Non-surgical treatments

For most reflux suffers the key consideration is the management of their symptoms. As symptoms can vary so much from patient to patient, methods of treatment will similarly vary. As alternative options to the long-term solutions outlined in the Surgical Treatments section, there are medication routes available, and it may also be beneficial to consider the impact of lifestyle changes.

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Lifestyle modifications

  • Position

    People often find that they experience heartburn after meals when lying down in bed. This is because when the valve is weak, lying down can cause gastric contents to reflux into the oesophagus. Maintaining an upright posture until the meal is digested, planning earlier dinner times, or avoiding bedtime snacks may help. If heartburn occurs regularly at night, consider raising the head of the bed or using more pillows.

  • What you eat

    Certain foods worsen reflux symptoms and heartburn more than others. Common food triggers include fats, onions, chocolate, and spicy foods. Drinks include coffee and tea (both caffeinated and decaffeinated), colas, fruit juices and alcoholic drinks. These triggers may aggravate symptoms by irritating the oesophagus or stimulating stomach acid production, and, in the case of alcoholic beverages, also by relaxing the valve.

    The food and drinks that worsen reflux can differ from person to person and so you may wish to consider keeping a record of your diet and symptoms to determine whether there are correlations. You can then aim to reduce these food and drink triggers in your diet.

  • How you eat

    Large meals fill the stomach and are more likely to cause reflux symptoms. Similarly, exertion after a meal or activities that require bending down may precipitate symptoms. Eating smaller meals and avoiding exertion after eating may therefore help lessen symptoms.

  • Weight management

    Being overweight can worsen reflux, as fat accumulates inside the abdomen and so this can put pressure on the stomach and valve. Many patients find that losing weight helps their symptoms.

  • Smoking

    Smokers on average experience more reflux than non-smokers. The nicotine in tobacco has been shown to reduce the pressure in the lower oesophageal sphincter valve (LOS) by up to 40%. Smoking also tends to reduce saliva production. Besides the other health benefits, quitting smoking may well help to improve your reflux symptoms.

  • Stress

    People who are stressed report higher levels of pain due to reflux symptoms. It is not yet known whether stress physically worsens reflux, or causes a greater awareness of discomfort. Either way, finding ways to combat stress may help to manage reflux symptoms.

  • Medications

    Although lifestyle changes can be beneficial for lessening symptoms, in many people they are not sufficient to control symptoms. In these cases medications may be required. The size of the problem is indicated by the number of people taking antacids. It is thought that in the UK alone there are approximately 1.5 million people taking Proton Pump Inhibitors (PPIs) regularly. The cost of these drugs amounts to over £500million per year!

Medication

  • Simple Antacids and Alginates

    A number of over-the-counter medicines can be used to help relieve mild to moderate symptoms of GORD.

    Antacids neutralise the effects of stomach acid. However, they should be taken with caution as they can prevent other medications from being absorbed properly, and can also damage the coating of some types of tablet. If you are taking other medications you should ask your GP or pharmacist for advice.

    Alginates, such as Gaviscon, work differently. They produce a protective coating that shields the lining of your stomach and oesophagus from the effects of stomach acid. They work best if taken just after finishing a meal.

  • H2-receptor antagonists

    These are powerful antacids which can be bought over the counter. Examples of H2-receptor antagonists include Ranitdine and Cimetidine. They block the effects of the chemical histamine which is used by your body to stimulate the production of stomach acid. These drugs therefore help reduce the amount of acid in your stomach. These days they are most often used in combination with PPIs for patients with significant reflux symptoms.

    Side effects of H2RAs are uncommon, but may include:

    • Diarrhoea
    • Headaches
    • Dizziness
    • Tiredness
    • A rash

  • Proton-pump inhibitors (PPIs)

    These are the most powerful antacid drugs available. They work by directly affecting the acid secreting cells in the stomach to significantly reduce the amount of acid produced. They have been shown in research studies to be effective at controlling some reflux symptoms as well as healing oesophagitis. Many millions of people use these drugs worldwide.

    However, PPIs are not always effective. Many patients will continue to experience symptoms despite high doses of PPIs. Fundamentally, this is because all medications do not cure the problem they only help control the symptoms. In this case, the problem is the failure of the valve at the bottom of the oesophagus which causes both acid and non-acidic reflux. Although the PPIs will help reduce acid production, stomach juice also contains many other substances that can be corrosive or irritant. Many people have symptoms that are caused by non-acidic, rather than acid, reflux. Consequently, even whilst taking high doses of PPIs, although the burning symptoms may improve, many patients will continue to experience other reflux symptoms. In particular, regurgitation symptoms tend to be poorly controlled by PPIs.

    Some patients find they can’t take PPIs. Side effects include

    • Headaches
    • Diarrhoea
    • Nausea
    • Abdominal pain
    • Constipation
    • Aching joints
    • Depression
    • Dizziness
    • Skin rashes

  • Complications of long-term medication

    Because GORD is a long-term disease patients often have to take drugs indefinitely. Over recent years there have been a series of studies published which suggest that long term use of PPIs is associated with significant health problems. While more research needs to be undertaken to clarify these associations, many patients do not wish to take drugs which alter the normal physiology of their body.

    The complications suggested in scientific papers include:

    • Clostridium difficile (stomach flu)
    • Reduced absorption of calcium, vitamin B12, Magnesium and Iron
    • Bone weakness, especially hip fractures
    • Heart attacks
    • Renal failure
    • Respiratory infections