Acid Reflux (GERD): Lifestyle Steps and Medication Options

That burning feeling rises behind your breastbone after dinner, or a sour taste wakes you at night. You may be reaching for antacids more and more often. Acid reflux is very common, and for many people it is more than an occasional nuisance. This guide explains what GERD is, what helps, and how clinicians decide on medication and tests.

What GERD is

GER (gastroesophageal reflux) is when stomach contents flow back up into the esophagus, the tube that carries food to the stomach [2]. Almost everyone has some reflux at times. GERD (gastroesophageal reflux disease) is when reflux happens often enough to cause troublesome symptoms or damage [2].

Typical symptoms include:

• Heartburn, a burning feeling in the chest
• Regurgitation, when sour liquid or food comes back up into the throat or mouth [4]

Other possible symptoms include:

• Chest pain
• Chronic cough or hoarseness
• A feeling of a lump in the throat
• Trouble sleeping because of symptoms

Things that can make reflux worse include extra weight around the belly, large or late meals, smoking, pregnancy, and some medications.

Lifestyle steps

The American College of Gastroenterology (ACG) 2022 guideline supports these steps [1]:

• Weight loss if you are overweight or have gained weight recently
• Raising the head of your bed by 15 to 20 cm (6 to 8 inches), using blocks or a wedge, if you have nighttime symptoms
• Avoiding meals for 2 to 3 hours before lying down
• Quitting tobacco
• Avoiding foods that trigger your symptoms

Common trigger foods include fatty foods, chocolate, coffee, alcohol, spicy foods, and citrus. Triggers vary, so there is no need to cut out foods that do not bother you.

Medication options

Antacids and alginates

• Antacids, such as calcium carbonate, neutralize acid quickly. They are good for occasional, mild heartburn.
• Alginates form a foam barrier on top of stomach contents and may help after meals or at night.

H2 blockers

H2 blockers, such as famotidine, reduce acid production. They work within about an hour and last several hours. They are less powerful than PPIs. Ranitidine was pulled from sale in Canada and the US in 2019 and 2020 because of concerns about an impurity.

Proton pump inhibitors

PPIs (proton pump inhibitors), such as omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole, and dexlansoprazole, are the strongest acid reducers. They heal esophagitis (inflammation of the esophagus) better than other drugs [1]. Some are available without a prescription.

Newer option

Vonoprazan is a different type of acid blocker. It has been approved in the US for erosive esophagitis and for heartburn from non-erosive GERD. Ask your clinician whether it is available and covered where you live.

What your doctor looks at

The PPI trial

For people with classic heartburn and regurgitation and no warning signs, the ACG recommends an 8-week trial of a once-daily PPI, taken 30 to 60 minutes before a meal [1]. If it works, the ACG suggests trying to stop the PPI after 8 weeks [1]. If symptoms return, the plan is the lowest effective dose. If symptoms do not respond, the guideline recommends further testing, such as endoscopy [1].

When to do an endoscopy

An upper endoscopy (a thin, flexible camera passed through the mouth) is recommended for [1] [3]:

• Trouble swallowing, or food sticking
• Painful swallowing
• Unexplained weight loss
• Signs of bleeding, or iron deficiency anemia
• Repeated vomiting
• Symptoms that do not respond to a PPI trial

Some people with long-term reflux and other risk factors may be offered endoscopy to check for Barrett's esophagus, a change in the lining that raises the risk of cancer. Risk factors include being male, older than 50, white, having a history of smoking, central obesity, or a family history of Barrett's esophagus or esophageal cancer [1].

Long-term PPI use

PPIs have been linked in observational studies to fractures, low vitamin B12 and magnesium, kidney problems, and certain gut infections such as C. difficile. Many of these links may not mean the PPI caused the problem. The ACG recommends that people who need long-term PPI therapy use the lowest effective dose, and that clinicians review the need regularly [1]. For people with severe esophagitis or Barrett's esophagus, ongoing PPI therapy is often needed.

Canada and US notes

UK NICE guidance and Canadian practice follow a similar approach of full-dose PPI for 4 to 8 weeks, then stepping down to the lowest dose that controls symptoms [3]. Which PPIs are available without a prescription differs between Canada and the US.

Surgery and procedures

For people who do not want long-term medication, or whose regurgitation does not respond, procedures such as fundoplication (surgery to tighten the valve between the esophagus and stomach) or magnetic sphincter augmentation may be options [1].

Questions to ask your clinician

• Do my symptoms fit GERD, or could something else be causing them?
• Am I taking my medication at the right time?
• How long should I stay on a PPI?
• Should I try to lower the dose or stop, and how?
• Do I need an endoscopy?
• Am I at risk of Barrett's esophagus?
• Could any of my other medications be making reflux worse?

When to get care quickly

Call 911 or go to the emergency department for:

• Chest pain, especially with shortness of breath, sweating, or pain spreading to the arm, jaw, or back. Heart attacks can feel like heartburn.
• Vomiting blood or material that looks like coffee grounds
• Black, tarry stools
• Food stuck in your throat that will not go down

Bottom line

GERD is common and usually treatable. Lifestyle steps help many people, and PPIs taken before meals are the most effective medications. After an 8-week trial, guidelines suggest trying to stop or using the lowest dose that works. Warning signs, such as trouble swallowing or bleeding, need a prompt check.

Primary AI can show you the guideline and study sources behind this topic in plain language, so you can bring better questions to your appointment.