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Acid reflux (GERD)

 GERD (Reflux) Management

LIFESTYLE CHANGES

1.     Weight loss (goal BMI less than 25) with diet and exercise

2.      Head of bed elevation with foam wedges or blocks

3.     Avoidance of meals 2-3hours before bedtime (especially high-fat)

4.     Limit smoking cigarettes, drinking alcohol

5.     Abdominal breathing exercises to strengthen the antireflux barrier (see next page)

6.      Some people have a response to apple cider vinegar (1 tsp diluted in ½ cup of water) in the AM

7.     Use a food diary & only avoid foods that are clear triggers. Common ones are:

·       Chocolate

·       Caffeine

·       Coffee

·       Alcohol

·       Carbonated beverages including seltzer, soda water (La Croix)

·       Acidic foods (citrus, tomatos)

·       Spicy foods

·       High-fat foods

·       Peppermint

 

MEDICATIONS

1.     Antiacids

·       Example: Tums, Maalox

·       On-demand use for mild symptoms that occur less than once a week

·       Provide relief within 5 minutes, last 30-60 minutes

·       Be careful with kidney disease

2.     H2-receptor blocker (Histamine blocker)

·       Example: Famotidine (Pepcid), Ranitidine (Zantac), Cimetidine (Tagamet)

·       Provide relief within 2.5 hours, last 4-10 hours

·       Temporary: Loses effect within 2-6 weeks

3.     Proton Pump Inhibitor (PPI)

·       Example: Omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium), pantoprazole (Protonix), dexlansoprazole (Dexilant), rabeprazole (Aciphex)

·       Provide relief within 2-3 days, weeks for maximum results. 

·       If no improvement after 2 weeks, contact your doctor

·       Take as soon as you wake up with a glass of water and do not eat for 30 minutes

·       Possible side effects= colitis, pneumonia, kidney disease (discuss details with doctor)

·       With long term use (>1year), monitor magnesium, vitamin 12, iron, bone density (OK for people with osteoporosis, use calcium citrate as supplement)

  

Abdominal (diaphragmatic) breathing for GERD

1.     Lay down on your back with one hand on the chest and the other hand on the abdomen above the belly button.

2.     Inhale through the nose, exhale with the mouth open, moving only the abdomen (think of inflating/deflating a balloon).

3.     Feel the abdomen slowly rise and fall with each breath while the chest and shoulders remain still. Completely inflate and deflate the abdomen with each breath.

4.     Count to 4 with each inhale, hold the breath for 4 counts and count to 4 with each exhale. Extend the exhale to 8 counts gradually. 

5.     The same exercise can be done sitting and standing.

6.     Perform this exercise for 30 breaths or 5 minutes, 3 times a day or for 5 minutes when symptomatic.

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Ming-Liang Ong et al. CGH 2018

Eherer et al. Am J Gastroenterology 2012

Pictures above adapted from my.clevelandclinic.org