Symptoms of acid reflux, such as heartburn and regurgitation, account for nearly 5 million outpatient doctor visits in the U.S. each year. According to an August 2008 review in "American Family Physician," most people with acid reflux do not see their doctor, at least not initially. Instead, many use over-the-counter medications to relieve their symptoms. If you have persistent or recurring acid reflux, medications are only a part of an appropriate treatment plan.
The mechanism that transports food and fluid from your mouth to your stomach is structurally quite simple. Your esophagus -- which connects your throat to your stomach -- is essentially a tubular pump. At the bottom end of the esophagus is a valve called the lower esophageal sphincter. Below that, your stomach acts as a reservoir for whatever your esophagus pumps into it. Any factor that interferes with the esophageal pump or loosens the LES sets the stage for acid reflux. Proper management of acid reflux disease requires attention to all of these factors.
Obesity a risk factor for acid reflux. By increasing the pressure inside your abdominal cavity, obesity overcomes the strength of the LES and pushes the stomach contents into your esophagus. So, weight loss is an important tool in managing acid reflux. People with acid reflux disease should wear loose-fitting clothing. Eating large meals and lying down after eating will also increase reflux, so eat smaller, more frequent meals and avoid lying down for 3 to 4 hours after eating. If acid reflux wakes you up at night, you can try raising the head of your bed.
Most people with acid reflux can identify which foods trigger it, such as spicy foods or apple juice, and consistently cause heartburn. Clearly, you should avoid these triggers if you don’t want to have heartburn. Some foods and beverages, either by loosening the LES, increasing stomach acidity or slowing stomach emptying, tend to cause heartburn or regurgitation in most people who have acid reflux disease. Caffeine, alcohol, peppermint, chocolate, onions, garlic, fats, citrus fruits and tomatoes are frequent offenders.
Reducing stomach acid secretion is the key to managing acid reflux disease. Two principal classes of acid-reducing medications -- proton pump inhibitors and H2 blockers -- are available by prescription and over the counter for this purpose. PPIs, such as omeprazole (Prilosec) or lansoprazole (Prevacid), inhibit acid secretion by blocking a cellular pump that helps produce hydrochloric acid. Similarly, H2 blockers -- cimetidine (Tagamet), ranitidine (Zantac) and others -- suppress acid production by attaching to a histamine receptor in the lining of your stomach. Over-the-counter PPIs and H2 blockers are identical to their prescription counterparts, except over-the-counter drugs have lower dosages. So, if you have persistent acid reflux symptoms despite taking over-the-counter medications, your doctor may prescribe higher doses or recommend combinations of medications. You may also be referred for further evaluation -- usually endoscopy, which allows the doctor to see your esophagus and stomach through a scope -- to ensure you are not developing any complications from acid reflux.
A number of surgical options may help when acid reflux does not respond to medications. The most common procedure -- laparoscopic fundoplication -- involves wrapping a portion of your stomach around your lower esophagus to halt reflux. Newer techniques, such as the Stretta and Endocinch procedures, can be performed by passing a scope through your esophagus. While fundoplication has an established track record, the long-term outcomes of newer procedures are still under investigation. If you have persistent or recurrent acid reflux symptoms, your doctor will help determine the best management approach for you.
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