Overview
GERD is almost never caused by the production of too much acid. It is caused by abnormal reflux of gastric contents into the esophagus. The body has multiple barriers to prevent gastric contents from refluxing into the esophagus, including a flap valve at the bottom of the esophagus, the breathing muscle (the diaphragm), and gravity. In GERD, certain foods, lifestyle habits, and anatomic issues (hiatal hernia) can weaken these barriers. Or can make a referral to lifestyle modifications section. Like see lifestyle medications for foods and lifestyle habits that can be addressed to treat GERD. Maybe insert a table for food items, lifestyle habits and treatment options. (caffeine, citrus/spicy foods, high fat foods, smoking, caffeine intake being overweight, etc.)
What are the treatment goals for GERD?
What are the treatments for GERD?
Lifestyle Modification
In order to decrease the amount of gastric contents that reach the esophagus, certain simple guidelines should be followed:
Raise the Head of the Bed. Use an under-mattress foam wedge to elevate the head about 6-10 inches. Pillows are not an effective alternative for elevating the head in preventing reflux.
Change Eating and Sleeping Habits. Avoid lying down for two hours after eating. Do not eat for at least two hours before bedtime. This decreases the amount of stomach acid available for reflux.
Avoid Tight Clothing.
Weight loss if overweight. Patients who are overweight are significantly more likely to have GERD compared to ideal body weight
Change Your Diet. Avoid foods and medications that trigger GERD (fats, chocolate and caffeinated drinks) and foods that may irritate the damaged lining of the esophagus (citrus juice, tomato juice, and probably pepper).
Both smoking and alcoholic beverages lower LES pressure, which contributes to acid reflux.
Medications
The main prescription medications to treat GERD include drugs called H2 receptor antagonists (H2 blockers) and proton pump inhibitors (PPIs). These medicines reduce the amount of acid produced in the stomach.
H2 Blockers
H2 blockers are generally less expensive than proton pump inhibitors and can provide adequate initial treatment or serve as a maintenance agent in GERD patients with mild symptoms.
proton pump inhibitors (PPIs
Proton pump inhibitors as first-line therapy for some patients, particularly those with more severe symptoms or esophagitis on endoscopy. Proton pump inhibitors will be required to achieve effective long-term maintenance therapy in a significant percentage of heartburn/GERD patients.
Surgery
Surgical management of GERD can be considered in patients who do not completely respond to medical management, patients who are unable to tolerate the medicines due to adverse reactions or in patients who do not want to take a chronic medicine. Surgical management prevents gastric reflux by strengthening the barrier between the stomach and the esophagus. There are a number of different surgical approaches to GERD. Consultation with both a gastroenterologist and a surgeon is recommended prior to such a decision. Additional testing is usually required.