With major improvement in the understanding, diagnosis and management of acid reflux, family doctors and gastro-enterologists have a greater variety of options for treatment of acid reflux.
The acid suppressant drugs available today are extremely effective. Drugs such as omeprazole and other proton pump inhibitor have become the mainstay of treatment. These drugs are now available over the counter and easy for patients to obtain. It is therefore so easy for practitioners and patients to ignore the simple basic ways to control acid reflux disease.
A simple and effective part of treatment is lifestyle modification and reassurance. This includes changing the types of food consumed, avoiding certain medication, stopping smoking, losing weight, elevating the head of the bed and sensible use of antacids and alginates . The most important foods to avoid are fatty foods. In this group are whole milk, butter, chocolate and some fast foods. In time a patient will know what foods to consume and what to avoid. Peppermint oil relaxes the lower oesophageal sphincter and can cause reflux. If it is used for IBS, be aware of this important side effect. If in doubt consult your GP or stop if you develop reflux symptoms. Smoking has a similar effect on the lower oesophageal sphincter. Give up smoking if you have acid reflux. It is making it worse.
Certain foods should be taken in moderation. Decide for yourself if citric foods, spicy foods or caffeine containing foods are problematic. Avoid these foods if they aggravate acid reflux . Obesity causes increased abdominal pressure and as a result produces increased pressure on the lower oesophageal sphincter. This pressure can result in acid reflux. Losing weight will reduce this pressure. It is very surprising how losing a small amount of weight can make a significant difference.
In nocturnal acid reflux, lying down at night causes refluxate to track up the oesophagus. Raising the head of the bed will help reduce this. In addition it reduces sensitisation overnight which leads to problems during the day. Evidence shows that extra pillows make no difference. Wearing tight clothes will increase intra abdominal pressure and stimulate reflux. Wearing loose clothes will avoid this.
Eating small regular meals is better than having a few big meals. Large volume of food will distend the stomach and affect the efficiency of the sphincter. Similarly do not lie down soon after a meal. Make sure your last meal before retiring is at least three hours earlier.
A review of the medical literature and the few placebo controlled trials suggests that most patients with gastro-oesophageal disease (GERD) can be reasonably controlled by reassurance and lifestyle modification.
Chronic and relapsing acid reflux, however, will need more than lifestyle changes and reassurance. Management should incorporate the use of effective dosage of acid suppressant drugs to gain satisfactory control of acid reflux symptoms.
If your symptoms are persistent in spite of the changes you make, see you family doctor. The thought of having an endoscopy may be daunting but persistent acid reflux can cause long term problems. Acid in the lower oesophagus can cause inflammation leading to oesophagitis. Recurrent oesophagitis can cause bleeding, strictures and Barrett’s oesophagus. 3 to 5 % of Barrett’s Oesophagus develops adenocarcinoma. This condition is diagnosed by biopsy at endoscopy. Bear these facts in mind if your symptoms persist.