Acid reflux occurs when acid from your stomach flows backward into your esophagus. While occasional heartburn is common, recurrent acid reflux, known as gastroesophageal reflux disease (GERD), is more serious may require medical treatment.
GERD is the result of a weak or damaged lower esophageal sphincter (LES). Your LES places pressure on the opening between your esophagus and your stomach, which keeps stomach acid contained within your stomach. If you have a weak or damaged LES, stomach acid may leak into your esophagus and cause acid reflux symptoms. Additionally, your stomach may also overproduce acid, which makes backflow into your esophagus more likely.
Common acid reflux symptoms include:
- Dry cough
- Sore throat
- Trouble swallowing
- A sour or metallic taste in your mouth
If you consistently experience these symptoms, speak with your doctor and/or dietitian, who will likely recommend trying diet and lifestyle modifications first, followed by over-the-counter (OTC) medications.
If these treatment options are not successful, your doctor may recommend prescription medication or a surgical procedure to treat your GERD.
Diet and Lifestyle Modifications
Changes to your diet and lifestyle are the first defense in treating acid reflux. Avoid triggering foods including high fat foods, acidic foods, spicy foods, garlic, onions, chocolate, mint, alcohol, and caffeine to control acid production and reflux. Eat a well-balanced diet that includes alkaline foods to neutralize stomach acid, and high fiber foods to improve digestive health.
Additionally, eat smaller, more frequent meals and avoid eating before laying down to help prevent acid from entering your esophagus. Managing your weight and stress have also been shown to improve reflux symptoms.
Antacids provide quick relief by neutralizing stomach acid. However, antacids do not heal the damage that your stomach acid causes to your esophagus. Antacids are a good treatment option if you have infrequent heartburn. However, if you find yourself taking antacids daily, you likely need a stronger medication.
Additionally, antacids leave your stomach quickly, which often results in an increase in stomach acid after they pass through. Common antacids include Tums, Rolaids, and Mylanta. Please note that overuse of antacids may cause diarrhea or kidney problems.
H-2-receptor blockers function to reduce stomach acid production. H-2-receptor blockers provide longer relief than antacids by decreasing acid production within your stomach for up to 12 hours. However, these medications do not work as quickly as antacids. H-2-receptor blockers successfully heal damage to the esophagus in about half of patients who use them them. Common H-2-receptor blockers are Pepcid AC, Axid AR, and Tagamet HB. Stronger versions of this class of medications are available by doctor prescription.
Proton pump inhibitors block stomach acid production from the three major acid production pathways. The reduction in stomach acid allows your esophagus to heal. These medications are stronger than H-2-receptor blockers, which makes them more effective at decreasing acid production. Additionally, these treatments give the esophagus more time to heal. Common proton pump inhibitors include Prevacid 24 HR, Prilosec OTC, and Zegerid OTC. Prescription strength options are also available if necessary.
Prescription H-2-receptor blockers provide additional stomach acid reduction. These medications are safe and well-tolerated for long-term use. Prescription strength famotidine (Pepcid) and nizatidine are the most common H-2-receptor blockers. Please note that long-term use may increase your risk for vitamin B12 deficiency and bone fractures, which you should discuss with your doctor.
Proton pump inhibitors may be switched from OTC to prescription if you do not see improvements when taking the OTC version. Prescription proton pump inhibitors include Prevacid, Prilosec, Zegerid, Nexium, Protonic, Aciphex, and Dexilant. As with H-2-receptor blockers, these medications are generally well-tolerated. However, potential side effects include diarrhea, headache, nausea, and vitamin B12 deficiency. Your risk for hip fractures also increases with chronic use.
Prokinetic agents relieve reflux by increasing smooth muscle activity within your gastrointestinal tract. The increase in muscle activity works to strengthen your LES. The stronger LES helps to keep a tighter seal over the stomach opening. These medications are often less effective than proton pump inhibitors but may be used in conjunction with an acid suppressing medication for increased effectiveness. Baclofen is the most common prokinetic agent. Side effects of Baclofen include nausea and fatigue.
Fundoplication is a procedure used when medications are not successful. Additionally, it may be an option if you decide you do not want to take medication for a long period of time. When a surgeon performs fundoplication, he or she wraps the top of your stomach around your LES to tighten the muscles around your stomach opening. This helps prevent the backflow of acid into your esophagus. This procedure is considered minimally invasive because it is done laparoscopically. There are different types of fundoplication, which may involve partially or fully wrapping your stomach around your LES.
LINX devices may be implanted surgically. A LINX device is a ring of magnetic beads that wraps around the connection between your esophagus and your stomach. The beads’ magnetic properties help to keep the LES opening closed. However, the attraction of the beads is not so strong that it prevents food from passing through. As with fundoplication, a LINX device is implanted in a minimally invasive procedure.
Transoral incisionless fundoplication (TIF) is a newer surgical treatment option for GERD. The TIF partially wraps your LES with polypropylene fasteners to help tighten your LES. This procedure is completed using an endoscope that is inserted through your mouth, which means no incisions are required. The TIF is generally well-tolerated and recovery time is short.
Putting It All Together
If you suffer from acid reflux, you have various treatment options. Generally, starting with diet and lifestyle medications is recommended. OTC medications, followed by prescription medications, are often the next treatment steps. Finally, surgery is an option for long-term relief from acid reflux.
Even if your acid reflux is well controlled, continuing to work with your doctor and dietitian to maintain the overall health of your digestive system is key to maintaining a healthy life.
If you are looking for more specific guidance to find your best eating pattern, our team of dietitians and nutritionists is here to help you build the acid reflux diet that can improve and even eliminate your heartburn symptoms!
Liz has been reading nutrition labels since she learned how to read. Growing up with severe peanut and tree nut allergies she learned that it’s important to know what you are putting into your body. She made her first big lifestyle change as a freshman in high school, when she decided to become a vegetarian. However, it wasn’t until she took a food class in Italy as part of a study abroad program in college that it clicked in her mind that she wanted to make food and nutrition her career. Liz graduated from Penn State University in 2015 with a bachelor's degree in Nutrition, as well as a bachelor's degree in Marketing. She completed her dietetic internship with Aramark in Philadelphia, and her master's degree at Northeastern University shortly after.