The Secrets of Managing GERD and Heartburn

Is it time to get serious about your GERD?

Medically Reviewed by Brunilda Nazario, MD on January 23, 2009
8 min read

Are you still trying to manage your heartburn and GERD by drinking milk by the gallon and popping antacids by the fistful? Chances are you’re not getting the relief you want. But the good news is with the right GERD treatment you can find relief.

“We’re more aggressive about treating GERD today,” says Lawrence Cheskin, MD. Cheskin is a gastroenterologist and an associate professor at the Johns Hopkins Bloomberg School of Public Health. He tells WebMD there are two reasons for the change. One is that GERD treatments are better. And the other is that the long-term risks of untreated gastroesophageal reflux disease are better understood.

There are many good reasons to treat GERD. First, GERD treatment makes you feel better. Living with uncontrolled GERD -- the pain, the cough, the sleepless nights -- can be tough.

“GERD puts quite a burden on a person’s quality of life,” says Goutham Rao, MD. Rao is a board member of the National Heartburn Alliance and an associate professor at the University of Pittsburgh School of Medicine. “GERD,” he says, “can be truly debilitating.”

Second, GERD poses some serious long-term health risks. Over time, the damage to the esophagus can cause complications. One of those is a condition called Barrett’s esophagus, which is associated with a small but significant risk of esophageal cancer. Fortunately, GERD treatment can prevent Barrett’s esophagus from developing.

How do you know if you need treatment for GERD? What’s the difference between harmless heartburn and more serious GERD? It’s not so much the severity, experts say, but the frequency.

The usual recommendation is that anyone with symptoms two or more times a week should see a doctor. Cheskin is more cautious. He says that even symptoms that occur just once a week should be checked out. “Over the years,” he says, “even that level of heartburn can cause damage.”

Sometimes the most obvious sign of trouble is how often you use over-the-counter (OTC) treatments for heartburn relief.

“For me, it got to a point where I was using Tums like they were going out of style,” says Carmen Butschlick of Milwaukee, who was diagnosed with GERD in 2006. “And I was still having symptoms. That’s when I knew I had to go see a doctor.”

Medications -- both prescription and over-the-counter -- are the most common treatment for GERD and heartburn relief. Here’s a rundown of your options.

  • Proton pump inhibitors (PPIs). If you have GERD, the odds are you’ll be prescribed one of these. This class of drugs -- which includes Aciphex, Nexium, Prevacid, Prilosec, and Protonix -- is now the standard GERD treatment. Not only do they help block the production of acid in the stomach, they also protect the esophagus from damage and allow it to heal.

“The proton pump inhibitors are a terrific class of medications,” says Rao. “They’re very effective, and they appear to be quite safe.” They’re even helpful in diagnosing GERD, Rao says. If they work, you probably have GERD. If they don’t, you probably have something else.

Like any medication, they can have side effects. There’s some concern that they may cause a small increase in the occurrence of weakened bones in older people. While the benefits of well-controlled GERD generally outweigh this risk, you should discuss it with your doctor.

  • H2 blockers. These come as prescription and OTC medicines. They include drugs like Axid, Pepcid, Tagamet, and Zantac and were once the standard treatment for GERD. But they’re not used as often now. “They’re perfectly good medicines,” says J. Patrick Waring, MD, a gastroenterologist at Digestive Healthcare of Georgia in Atlanta and a board member at the International Foundation for Functional Gastrointestinal Disorders (IFFGD.) “But H2 blockers just aren’t as powerful as the proton pump inhibitors.”

Some doctors still recommend them as GERD treatment, at least for mild cases. They’re also sometimes added to PPIs to help treat occasional breakthrough symptoms. Cheskin tells WebMD that H2 blockers may have one significant advantage. Because most are generic, they can be less expensive than PPIs.

  • Antacids. The old standbys from your grandparents’ medicine cabinet -- tablets like Tums and Rolaids and liquids like Maalox and Mylanta -- can still play a role in controlling GERD. These heartburn remedies aren’t suited for regular, long-term use. But their main advantage is that they work quickly, unlike more powerful GERD medications.

“If you’re suffering with heartburn after drinking or eating a big spicy meal, a proton pump inhibitor is not going to help,” Cheskin says. “But an antacid will.” Just as antacids offer heartburn relief to people without GERD, they can help GERD sufferers who have occasional breakthrough symptoms.

  • Prokinetics. These prescription drugs -- like Reglan and Urecholine-- help speed up the emptying of the stomach. While they’re often mentioned alongside other GERD treatments, experts say that they’re rarely helpful. They might be of benefit to people who have GERD on top of another condition that’s slowing down their digestion. At the same time, prokinetics can have serious side effects.

Many potent drugs that were once only available by prescription -- like H2 blockers and the PPI Prilosec -- are now available over the counter. Experts say it’s fine for a person with occasional heartburn to use them, provided they follow the directions. Generally, they should never be used for more than two weeks.

