Lifestyle Modification

In order to decrease the amount of gastric contents which reach the lower esophagus, certain simple guidelines should be followed:

• Raise the Head of the Bed. The simplest method is to use a 4" x 4" piece of wood to which two jar caps have been nailed an appropriate distance apart to receive the legs or casters at the upper end of the bed. Failure to use the jar caps inevitably results in the patient being jolted from sleep as the upper end of the bed rolls off the 4" x 4."

  Alternatively, one may 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. Reduce your weight if obesity contributes to the problem.

• Change Your Diet. Avoid foods and medications which lower LES tone (fats and chocolate) and foods which may irritate the damaged lining of the esophagus (citrus juice, tomato juice, and probably pepper).

• Curtail Habits Which Contribute to GERD. Both smoking and the use of alcoholic beverages lower LES pressure which contributes to acid reflux.

Medical Treatment of GERD

GERD has a physical cause, and frequently is not curtailed by these lifestyle factors alone. If you are using over-the-counter medications more than twice a week, or are still having symptoms on the prescription or other medicines you are taking, you need to see your doctor. If results are not forthcoming, medications may be used to neutralize acid, increase LES tone, or improve gastric emptying.