Dietary and Lifestyle Changes
Many patients succeed in relieving most if not all the symptoms of gastroesophageal reflux disease (GERD) by changing the way they eat, what they eat and when they eat.
Several foods can decrease the pressure at the lower esophageal sphincter, which works as a gateway preventing the acid from getting to the esophagus. Avoiding those foods will help control GERD, including:
- spicy foods
- fatty foods
- smoking cigarettes
- coffee and all caffeinated products
- tomato-based juices and products
- citrus products
Some day-to-day lifestyle modification should be initiated and continued throughout the course of treatment for reflux disease. These include:
- avoiding tight clothes
- elevating the head of the bed
- avoiding large meals
- fasting for three hours before going to bed
- losing 5 percent of one’s body weight
Despite dietary and lifestyle changes, some patients still require medications to control their reflux symptoms. The medications can be given for a short period of time to help with the acute symptoms and to give time for the lifestyle and habits to change. However, some patients require lifetime treatment.
Many medications have been used to control gastroesophageal reflux disease (GERD).
- Proton pump inhibitors (PPI) are the mainstay of treatment. They are potent acid reducers that block the pumps responsible for supplying the acid to the stomach. PPIs include:
These medications are generally safe and can be taken once or twice per day (half an hour before breakfast or dinner).
- Antacids neutralize the acidity of the stomach and provide short-term relief.
- Other medications such as sucralfate provide a barrier that lines the esophageal and stomach mucosa and protect it from the gastric juices, thus providing the needed time to heal.
- Antihistamines such as ranitidine and famotidine also can be used to decrease the secretion of acid into the stomach lumen.
Effect of Bile
Most commonly the refluxed gastric contents are acidic, and typical medical therapy for reflux aims to suppress gastric acidity. However, bile (non-acidic fluid) may also be present within the gastric juice that is refluxed up into the esophagus. Neutralization of acid does not prevent injury to the esophagus from the non-acidic fluid. Therefore, even with suppression of acid production and decrease or elimination of heartburn, damage to the lining of the esophagus may continue despite medical therapy in patients with bile (non-acidic fluid) reflux.