Living With GERD

Managing Your Symptoms

Reflux is a common problem that can cause lots of troublesome symptoms. The good news is that there are lifestyle changes you can make that can help and useful medications you can take.

Lifestyle changes are very important initially in the management of GERD. There are certain foods that predispose to reflux and it is important to try and minimize or avoid alcohol, peppermint, greasy or spicy foods, tomatoes, fatty foods, citrus foods and caffeine products such as coffee and chocolate. 

Eating frequent, small meals may help prevent reflux, do not lie down after meals and stop eating 3-4 hours before going to bed.

Do not smoke. Smoking increases acid production, decreases the sphincter pressure between the esophagus and the stomach and predisposes to esophageal cancer.

It is very important to try and achieve an optimum weight. Being overweight puts more pressure on the sphincter and contributes to reflux.

For those who suffer from nighttime reflux, elevating your upper body with either a foam wedge or putting blocks under the legs at the head of the bed may be helpful. There may be less reflux if you lie on you left rather than your right. 

It is very common during pregnancy for reflux to be a problem. The fetus increases the abdominal pressure and the hormones of pregnancy may decrease the lower esophageal sphincter pressure. Also, if the stomach doesn't empty because of a motility problem or a blockage then there is a greater risk for acid to reflux into the esophagus.

Treatment Options

Medical therapy is very effective and is the preferred treatment for reflux

• Antacids are effective for individuals who experience intermittent occasional heartburn as they work very fast. However antacids only last a short time. Antacids work by neutralizing the stomach acid. Aluminum containing antacids may cause constipation. Magnesium containing anacids can cause diarrhea. Foam barrier drugs contain an antacid to neutralize and a foaming agent to act as a physical barrier to reflux. 
• H2 RA or histamine receptor antagonists block the receptors in the stomach that are stimulated by histamines and stimulate acid production. These medications are more effective than antacids and help with reflux. They can relieve symptoms and heal esophagitis in 50% of patients. These are now available without a prescription.
• Proton pump inhibitors (PPIs) are our most effective medications in controlling acid reflux. They may relieve symptoms and heal esophagitis in more than 80% of patients. They never completely suppress the ability of the stomach to make acid so the stomach can carry on its normal functioning. These medications are best taken before food such as breakfast or dinner depending on when one's symptoms are most troublesome and can be taken daily or on an as needed basis. 
• Prokinetics increase the ability of the stomach to empty it's contents so that they are less likely to reflux back into the esophagus. 
• Surgery is an option for some people who have troublesome retrosternal burning and extraesophageal symptoms of cough, asthma, voice change and pulmonary infections inspite of a trial with at least a double dose of a proton pump inhibitor. The aim of surgery is to increase the sphincter pressure between the esophagus and stomach by wrapping the top of the stomach around the lower esophagus. This increases the lower esophageal sphincter pressure and makes it more difficult for stomach contents to come up into the esophagus. Surgery can be performed laparoscopically (operating through small incisions made thru the abdominal wall). Sometimes the laparoscopic approach is not possible and one requires an open procedure where a larger abdominal incision is necessary