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Straight, No Chaser: Treatment of Acid Reflux (Gastroesophageal Reflux Disease)

By Jeffrey Sterling, MD July 18, 2019


If you experience heartburn two times a week or more, you may have gastroesophageal reflux disease (GERD). Because there are significant differences in the severity of GERD, you should know when varying forms of treatment may be necessary. This Straight, No Chaser focuses on treatment of mild symptoms. For discussion of more severe GERD, visit or discuss the options listed below with your healthcare provider.


Mild symptoms As is the case for many diseases, simple dietary changes away from foods that increase acid producing and reflux symptoms often can be sufficient. As a reminder, such foods include alcohol, caffeine, chocolate, fatty foods and peppermint. With mild symptoms, over the counter medications such as antacids or antihistamines might be all that’s needed. Additional considerations such as the following have been shown to be helpful in some people with mild reflux and is worth the effort.

  • avoiding large meals
  • avoiding late meals
  • avoiding tight-fitting clothing
  • elevating the head of your bed six to eight inches
  • increasing the chewing of gum or use of oral lozenges (this is related to saliva production, which can neutralize acid)
  • quitting smoking (smoking actually reduces saliva production)
  • weight loss


If and when medicines are used for mild symptoms, there are two classes of medicines used.

  • Antacids — Antacids such as Maalox, Myalanta and Tums are commonly used for short-term relief of acid reflux. The frustration you may have experienced in taking them is related to the fact that these medicines only neutralize stomach acid very briefly after each dose.
  • Histamine antagonists (aka antihistamines) — These medicines, including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac), reduce acid production in the stomach and are often helpful as a first line effort.

Moderate to severe symptoms — For patients with moderate, severe or refractory symptoms of acid reflux, or for those with complications of gastroesophageal reflux disease, different treatment options must be used.

  • Proton pump inhibitors (PPIs) — This class of prescription medicine is stronger and more effective than the histamine antagonists listed above. When these are necessary, it typically takes an eight-week course of treatment to optimize dosing and produce the best results that can be achieved.
  • Surgical treatment — When PPIs are ineffective, surgical options such as strengthening the lower esophageal sphincter and repairing any hiatus hernias (conditions in which the stomach partially slips through the diaphragm into the chest, facilitating more escape of acid into the esophagus) may be necessary.

There’s a lot you can do to avoid taking medicines and needing surgery. Make those better choices and live a healthier, happier life!
Feel free to ask your SMA expert consultant any questions you may have on this topic.
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