleeding, causing iron deficiency anemia over time.

In a 2022 study of 172 children with GERD, researchers found that 23 also had anemia. The findings suggest a link between anemia and GERD in children, specifically related to reflux esophagitis.


GERD can contribute to malabsorption by disrupting the standard digestive process. When stomach acid flows back into the esophagus, it can also reach the upper gastrointestinal tract, where it can interfere with the breakdown and absorption of nutrients, including iron.

The reduced availability of iron affects the body’s ability to produce an adequate number of healthy red blood cells, resulting in anemia.

Low stomach acid

Stomach acid plays an important role in absorbing iron from foods. It helps convert dietary iron into a form that is readily absorbed by the body.

When stomach acid levels are low, the efficiency of iron absorption may be compromised. This can lead to decreased iron uptake from the diet, potentially resulting in low iron levels over time.

Anemia itself is not a direct sign of GERD. But it can be a consequence of GERD-related complications, such as chronic blood loss from erosions or ulcers in the esophagus.

Esophagitis, a serious complication of GERD, can cause gastrointestinal bleeding. This can lead to anemia, as well as symptoms such as vomiting blood or dark material and passing black, tarry stools.

According to research in 2018, anemia is also considered one of the “alarm symptoms” for GERD. Alarm symptoms are a group of symptoms that suggest a need for urgent evaluation by a medical professional, such as difficult or painful swallowing.

GERD symptoms

The symptoms of GERD can vary from person to person but commonly include:

  • heartburn
  • a sour or bitter taste in the mouth
  • difficulty swallowing or a feeling of food getting stuck in the throat
  • painful swallowing
  • chest pain
  • chronic cough
  • hoarseness or voice changes
  • wheezing and shortness of breath
  • laryngitis
  • dental problems

Anemia symptoms

Some common symptoms of anemia include:

  • fatigue and weakness
  • pale skin
  • shortness of breath
  • rapid or irregular heartbeat
  • dizziness or lightheadedness
  • headaches
  • cold hands and feet
  • chest pain
  • brittle nails and hair
  • unusual cravings (pica)

The management of GERD typically includes lifestyle modifications, dietary changes, and medications.

Lifestyle modifications may involve:

  • avoiding trigger foods
  • maintaining a healthy weight for your body
  • elevating the head of your bed during sleep
  • avoiding lying down after meals

Dietary changes may include avoiding spicy and acidic foods, caffeine, alcohol, and fatty foods.

Medications commonly used for GERD help reduce acid production and alleviate symptoms:

Anemia treatment

If anemia is diagnosed and attributed to iron deficiency, iron supplements may be recommended. The type and dosage of iron supplements will be determined by your healthcare professional based on your iron levels and individual needs.

Supplementing with iron is available in different forms, such as oral tablets or intravenous infusion, depending on the severity of anemia and your body’s ability to absorb iron through the digestive system.

Other treatment options for anemia may include:

Using antacids and PPIs to suppress stomach acid can disrupt digestion and affect the absorption of nutrients.

In a 2018 study with over 26,000 participants, researchers found that chronic PPI use increased the risk of iron deficiency. The risk was higher for those who used PPIs continuously compared with intermittent users and non-users.

These findings highlight the need for caution when prescribing long-term PPI therapy due to the potential risk of developing iron deficiency.

Can iron aggravate GERD?

Iron supplements can potentially aggravate GERD symptoms in some individuals.

Iron can be irritating to the gastrointestinal tract, and certain forms of iron supplements, such as ferrous sulfate, may cause gastrointestinal side effects like heartburn, stomach pain, and acid reflux.

GERD and anemia are distinct but interconnected conditions. GERD, characterized by chronic acid reflux, can lead to erosions in the esophagus and chronic blood loss, resulting in anemia.

Anemia, in turn, can worsen GERD symptoms.

Early identification and management of both conditions are important for better outcomes. If you think you have GERD or anemia — or both — consider reaching out to a healthcare professional to get a comprehensive evaluation.