Treatment:

To prevent heartburn, avoid foods and beverages that may trigger your symptoms. For many people, these include:

• Alcohol
• Caffeine
• Carbonated beverages
• Chocolate
• Citrus fruits and juices
• Tomatoes
• Tomato sauces
• Spicy or fatty foods
• Full-fat dairy products
• Peppermint
• Spearmint

If other foods regularly give you heartburn, avoid those foods, too.

Also, try the following changes to your eating habits and lifestyle:

• Avoid bending over or exercising just after eating
• Avoid garments or belts that fit tightly around your waist
• Do not lie down with a full stomach. For example, avoid eating within 2 - 3 hours of bedtime.
• Do not smoke.
• Eat smaller meals.
• Lose weight if you are overweight.
• Reduce stress.
• Sleep with your head raised about 6 inches. Do this by tilting your entire bed, or by using a wedge under your body, not just with normal pillows.

Over-the-counter antacids may be used after meals and at bedtime, although they do not last very long. Common side effects of antacids include diarrhea or constipation.

Other over-the-counter and prescription drugs can treat GERD. They work more slowly than antacids but give you longer relief. Your pharmacist, doctor, or nurse can tell you how to take these drugs.

• Proton pump inhibitors (PPIs) are the most potent acid inhibitors: omeprazole (Prilosec), esomeprazole (Nexium), iansoprazole (Prevacid), rabeprazole (AcipHex), and pantoprazole (Protonix)
• H2 antagonists: famotidine (Pepsid), cimetidine (Tagamet), ranitidine (Zantac), and nizatidine (Axid)
• Promotility agents: metoclopramide (Reglan)

Anti-reflux operations (Nissen fundoplication and others) may be an option for patients whose symptoms do not go away with lifestyle changes and drugs. Heartburn and other symptoms should improve after surgery, but you may still need to take drugs for your heartburn. There are also new therapies for reflux that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach).

Expectations (prognosis):

Most people respond to nonsurgical measures, with lifestyle changes and medications. However, many patients need to continue taking drugs to control their symptoms.

Complications:

• Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of cancer)
• Bronchospasm (irritation and spasm of the airways due to acid)
• Chronic cough or hoarseness
• Dental problems
• Esophageal ulcer
• Inflammation of the esophagus
• Stricture (a narrowing of the esophagus due to scarring from the inflammation)

Calling your health care provider:

Call your health care provider if symptoms worsen or do not improve with lifestyle changes or medication.

Also call for any of the following symptoms:

• Bleeding
• Choking (coughing, shortness of breath)
• Feeling filled up quickly when eating
• Frequent vomiting
• Hoarseness
• Loss of appetite
• Trouble swallowing (dysphagia) or pain with swallowing (odynophagia)
• Weight loss