Gastroesophageal Reflux (Heartburn) Precautions
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Quit smoking – Smoking lowers the pressure in the lower esophageal sphincter and provokes coughing, causing frequent episodes of acid reflux in the esophagus. Finally, smoking reduces the amount of saliva in the mouth and throat which usually contributes to neutralizing refluxed acid.
Avoid reflux inducing foods – Some foods also cause relaxation of the lower esophageal sphincter, promoting reflux. Patients can usually identify those foods themselves, but, in general, it is best to avoid excessive caffeine, chocolate, alcohol, and peppermint. Other foods that may contribute to symptoms include fatty foods. Note that although it is frequently recommended to avoid acidic foods, most GERD symptoms are caused by acid that your stomach makes, not by what you eat.
Avoid late meals – Lying down with a full stomach makes reflux more likely. You should not lie down for two to three hours after eating.
Weight loss – In significantly overweight people, losing weight may help reduce reflux.
Raise the head of the bed six to eight inches – Having the head and shoulders higher than the stomach lets gravity work to keep acid from refluxing. You can raise the bed with blocks of wood or a foam wedge under the mattress. Do not prop yourself up on pillows, as this can produce an unnatural bend in the body that will increase pressure on the stomach, making reflux more likely.
Avoid wearing tight fitting garments – Tight fitting garments can raise stomach pressure, forcing stomach contents into the esophagus.
Promote salivation by chewing gum or using oral lozenges – This will help to clear stomach acid that has entered the esophagus.
Eat smaller meals – Eating smaller meals helps prevent the stomach from becoming over-distended, which tends to cause reflux.
Review your medications – Medications you may be taking for other conditions may also be contributing to reflux.
Prescription Antacids – Acid reducing medications can broadly be further divided into two groups: "H2 antagonists" (Zantac®, Axid®, Pepcid®, Tagamet®) and "proton pump inhibitors" (Prilosec®, Prevacid®, Protonix®, Aciphex®, Nexium®). Over the counter or prescription strength H2 antagonists are sufficient to control symptoms in many people. However, the proton pump inhibitors are much stronger (and thus more effective) than the H2 antagonists. In fact, the degree of relief provided by proton pump inhibitors makes many patients reluctant to discontinue them. Nevertheless, many doctors recommend a trial off treatment once symptoms have been brought under control. On the other hand, many patients continue taking these medications for years. Fortunately, both the H2 antagonists and the proton pump inhibitors are very safe. The major problem with them is that they are expensive.