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Patient Instructions

You have gastroesophageal reflux disease (GERD), a condition where food or liquid travels backwards from the stomach to the esophagus (the tube from the mouth to the stomach).

You may have had tests to help your doctor diagnose your GERD or complications you have from it.

You can make many lifestyle changes to help treat your symptoms. Avoid foods that cause problems for you.

• Do not drink alcohol.
• Avoid drinks and foods that have caffeine, such as soda, coffee, tea, and chocolate.
• Avoid decaffeinated coffee. It also increases the level of acid in your stomach.
• Avoid high-acid fruits and vegetables, such as citrus fruits, pineapple, tomatoes, or tomato-based dishes (such as pizza, chili, and spaghetti).
• Avoid items with spearmint or peppermint.

Other lifestyle tips that may make your symptoms better are:

• Eat smaller meals, and eat more often.
• Lose weight, if you need to.
• If you smoke or chew tobacco, try to quit. Your doctor can help.
• Exercise, but not right after eating.
• Reduce your stress and watch for stressful, tense times. Stress can bother your reflux problem.
• Bend at the knees -- not your waist -- to pick things up.
• Avoid wearing clothes that put pressure on your waist or stomach.

Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve). Take acetaminophen (Tylenol) to relieve pain. Take any of your medicines with plenty of water. When your doctor gives you new medicines, remember to ask if it will make your heartburn worse.

Try these tips before going to sleep:

• Do not skip meals or eat a large meal for dinner to make up for missed meals.
• Avoid late night snacks.
• Do not lie down right after you eat. Remain upright for 2 to 3 hours before you go to bed.
• Raise your bed 4 to 6 inches at the head of your bed, using blocks. You can also use a wedge support that raises the top half of your body when you are in bed. (Extra pillows that raise only your head may not help.)

Antacids can help neutralize your stomach acid. They do not help to treat the irritation in your esophagus. Common side effects of antacids include diarrhea or constipation. See also: Taking antacids

Other over-the-counter drugs and prescription drugs can treat GERD. They work more slowly than antacids but give you longer relief. Your doctor or nurse can tell you how to take these drugs. There are two different types of these drugs:

• H2 antagonists: famotidine (Pepcid), cimetidine (Tagamet), ranitidine (Zantac), and nizatidine (Axid)
• Proton pump inhibitors (PPI): omeprazole (Prilosec), esomeprazole (Nexium), iansoprazole (Prevacid), rabeprazole (AcipHex), and pantoprazole (Protonix)

You will have follow-up visits with your doctor to check your esophagus. You may also need to have dental check-ups every 6 months. GERD can cause the enamel on your teeth to wear away.

Call your doctor or nurse if you have:

• Problems or pain with swallowing
• Choking
• A full feeling after eating a small meal portion
• Weight loss that cannot be explained
• Vomiting
• Loss of appetite
• Chest pain
• Bleeding, blood in your stools, or dark, tarry looking stools
• Hoarseness

Peptic esophagitis - discharge; Reflux esophagitis - discharge; GERD - discharge; Heartburn - chronic - discharge

Wang, KK, Sampliner, R E. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008;103(3):788-97.

Khan, M, Santana, J, Donnellan, C, Preston, C, Moayyedi, P. Medical treatments in the short term management of reflux oesophagitis. Cochrane Database Syst Rev(2). 2007;CD003244.

Wilson, J F. In the clinic. Gastroesophageal reflux disease. Ann Intern Med. 2008;149(3): ITC2-1-15; quiz ITC2-16

Updated by: George F Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.