H2 blockers are most effective when taken about an
hour before meals. They do not affect acid already in
the stomach.
Proton pump inhibitors use a different chemical
mechanism to block acid production by the stomach.
They are more effective than H2 blockers and are used
when H2 blockers fail. Some are available in over-the-
counter strengths, while others require a prescription.
Common proton pump inhibitors include omeprazole
(Prilosec), lansoprazole (Prevacid), rabeprazole (Aci-
phex), esomeprazole (Nexium), and metoclopramide
(Reglan).
Surgery is the most drastic treatment for GERD.
It is used when all other treatments fail and symptoms
remain. The most common surgical operation to cor-
rect GERD is called fundoplication. This surgery is
done laparoscopically; the entire abdomen does not
need to be opened. A small slit is made in the abdomen
and a camera guides the surgeon who manipulates
small instruments through this slit to wrap the top of
the stomach (the fundus) like a cuff around the bottom
of the esophagus. This provides additional support for
the LES, and is initially successful in stopping GERD
about 92% of the time. Long-term success rates are
variable. Laparoscopic fundoplication usually
requires a hospital stay of 1–3 days and takes about
2–3 weeks for complete recovery.
In 2000, the United States Food and Drug
Administration (FDA) approved two other proce-
dures to treat chronic acid reflux. On involves putting
stitches in the LES to create small pleats that make the
muscle stronger. The other involves making small cuts
in the LES. The scar tissue that forms when the muscle
heals makes the LES stronger. There is little data on
the long-term success of these procedures. More
recently, the FDA has approved an implant that
does not require surgery. The implant reinforces and
strengthens the LES reinforces. This procedure is too
new to have any data concerning long-term success.
Nutrition/Dietetic concernsNutritional concerns related to GERD involve
lifestyle changes designed to reduce or eliminate heart-
burn. These dietary changes are likely to have other
beneficial health effects as well. Foods to avoid
include:
alcoholic beverages
coffee, tea, and caffeinated soft drinks
fatty or fired foods
acidic foods such as citrus fruit or juice and tomato-
based foods
chocolate or foods with mint flavorings
highly spiced foodsPrognosisAbout 80% of people get relief from GERD
through lifestyle changes and medication, although
relapses are common. H2-blockers successfully treat
50 to 60% of people with grade I or grade II GERD.
Most people not helped by H2 blockers can be healed
by 6–8 weeks of treatment with proton pump inhibitor
drugs. Of the 20% of people not helped by medication,
92% improve with fundoplication surgery.
The most serious complication of GERD is Bar-
rett’s esophagus. In this disease, normal cells lining the
esophagus are replaced with abnormal cells. About
30% of people with Barrett’s esophagus go on to
developcancerof the esophagus. Those at highest
risk are white men.
Other long-term complications of GERD include
narrowing or scarring of the base of the esophagus, a
condition called peptic stricture. This can cause diffi-
culty swallowing. Also, people with GERD may have
more ear infections and laryngitis. GERD may worsen
asthma.PreventionPrevention of GERD is very similar to the lifestyle
changes suggested in the initial stage of treatment—
stop smoking, lose weight, reduce or eliminatealcohol
consumption, and avoid foods likely to cause
heartburn.Resources
BOOKS
Magee, Elaine.Tell Me What To Eat If I Have Acid Reflux:
Nutrition You Can Live With. Franklin Lakes, NJ: New
Page Books, 2002.
Rinzler, Carol Ann and Ken DeVault.Heartburn & Reflux
for Dummies. Hoboken, NJ: Wiley Pub., 2004.
Sklar, Jill and Annabel Cohen.Eating for Acid Reflux: A
Handbook and Cookbook for Those with Heartburn.
New York: Marlowe, 2003.
Welland, Barbara E. and Ruffolo, Lisa M.Chronic Heart-
burn: Managing Acid Reflux and GERD Through
Understanding, Diet and Lifestyle—Includes More than
100 Recipes. East Toronto, Ontario: Robert Rose, 2006.
PERIODICALS
Shaheen, N, and D. F. Ransohoff. ‘‘Gastroesophageal
Reflux, Barrett Esophagus, And Esophageal Cancer:
Scientific Review.’’Journal of the American Medical
Association. 287, no. 15 (April 17, 2002):1972-81.Gastroesophageal reflux disease