What to Do When GERD Flares Up

If you've had symptoms of GERD in the past, chances are you'll have them again. The symptoms of GERD are, after all, one of the most common medical complaints in the Western world, affecting some 60 percent of the population at least once in the course of a year, according to a January 2008 statistical brief by the Healthcare Cost and Utilization Project. When chronic acid reflux disease, or GERD, flares up, it's important to take action promptly to put out the fire before it gets out of control and causes painful complications. When you and your doctor find that your GERD is back, there are some measures that may help stop it in its tracks.

There are many very effective over-the-counter remedies for GERD. When acidic digestive juices splash up from your stomach into your esophagus, neutralizing the acid can provide rapid symptom relief; for occasional bouts of acid reflux brought on by a night of overindulgence, old-fashioned antacids such as Tums or Rolaids are still a good bet. However, the most effective way in the long run is to suppress acid secretion from the start.

Drugs known as proton pump inhibitors, or PPIs, do that by inhibiting stomach acid secretion. PPIs are available over the counter and include familiar brand-name drugs like lansoprazole (Prevacid), omeprazole (Prilosec) and esomeprazole (Nexium). Nonprescription PPIs are approved by the Food and Drug Administration for once-a-day use for up to 14 days, though doctors may prescribe them at higher doses.

H2 blockers are an earlier acid blocker that work well enough for some cases and are less expensive than PPIs. H2 blockers are also available over the counter under such generic names as famotidine (Pepcid), cimetidine (Tagamet) and ranitidine (Zantac).

Certain foods might trigger GERD or make it worse in several ways. Acidic foods like orange juice and coffee can potentially irritate the esophageal lining on contact. Other foods, like raw onions, stimulate acid secretion in the stomach. Others can cause loosening of the antireflux valve that serves as a barrier between the stomach and esophagus, allowing acid to leak up into the esophagus. Foods that you might want to avoid include: - coffee and caffeinated drinks, including tea and soda - alcohol, especially red wine - dairy products - citrus fruits and products, such as oranges and orange juice - vinegar and foods containing it - black pepper, garlic, raw onions and other spicy foods - chocolate - peppermint - tomatoes

Medications can cause or contribute to GERD in much the same way as foods can. Common culprits in GERD include: - nonsteroidal antiinflammatory drugs such as ibuprofen (Advil, Motrin), naproxen (Aleve) and aspirin - opiates - tricyclic antidepressants - blood pressure medications - some antibiotics, such as doxycycline and tetracycline

Excess body weight is associated with GERD. While the nature of the interaction between obesity and GERD is not entirely clear, one factor may be that excess visceral fat puts stress on the LES, causing it to weaken and diminishing its ability to function. Losing weight is one of the first things doctors recommend for people who are living with obesity and GERD.

Gravity is GERD's friend, and when you're lying down, it's easier for gastric juices to travel from the stomach to the esophagus. Using a wedge pillow to elevate your upper body by 6 to 8 inches at bedtime is recommended for many GERD patients because gravity helps keep acidic digestive juices in your stomach where they belong. Avoiding food consumption for 2 to 3 hours prior to bedtime or before lying down is also recommended.

Medical advisor: Jonathan E. Aviv, M.D., FACS