Getting a Handle on Acid Reflux and Its Treatments

By Jeanine Kendle

Gastroesophageal reflux disease is a more serious form of gastroesophageal reflux, which is common. GERD occurs when the lower esophageal sphincter opens spontaneously, for varying periods of time, or does not close properly and stomach contents rise up into the esophagus.

GERD also is called acid reflux or acid regurgitation because digestive juices — called acids — rise up with the food. The esophagus is the tube that carries food from the mouth to the stomach. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach.

The main symptom of GERD in adults is frequent heartburn, also called acid indigestion — burning-type pain in the lower part of the mid-chest, behind the breast bone and in the mid-abdomen. Most children under 12 years with GERD, and some adults, have GERD without heartburn. Instead, they may experience a dry cough, asthma symptoms or trouble swallowing.

Factors that may contribute to GERD include obesity, pregnancy and smoking.

Common foods that can worsen reflux symptoms include citrus fruits, chocolate, drinks with caffeine or alcohol, fatty and fried foods, garlic and onions, mint flavorings, spicy foods and tomato- based foods, such as spaghetti sauce, salsa, chili and pizza.

See your health care provider if you have had symptoms of GERD and have been using antacids or other over-the-counter reflux medications for more than two weeks. Your health care provider may refer you to a gastroenterologist.

Depending on the severity of your GERD, treatment may involve one or more of the following lifestyle changes, medications or surgery: If you smoke, stop. Avoid foods and beverages that worsen symptoms. Lose weight if needed. Eat small, frequent meals. Wear loose- fitting clothes. Avoid lying down for three hours after a meal. Raise the head of your bed 6 to 8 inches by securing wood blocks under the bedposts. Just using extra pillows will not help.

Common medications used to treat GERD include antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids and Riopan. They usually are the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts — magnesium, calcium and aluminum — with hydroxide or bicarbonate ions to neutralize the acid in your stomach.

But antacids can have side effects. Magnesium salt can lead to diarrhea and aluminum salt may cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

Calcium carbonate antacids, such as Tums, Titralac and Alka-2, can be a supplemental source of calcium. They can cause constipation, as well.

Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux.

H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) and ranitidine (Zantac 75), decrease acid production. They are available in prescription strength and over- the-counter strength. These drugs provide short-term relief and are effective for about half of those who have GERD symptoms.

Proton pump inhibitors include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex) and esomeprazole (Nexium), which are available by prescription. Prilosec also is available in over-the-counter strength. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms and heal the esophageal lining in almost everyone who has GERD.

Prokinetics help strengthen the LES and make the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness — fatigue, sleepiness, depression, anxiety and problems with physical movement.

Because drugs work in different ways, combinations of medications may help control symptoms.

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