What is acid reflux?

Lifestyle Modifications
Sensible changes in lifestyle, especially if their rationale is explained to the patient, should be part of the initial management of all subjects. These include head of the bed elevation, avoidance of tight-fitting clothes, weight loss, restriction of alcohol, elimination of smoking, dietary therapy, refraining from lying down after meals, and avoidance of evening snacks before bedtime. Physiological studies show that these maneuvers enhance esophageal acid clearance, minimize acid-reflux related events, or ease heartburn symptoms, but their therapeutic efficacy in controlled trials usually has not been evaluated. The head of the bed can be elevated either by putting 6- to 8-inch blocks under the legs of the bed or by using a Styrofoam wedge under the mattress to elevate the upper torso. Eating several hours before retiring and avoiding evening snacks keep the stomach empty at bedtime, thereby decreasing the number of nocturnal reflux episodes. These three lifestyle changes are recommended for patients with nocturnal GERD symptoms or laryngeal complaints. One study found that head of the bed elevation was nearly as effective as ranitidine therapy in healing esophagitis. Avoidance of tight-fitting clothes and weight loss are interventions aimed at reducing the incidence of reflux by the abdominal stress mechanism. The efficacy of weight reduction is especially controversial, but it may be helpful when discrete periods of weight gain can be associated with exacerbation of reflux symptoms. Cessation of smoking and elimination of alcohol are valuable because both agents lower LES pressure, reduce acid clearance, and impair intrinsic squamous epithelial protective functions. Dietary changes include reducing the size of the meal and intake of fats, carminatives, and chocolate, to reduce the frequency of reflux by decreasing gastric distention and by reducing the episodes of transient LESRs, and avoiding foods that lower basal LES pressure. Additionally, some patients complain of heartburn after consuming citrus drinks, spicy foods, tomato-based products, coffee, tea, or cola drinks. Stimulation of gastric acid or esophageal sensitivity to low pH or hyperosmolar liquid solutions may account for these symptoms. However, the indiscriminate prohibition of food products should be avoided, but rather tailored to those foods that bring on individual symptoms, to promote dietary compliance. Finally, patients should avoid, if possible, drugs that lower LES pressure or can promote localized esophagitis.