Gastroesophageal Reflux: Soothing Heartburn

Gastroesophageal reflux occurs when acidic stomach contents flow back into the esophagus. The lower esophageal sphincter, normally sealed, becomes incompetent.

Typical Symptoms

• Retrosternal burning (heartburn), especially after meals and when lying down
• Acid regurgitation
• Bitter taste in the mouth

Atypical Symptoms

• Chronic nocturnal cough
• Morning hoarseness
• Chest pain (can mimic a heart problem)
• Dental erosion

Lifestyle and Dietary Measures

• Elevate the head of the bed by 15-20 cm
• Do not lie down within 3 hours after a meal
• Avoid copious and fatty meals
• Limit coffee, alcohol, chocolate, mint, citrus, tomatoes
• Lose weight if overweight (every kilo lost reduces abdominal pressure)
• Quit smoking (smoking reduces sphincter tone)

Medical Treatments

• Antacids: rapid but temporary relief (Gaviscon, Maalox)
• PPIs (proton pump inhibitors): omeprazole, esomeprazole. Very effective, to be used at the lowest effective dose for the shortest duration
• Anti-H2: famotidine, as an alternative or complement

Long-term PPIs are not harmless (risk of deficiencies, digestive infections). Discuss with your doctor the relevance of continuing if treatment lasts more than 8 weeks.