Treatment

1. getting rid of symptoms
2. decreasing the frequency
3. promote healing of the damaged esophageal mucosa
4. prevent long term damage

1. increasing the pressure in the esophageal sphincter
2. enhance esophageal acid clearance
3. increase speed of gastric emptying
4. protect esophageal mucosa
5. decrease acidity of the refluxed content
6. decrease the volume of the stomach content

Many patients are able to successfully treat Acid Reflux themselves. In situations where symptoms are severe and frequent or complications have arisen more intensive treatment may be required.

Treatment Choices

1. Lifestyle Changes
   • smaller, more frequent meals
   • quit smoking
   • avoid foods that delay gastric emptying (chocolate, onions, spearmint, peppermint, fat, coffee, garlic)
   • avoid acidic or spicy foods (citrus juices, tomatoes, tomato based foods)
   • reduce alcohol intake
   • try to achieve an ideal body weight
   • avoid lying down after meals
   • elevate the head of the bed approximately 10 cm (4 inches)
   • avoid exercising on a full stomach
   • avoid tight fitting clothes around the waist
   • do not snack within three hours of bedtime
2. Medications
   1. Over the counter antacids - neutralize acids in stomach
      • aluminum hydroxide
      • calcium hydroxide
      • calcium carbonate
      • magnesium hydroxide
      • magnesium carbonate
      • magaldrate (contains aluminum and magnesium)
      • sodium bicarbonate
   2. Over the counter foaming agents - lie on top of stomach contents, decreasing the ability of the acid to come in contact with the esophagus.
      • Alginic acid (Gaviscon)
      • Sodium alginate (Gaviscon)
   3. Over the counter H2¬- receptor antagonist - decrease acid production
      • ranitidine(Zantac, generics)
      • famotidine(Pepcid, Fluxid, Ulcidine, generics)
      • cimetidine(Tagamet, generics)
      • nizatidine(Axid, generics)
   4. Prescription strength H2-receptor antagonists decrease acid production. These medications relieve symptoms in 60% of patients and heal mild esophageal complications in 40% of patients.
      • ranitidine(Zantac, generics)
      • famotidine(Pepcid, Fluxid, Ulcidine, generics)
      • cimetidine (Tagamet, generics)
      • nizatidine (Axid, generics)
   5. simethicone helps to reduce gas and is often found in medications for heartburn to help reduce belching.
   6. Proton Pump Inhibitors (PPI) show potent decrease in acid secretion and rapid symptom relief and healing rates in about 90% of patients.
      • Esomeprazole (Nexium)
      • lansoprazole (Prevacid)
      • omeprazole (Losec, Prilosec, Zegerid)
      • pantoprazole (Pantolol, Protonix)
      • rabeprazole (AcipHex)
   7. Prokinetics help strengthen the lower esophageal sphincter and increase rate of stomach emptying. They have a high incidence of side effects and are of little benefit except in delayed gastric emptying or alkaline esophagitis.
      • bethanechol (Urecholine, Duvoid, Urabeth)
      • metoclopramide (Reglan, generic forms)
      • domeperidone

Acid reflux treatment should always begin with healthy lifestyle choices. If this is not effective alone, a foaming agent, antacid or an over the counter H2-receptor antagonist may be added. If these are not effective, symptoms become more severe or occur three or more times weekly, you should see a physician. If you are on a health plan, most likely they will require you try a H2-receptor antagonist (i.e. Zantac) before trying a PPI (i.e. Losec), since PPIs often cost more and are frequently reserved for those times an H2-receptor antagonist does not work.