Acid reflux disease, also known as gastroesophageal reflux disease, or GERD, occurs when stomach acids leak back into the esophagus, causing irritation and inflammation of the esophageal lining. Protecting the esophagus from acidity allows the lining to heal. Steps you can take to protect your esophagus from acid reflux include weight loss and lifestyle changes, medications to suppress stomach acid and, in some instances, surgery to strengthen the valve -- the lower esophageal sphincter, or LES -- that stops acid from refluxing upward.
Excess body weight puts pressure on the LES, causing structural weakness and hindering its ability to function. Your doctor may recommend that you lose weight, especially if you have experienced recent weight gain. You may want to avoid body positions that increase pressure on the stomach, as well as high-impact activities such as jogging that can cause reflux. Opt for looser clothing, since tight clothing or control-top hosiery and body shapers can increase pressure on the abdomen.
Raising the Head of Your Bed
Many find their symptoms are worse when lying down. Elevating your upper body with pillows by 6 to 8 inches at bedtime is recommended for many GERD patients because gravity keeps acidic digestive juices in your stomach where they belong. Avoiding food consumption for 2 to 3 hours prior to bedtime or before lying down is also recommended.
Watching Your Intake and Stopping Smoking
Foods that trigger acid reflux vary among individuals, and some doctors may recommend keeping a food diary to determine which foods are a problem for you. Foods that commonly trigger symptoms include dairy products, alcohol, chocolate, soft drinks, fried or fatty foods and foods containing vinegar. Eating smaller meals and avoiding late snacks is recommended. Coffee, including decaf, is also a major culprit. Smoking weakens the lower esophageal sphincter and prevents it from working properly. Avoid nonsteroidal antiinflammatory drugs -- NSAIDs -- such as aspirin, ibuprofen (Motrin, Advil, Nuprin) and naproxen (Aleve) as they may cause or worsen GERD.
Use of Proton Pump Inhibitors
Drugs known as proton pump inhibitors, or PPIs, reduce symptoms and help heal the esophagus by inhibiting stomach acid secretion. PPIs are available over the counter and include familiar brand-name drugs like lansoprazole (Prevacid), omeprazole (Prilosec) and esomeprazole (Nexium). Nonprescription PPIs are approved by the Food and Drug Administration for once-a-day use for up to 14 days, though doctors may prescribe them at higher doses. Long-term use has been linked to an increased risk of bone fractures and might also deplete magnesium blood levels, causing muscle spasms, irregular heartbeats and convulsions.
H2 blockers are an earlier acid blocker than PPIs that work by neutralizing histamine, a chemical involved with acid secretion. They are recommended for some patients, are less expensive than PPIs and may work well for milder cases of GERD. H2 blockers are also available over the counter under such generic names as famotidine (Pepcid), cimetidine (Tagamet) and ranitidine (Zantac). Famotidine is not recommended for people with kidney problems. Pregnant or nursing women should consult their doctor before taking sucralfate (Carafate), another drug sometimes prescribed for GERD. For occasional bouts of acid reflux, old-fashioned antacids such as Tums or Rolaids are still a good bet.
When less invasive measures fail to resolve GERD, surgery can be an option. The most common surgery for GERD is the Nissen fundoplication. This involves first repairing any hiatal hernia, should there be one, then coiling the upper part of the abdomen around the lower end of the esophagus. This strengthens the LES, restoring its function as the “one-way valve” that acts to prevent acid reflux. Surgery is recommended for patients whose conditions include inflamed esophagus, strictures in the esophagus. Children who are unable to gain or maintain their weight also may be candidates for surgery.
Medical advisor: Jonathan E. Aviv, M.D., FACS
- American Gastroenterological Association: Gastroesophageal Reflux Disease (GERD)
- American Journal of Gastroenterology: Diagnosis and Management of Gastroesophageal Reflux Disease
- Gastroesophageal Reflux Disease -- A Clinician's Guide; Gary Gitnik, M.D.
- University of Michigan Faculty Group Practice Quality Management Program: Gastroesophageal Disease (GERD)
- World Journal of Gastroenterology: Body Weight, Lifestyle, Dietary Habits and Gastroesophageal Reflux Disease