Eat small and frequent meals. Do not over fill
your stomach with a large meal.
Avoid any foods that seem to aggravate your
symptoms, especially chocolate, spearmint, peppermint, tomato and citrus fruits and
juices, tea, the colas and spicy, acidic, or fatty foods.
Limit coffee or other caffeine-containing
beverages to two or three servings per day.
Avoid cigarettes (or any other form of
nicotine). If you cannot stop smoking, at least try to decrease the number of cigarettes
Restrict your alcohol intake to no more than two
drinks per day.
Avoid wearing tight-fitting clothes that can
increase pressure on the abdomen.
If you are overweight, try to lose weight. Excess
weight increases the amount of pressure constantly placed on your stomach. Even small
amounts of weight loss may help.
Avoid exercising, straining, or bending over
immediately after eating (bend at the knees).
After eating, wait at least 3 hours before
Elevate the head of your bed about six inches with
wood blocks. Using extra pillows is not a good substitute but use of a foam wedge beneath
the upper half of the body is a suitable alternative.
Many medications, especially aspirin and
aspirin-like products used for arthritis (Ibuprofen, etc.), may adversely affect your
condition. Long-term use of anti-inflammatory medications puts you at high risk for
gastrointestinal irritation and ulceration. Be sure to let your doctor know of all
medications and over-the-counter products that you take on a regular basis.
Most patients with GERD achieve adequate symptom
control and esophageal healing through a combination of lifestyle modifications and drug
therapy and therefore do not require surgical intervention. The ultimate goal of treatment
is to minimize exposure of the esophagus to refluxed stomach juices, thereby relieving
symptoms, healing the esophagus, preventing complications and maintaining remission while
improving quality of life. The intensity of treatment is based on the frequency and
severity of symptoms.
Symptoms two days per week or less (mild to
Antacids, like Maalox®, Mylanta® or Gaviscon®,
remain the drugs of choice for quick relief of symptoms associated with GERD. Although
antacids are effective in relieving symptoms, they are not recommended as sole agents for
treating GERD because of the high dosage requirements. They are commonly used in
combination with over-the-counter H2-receptor blockers, like Zantac®,
Pepcid®, Axid®, or Tagamet®. These agents do not act as rapidly as antacids but they
provide longer relief of symptoms. Because of their slower onset of action, H2-receptor
blockers can be used to prevent GERD symptoms (before that meal that you think will cause
Symptoms more than two days per week (moderate to
Symptoms that continue at this frequency and
intensity puts one at higher risk for complications even if medications are currently
being used. This problem should be evaluated and treated by a physician. Diagnostic
studies may be indicated to evaluate for esophageal erosions or other complications of
GERD. Medications of higher potency are available by prescription and are often used
continuously for 8-12 weeks. If symptoms are well controlled after this time, and no
erosions were documented or suspected, the medications might be reduced to an "as
needed" basis. A modification in treatment, and possible further evaluation, will be
indicated in those who remain symptomatic after 8-12 weeks of continuous therapy.
GERD has a high recurrence rate because no currently
available medication is able to correct the underlying cause or causes of the disease. The
need for maintenance therapy depends largely on the severity of the disease and the
persistence of symptoms after the withdrawal of initial medical therapy.
Surgery should be considered in patients
who fail medical therapy or develop complications from GERD. Surgical intervention has
been shown to provide long-term relief of symptoms. The Nissen fundoplication procedure
has a cure rate of up to 90 percent. This operation can now be performed laparoscopically
in about 2 hours (usually followed by an overnight stay in the hospital). The purpose of
the fundoplication procedures is to reduce a hiatal hernia and restore the competence of
the gastroesophageal junction by constructing a valve mechanism.