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Reflux Disease

Intro

Although many people can relieve their reflux disease symptoms by changes in their habits and lifestyle, others need to consult their health care provider.

Call your health care provider when symptoms of  GERD   occur frequently, disrupt your sleep, interfere with work or other activities, or are not relieved by self-care measures alone.
Make your health care provider aware that you are using self-care measures so that he or she can monitor how well they work and how often you need to use them.

If you have any of the following, go immediately to the closest emergency department:

  • Severe chest pain   or pressure, especially if it radiates to your arm, neck, or back  
  • Vomiting followed by severe chest pain  
  • Vomiting blood
  • Dark, tarry stools
  • Difficulty swallowing solids or liquids

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Self-Care at Home

Many people can relieve their symptoms by changing their habits and lifestyle. The following steps, if followed, may reduce your reflux significantly.

  • Don't eat within 3 hours of bedtime. This allows your stomach to empty and acid production to decrease. If you don't eat, your body isn't making acid to digest the food.
  • Similarly, don't lie down right after eating at any time of day.
  • Elevate the head of your bed 6 inches with blocks. Gravity helps prevent reflux.
  • Don't eat large meals. Eating a lot of food at one time increases the amount of acid needed to digest it. Eat smaller, more frequent meals throughout the day.
  • Avoid fatty or greasy foods, chocolate, caffeine, mints or mint-flavored foods, spicy foods, citrus, and tomato-based foods. These foods decrease the competence of the LES.
  • Avoid drinking alcohol. Alcohol increases the likelihood that acid from your stomach will back up.
  • Stop smoking. Smoking weakens the lower esophageal sphincter and increases reflux.
  • Lose excess weight  . Overweight and obese people are much more likely to have bothersome reflux than people of healthy weight.
  • Stand upright or sit up straight, maintain good posture  . This helps food and acid pass through the stomach instead of backing up into the esophagus.
  • Talk to your health care provider about taking over-the-counter pain relievers such as aspirin, ibuprofen (Advil, Motrin), or medicines for  osteoporosis  . These can aggravate reflux in some people.

Some of these changes may be difficult for people to make. Talk to your health care provider if you need some tips on losing weight or quitting smoking. Knowing that your heartburn will get better may keep you motivated.

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Nonprescription (over-the-counter) remedies

These also may help relieve your symptoms. Check with your health care provider before trying any of these.

Antacids: These are effective when taken 1 hour after meals and at bedtime because they neutralize acid already present.

Some familiar brand names of antacids are Gaviscon, Maalox, Mylanta, and Tums. Some are combined with a foaming agent. Foam in the stomach apparently helps prevent acid from backing up into the esophagus. These agents are safe to use every day over a few weeks, but if taken over a longer period can cause side effects:

  • Diarrhea  
  • Impaired metabolism of calcium in the body
  • Build-up of magnesium in the body, which can damage the kidneys

If you use these daily for more than 3 weeks, you should let your health care provider know. Histamine-2 receptor blockers (H2-blockers). These prevent acid production. H2-blockers are effective only if taken at least 1 hour before meals because they don't affect acid that is already present. Common H2-blockers are cimetidine (Tagamet), famotidine (Pepcid), ranitidine (Zantac), and nizatidine (Axid).

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Follow-up

For best results, follow the advice of your health care provider concerning medication and lifestyle.

  • Let him or her know what you are doing about your reflux disease and how well it is working.
  • Keep follow-up appointments faithfully. Your health care provider may want to adjust your treatment at preset intervals of time or decide to refer you to a specialist if initial therapy fails.
  • He or she can help you only to the extent that you provide honest and timely feedback.
Prevention

The best and safest way to prevent reflux disease from occurring is to change the things that cause reflux.

  • Maintain a healthy body weight.
  • Avoid large meals and eating within 3 hours of bedtime.
  • Limit fatty or greasy foods, chocolate, caffeine, and other irritating foods.
  • Avoid alcohol.
  • Stop smoking.
  • Maintain good posture, especially while seated.
  • Avoid working out, bending, or stooping on a full stomach.

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Outlook

Reflux disease (GERD) is treatable, but relapses are common, especially if you do not change your lifestyle.

  • For people with mild-to-moderate disease (grades 1-2), home care and H2-blockers are effective about 60% of the time.
  • Severe esophagitis (grades 3-4) usually requires PPI therapy.
  • If relapses occur, long-term therapy or surgery will be necessary to avoid complications.

Complications of acid reflux can include any of the following. Most of these are rare, but GERD can be the first step toward any of them. The best treatment for any of these is prevention.

  • Esophagitis and esophageal ulcers - Inflammation, irritation of the lining of the esophagus
  • Laryngopharyngeal reflux - When acid from the stomach gets into the throat, the voice becomes hoarse.
  • Bleeding - Due to ulcers in the damaged esophageal lining
  • Strictures - Narrowing of the esophagus due to chronic scarring
  • Swallowing problems - Due to strictures
  • Respiratory problems - When acid from the stomach gets into the breathing passages
  • Barrett esophagus - Changes in the cells lining the esophagus, a precancerous condition
  • Cancer of the esophagus - Has a very low incidence rate

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