While drugs are often the main GERD treatment, there’s a lot you can do on your own. Here are some lifestyle tips for heartburn relief.

  • Avoid trigger foods. Changing your diet can yield big benefits. Classic GERD triggers include chocolate, coffee, alcohol, peppermint, citrus juices, and tomatoes. The exact food triggers vary from person to person.

The prospect of life without coffee or chocolate may seem terribly depressing. But you don’t necessarily have to give them up entirely. “It’s about how much of these foods you eat,” says Cheskin. “So you can probably still have a half cup of coffee without a problem. The trouble starts if you’re having the coffee after a spicy meal.”

Butschlick says she misses chocolate the most, but she still eats it on occasion. “I just try to keep it to a small piece,” she tells WebMD, “and I’m prepared with some Tums for afterward.”

  • Eat smaller meals. It’s not just what you eat, but how much. So avoid stuffing yourself. Instead of eating three big meals a day, try more frequent smaller meals.
  • Don’t eat before bed. Waring says you shouldn’t eat two to three hours before bed. Not eating gives your stomach time to empty before you lie down.
  • Loosen your belt. Tight belts or pants can aggravate your GERD symptoms. Wear looser clothing, especially at night.
  • Prop up the bed. When you stick blocks under the head of your bed and raise it 6 to 8 inches, gravity will prevent the acids in your stomach from flowing into the esophagus during the night. While this used to be common advice, not everyone can do it. “Sleeping on an elevated bed just isn’t very comfortable,” says Waring.
  • Lose weight. The heavier you are, the higher your risk of GERD. How much weight do you need to lose to control your symptoms? No one knows for sure, Rao says. But if you’re obese, aiming for a 10% weight loss is always a good idea.
  • Evaluate your other medications. Many common medications -- aspirin and other NSAID painkillers, along with some drugs for high blood pressure -- can make GERD worse. Talk to your doctor about possible alternatives that may not worsen your symptoms.
  • Stop smoking. Some experts believe that smoking may aggravate GERD symptoms. Add it to your list of good reasons to kick the habit.
  • Take your GERD medicine as prescribed. GERD symptoms may come and go, but the underlying condition remains. Once you’re feeling better, you may be tempted to stop your long-term medication. That’s not a good idea. “Even if you’re not having symptoms, the GERD could still be causing damage,” Cheskin says. “You may feel fine right up until the acid bores a hole in your esophagus.” Never stop taking your medication unless you’ve talked to your doctor.

Can lifestyle changes be a person’s onlyGERD treatment? Experts disagree. Some believe that lifestyle changes can be enough on their own; others think that they should be added to medication. Talk to your doctor about the best approach in your case.

Some people opt for lifestyle changes because they don’t like the idea of being on lifelong medication. Al Kenny, a GERD sufferer from Englewood Cliffs, N.J., says he prefers to control his GERD with a better diet instead of his PPI. But it’s hard to find the motivation.

“My medicine lets me eat almost anything, which is the good news,” Kenny says. “But the bad news is that it works so well that I’m really not too careful about what I eat. So I can’t stop taking the drug.”

Surgery for GERD can be effective. But because PPIs control symptoms so well, Rao says, rates of GERD surgery in the U.S. are falling rapidly.

Still, some patients -- Rao estimates less than 1% of all people with GERD -- might need it. Experts say that candidates for GERD surgery are people who

  • Get some relief from medication, but still have symptoms anyway
  • Can’t or won’t take GERD medication
  • Already have complications, like Barrett’s esophagus, from GERD

Considering that the surgery does have a small risk of serious complications, it’s crucial that you get a correct diagnosis. You’ll need an endoscopy and probably other tests to make sure that you really do have GERD. To be certain, you may also want to consider a second opinion.

Finally, when finding a surgeon, choose someone with a lot of experience doing the specific operation you need. Waring recommends that they have a track record of at least 200 procedures.

If you have GERD, there are a lot of effective ways you can control it. While newer, powerful over-the-counter medicines are one option, Cheskin notes a serious downside.

“These drugs provide such effective relief that there’s much less incentive for people with undiagnosed GERD to seek medical help,” says Cheskin.

That’s a problem. Self-diagnosis and self-treatment aren’t smart. If you have GERD, you need a doctor’s help. Together you can sort out the best GERD treatment -- and make sure that you don’t have another condition altogether.

GERD sufferer Chuck Alkin, 75, agrees. “My advice to people is to get treatment early,” says the New York City resident. He developed GERD about 45 years ago, and more recently, Barrett’s esophagus. Now, he’s concerned about his increased risk of cancer.

“It took me 20 years to get a diagnosis, and I regret that,” Alkin says. “If I’d been diagnosed earlier, and gotten treatment, I don’t think I’d be in this situation now.”

* Some patient names have been changed by request.