Acid Reflux Treatment: Lifestyle Changes and Medicine Options

Living with frequent heartburn can be tiring, but there are several ways doctors help people manage GERD. This article describes the general approaches set out by the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). It is not personal advice: your doctor decides what is right for you, and you should not start, stop or change any medicine without talking to them.

Lifestyle changes

NIDDK lists several steps that may help reduce GERD symptoms:

• Weight loss if you are overweight or have obesity.
• Raising the head of your bed by 6 to 8 inches, using a foam wedge or extra pillows under the head and upper back.
• Stopping smoking.
• Changing eating habits and diet. For example, if symptoms happen at night, eating at least 3 hours before lying down or going to bed may help.

Foods and drinks

NIDDK notes that triggers differ from person to person. Foods and drinks that people commonly report as triggers include acidic foods such as citrus fruits and tomatoes, alcohol, chocolate, coffee and other caffeine, high-fat foods, mint and spicy foods. Your doctor may suggest cutting back on or avoiding certain items to see whether your symptoms improve. You do not need to give up everything on this list; it is about finding what affects you.

Medicines

NIDDK describes three main groups of medicine, and says other medicines may be considered if these do not help.

• Antacids are sold over the counter for mild heartburn. NIDDK says they are not meant for daily use or for severe symptoms without a doctor's guidance. They can cause diarrhoea or constipation in some people.
• H2 blockers reduce the amount of acid the stomach makes. They are available over the counter or by prescription. They help heal the food pipe, though less effectively than proton pump inhibitors.
• Proton pump inhibitors (PPIs) reduce stomach acid more strongly. NIDDK says they are better than H2 blockers at controlling symptoms and heal the lining of the food pipe in most people. Doctors may prescribe them for long-term use. They are generally considered safe, with uncommon side effects such as headache, diarrhoea and upset stomach. NIDDK adds that PPIs may increase the chance of a gut infection called C. difficile, and that the effects of long-term or high-dose use are still being studied.

Because of these points, it is sensible to review any long-term acid medicine with your doctor from time to time.

Surgery and procedures

NIDDK says surgery may be considered if symptoms continue despite lifestyle changes and medicine, or if someone wants to stop taking medicine long term. Surgery carries a higher risk of complications than medicine. Options mentioned include:

• Fundoplication, the most common GERD operation, in which the top of the stomach is wrapped around the lower end of the food pipe to tighten the valve. It is most often done by keyhole (laparoscopic) surgery.
• Weight-loss (bariatric) surgery for people who have both GERD and obesity.
• Endoscopic procedures, which NIDDK says are rarely used.

When to see a doctor

See a doctor if you suspect GERD, or if symptoms continue despite over-the-counter medicines or lifestyle changes. Seek medical advice promptly for any of these warning signs listed by NIDDK:

• Chest pain
• Loss of appetite
• Vomiting that keeps happening
• Trouble or pain when swallowing
• Vomit with blood or that looks like coffee grounds
• Black, tarry or bloody stools
• Unexplained weight loss

In an emergency, call your local emergency number (112 in India, 911 in the United States).