In all cases, treatment begins with suggestions for lifestyle modifications that will reduce symptom frequency and severity.
The suggested lifestyle changes are:
Reduce or eliminate alcohol and tobacco. Both alcohol and tobacco decrease the pressure the lower esophageal sphincter (LES) places on the stomach to keep its contents in, and tobacco also increases stomach acidity and irritates the esophagus.
Avoid dietary triggers. Many food products affect or relax the LES, leading to reflux when you eat them. Examples are chocolate, caffeine, tomato, and citrus juices.
Review your medications with your doctor. Some medications can alter how tight the LES closes or may irritate your esophagus, making heartburn symptoms feel worse.
Stay upright for at least 2 hours after eating. Lying down with a full stomach often triggers GERD symptoms by increasing pressure on the LES.
Try propping the head of your bed up about 6 inches. You can add blocks under the front legs of the bed or use a large, wedge-shaped pillow.
Try chewing gum. Chewing stimulates saliva, which neutralizes stomach acid.
Lose weight. Obesity is often associated with GERD. Weight loss can decrease the pressure your abdomen puts on the LES.
Wear loose clothing. Tight pants, belts, or sashes increase pressure on the LES and can force stomach content back into the esophagus.
A variety of prescription and over-the-counter medications are available to treat GERD. Doctors commonly prescribe these medications indefinitely because the medications primarily address symptom of GERD and not the root cause.
Antacids: Commonly available over-the-counter, antacids work by reducing the acidity of stomach contents to decrease the damage caused by acid reflux.
H2 Blockers: Histamine-2 receptor blockers reduce stomach acid production and are useful for mild GERD. Some H2 blockers are now available without prescription.
Proton Pump Inhibitors (PPIs): Considerd to be the most effective of the GERD medications, PPIs rapidly reduce stomach acid production and are part of a long-term, often lifelong, GERD treatment strategy.
Coating Agents: These medications bind with proteins in the wall of the esophagus and stomach to create a protective coating.
Promotility drugs: By helping the stomach empty faster, promotility drugs help reduce pressure on the LES and reduce the frequency of reflux.
Surgical repair of the lower esophageal sphincter is becoming an increasingly popular treatment option for GERD. Recent advances in laparoscopic and natural orifice surgery provide excellent results for patients suffering from chronic GERD.
Traditionally, surgical options are considered if: