Acid Reflux and GERD: Causes, Treatment and Symptoms

Eat regularly throughout the day. Overeating is never a good idea, but an empty stomach can cause problems, too. Go more than three to four hours without chowing down and stomach acid collects. Eat small meals — and drink water — throughout the day.

Don’t eat before bed. Nocturnal acid reflex is a real concern. “Normally, someone who is sitting upright will swallow saliva and neutralize that acid,” Ergun says. “But if you’re sleeping, it could be sitting in your esophagus for a while.” Wait at least two to three hours after eating before you go to bed. And watch how you sleep. “Liquid and gas want to go to the path of least resistance,” Pichetshote says. “If you’re lying flat, it can easily go up toward your head. If you’re sleeping a little more upright, it has to fight gravity.”

Elevate your head six to eight inches by buying a wedge pillow or slipping a wedge-shaped piece of foam underneath your mattress. Some research suggests that lying on your left side can reduce acid reflux. “There’s a pocket in our stomach that has a little more acid than the rest of our stomach,” Pichetshote says. “When we sleep on our right side, the pocket becomes closer to our esophagus and that can give us more reflux.”

Drop some pounds. Obesity or overeating can also up your chances of having GERD by increasing your intragastric (stomach) pressure. “If you had a baby and fed it, you would not squish its stomach because the food would come right back up,” Ergun says. “Well, having an extra 30 pounds of abdominal fat, which is where most people get the extra weight, is the same as squishing the belly. It’s easier for material to come up into your chest.” Even a 10 percent reduction in weight can cause a significant reduction in symptoms, notes Pichetshote.

Hit the gym. Being active can help with reflux as well. “The muscles around the lower esophagus can actually get stronger when you exercise, making the area tighter,” Pichetshote says. “When you have acid in your stomach, there’s more of a barrier so it doesn’t go up into your esophagus.”

Don’t down meds without water. Certain medications — among them, aspirin and ibuprofen, bisphosphonates to prevent bone loss, and some antibiotics — can worsen reflux-related heartburn. What’s more, if they break down before they reach the stomach, they can irritate the lining of the esophagus.

Reflux Rx’s and when to consider surgery

If lifestyle tweaks aren’t doing the trick, you might consider medication. Over-the-counter antacids neutralize stomach acid and offer fast relief. At the next level of treatment, for moderate to severe acid reflux, are H2-receptor blockers ( Tagamet and Pepcid), which reduce the production of acid in your stomach. “H2 blockers don’t completely block acid production but affect it enough that people feel improved, and they work pretty fast,” Ergun says.

The next choice: proton pump inhibitors (Prevacid and Prilosec). Stronger than H2-receptor blockers, they block stomach acid secretion and give damaged esophageal tissue time to heal. These drugs are helpful when you have esophagitis or Barrett’s esophagus. And, unlike H2 blockers, you don’t have to take them two or three times a day. Many are found over the counter, but a doctor can prescribe them in higher doses.

The good news: GERD can usually be tamed with medication. But if the problem is persistent, your doctor may suggest using a medical procedure or surgery to get things under control. Laparoscopic fundoplication is one such treatment. During this minimally invasive procedure, a surgeon wraps the top of your stomach around the lower esophageal sphincter to tighten the muscle and prevent reflux.

“The two major components of gastro reflux are heartburn and regurgitation,” Ergun says. “When you have heartburn, if you block the acid, the heartburn gets better. You’re preventing what comes up from being as noxious as it normally is . But although pills may take care of the acid, they won’t do anything for the reflux barrier, which is why people will say, ‘The heartburn is gone, but I still have regurgitation.’ That’s evidence there’s a mechanical problem, such as hiatal hernia, and that’s when surgery makes the biggest difference.”


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