1. How safe are these drugs for long-term use?
2. Are the drugs actually treating the cause of your acid reflux or just the symptoms?

To help you determine the answers to these questions, the following is information regarding the popular medical treatment options for acid reflux, as well as information on their side effects.  

Antacids - Gaviscon, Maalox, Mylanta, Rolaids, Tums, Pepto-Bismol

Antacids are used to prevent and relieve heartburn.  They are designed to neutralize stomach acid.  For best results, antacids should be taken one hour before eating, or right before reflux symptoms start after a meal.  This allows for the antacid to remain longer in your system, because it takes the stomach longer to empty.  Nevertheless, it is not uncommon for a person to take more than one antacid to relieve heartburn symptoms.

Side effects:  When taken as recommended, antacids are considered safe to use, and though side effects are rare, the most common include: chalk-like taste, increased thirst, stomach cramps, constipation and diarrhea.

Long-term use:  Unless otherwise directed by your doctor, antacids should not be taken on a regular basis for longer than 2 weeks, and recommended doses should not be exceeded.  Antacids are meant for occasional relief of heartburn symptoms; they should not be considered a permanent treatment option.

H2 Blockers / H2 Antagonists (Histamine Antagonists) – Cimetidine (Tagamet), Ranitidine (Zantac), Nizatidine (Axid), Famotidine (Pepcid), Ranitidine bismuth citrate Pylorid).

Similar to antacids, H2 blockers stop acid production, but are more effective at relieving heartburn associated with GERD.  H2  blockers work by attaching to H2 receptors in the stomach to stop the production of acid.  H2 receptors are specific stomach cells that produce acid.  These stomach cells produce acid when they are stimulated by a chemical known as histamine.  Histamine is naturally produced by the body, and when it binds to the H2  receptors of the cells, more acid is produced.  Hence, H2 blockers have a counter effect, and attach to the H2  receptors in order to stop the cell from producing acid.

H2 blockers are most effective when they are taken 30 minutes prior to eating, because by the time the drug has reached its peak level in the body, the stomach is producing the most acid.  H2 blockers can also be taken before bed to help suppress nighttime acid production.

Side effects:  H2 blockers generally cause few side effects, but if side effects occur, the most common include: diarrhea and other digestive problems, dizziness, headache, fatigue, hair loss (Tagamet), sweating (Axid), darkening of the tongue and black stools (Pylorid)

Long-term use:  Unless otherwise directed by your doctor, H2 blockers should not be taken regularly for longer than 2 weeks, and recommended doses should not be exceeded.  H2 blockers are meant for occasional relief of heartburn in GERD that is not accompanied by inflammation or other complications (I.E. ulcers, strictures, Barrett’s esophagus).  H2 blockers should not be considered a permanent treatment option.

Proton Pump Inhibitors – Omeprazole (Prilosec), Esomeprazole (Nexium), Pantoprazole (Protium), Lansoprazole (Zoton), Rabeprazole sodium (Pariet)

Proton pump inhibitors (PPI’s) have been specifically designed to treat GERD and other acid-related diseases. PPI’s completely blocks acid-secreting cells from secreting acid into the stomach.  More specifically, a PPI works by inhibiting a system in the stomach known as hydrogen-potassium adenosine triphosphate enzyme system (commonly known as proton pump).

Although a PPI is similar to H2 blockers, the difference is that a PPI completely stops the production of acid, and does so for a longer time.  Furthermore, PPI not only relieves symptoms of heartburn, it also helps to protect the esophagus from acid, so an inflamed esophagus can heal.   Thus, a PPI is used when H2 blockers do not relieve symptoms, or when there are additional complications with GERD.

PPI’s are highly effective when they are taken an hour before eating.  This allows them to be most active during the time of the stomach’s largest acid production, which occurs after food has been ingested.

Side effects:  Proton pump inhibitors do not usually cause side effects when taken as recommended.  However, common side effects that can occur include:  diarrhea, constipation, flatulence, abdominal pain, nausea, and headaches.  Those who take PPI’s long-term may experience stomach infections, due to the fact that not enough acid is being made in the stomach to destroy bacteria.

Long-term use:  PPI’s are only available by prescription.  They are usually prescribed for 1-2 months, but depending on the individual, they may be prescribed for longer.

Pro-motility Drugs – metoclopramide (Reglan, Clopra, Maxolon, Octamide, Reclomide)

Pro-motility drugs work by stimulating the gastrointestinal tract muscles, which includes the esophagus, stomach, small intestine and colon.  They help increase the pressure in the LES (lower esophageal sphincter) and strengthen the peristalsis (contractions) of the esophagus.  That being said, the overall effects the pro-motility drugs have on the LES is small.  Thus, it is thought that the primary effect of these drugs is that they speed up the emptying of the stomach, which helps to reduce acid reflux by decreasing the length of time food remains in the stomach.

Pro-motility drugs are most effective when taken 30 minutes prior to eating, and before bed.  They are typically used to help GERD sufferers who do not respond well to other treatments, or they are taken in addition to other remedies to help enhance other treatments for GERD.

Side effects:  Pro-motility drugs may cause certain side effects in some individuals including:  involuntary movements of the eyes or limbs, spasms of the face, jaw, and neck muscles.

Long-term use:  The only pro-motility drug approved for GERD is metoclopramide, and it is available through prescription.   It should be used according to a doctor’s instructions.

Remember, every drug has side effects, so make sure you talk to your pharmacist, and read the information that comes with the medication before taking it, to make sure you are aware of what the side effects are.   You should also read the ingredients of the medication to make sure you are not allergic to any of them.  Furthermore, for best results you should only take the medication as prescribed by the product information or your doctor.

While taking medications to treat your acid reflux, regardless if they are prescription or OTC, you should be monitored by your doctor.  Furthermore, you should seek the advice of your doctor when it comes to taking any drug for long term use, and to make sure that the drug will not have interactions with any other medications you may be taking.

Every drug, no matter how minimal the side effects, carries certain risks, and can cause damage when used daily for a prolonged period of time.  Furthermore, if used on a regular basis to treat acid reflux, it is possible for your body to build up immunity to the drug (particularly antacids), causing it to lose its effectiveness.  This typically results in you having to take another and usually stronger drug, further increasing your risk of suffering side effects.

Therefore, although medications may be a useful reflux treatment option, they do not treat the actual cause of your acid reflux, and should not be your only treatment option, or your main method of treatment.  The best way is to prevent acid reflux before it starts, and this is achieved through lifestyle change.

The food you eat isn’t the only culprit of acid reflux.  There are other factors that could lead to fluctuations in acid reflux symptoms including:

The way you eat – When you eat your meals, do you…

- Eat small portions?
- Eat slowly?
- Sit down with a straight posture?

If you have answered “No” to any of these questions, then the way you are eating your meals could be one of the reasons why you are still experiencing symptoms.  Therefore, you need to begin eating smaller and more frequent meals instead of eating three large meals per day.  Smaller amount of food decreases the acid your stomach needs to secrete to handle digestion, which decreases the chance of excess acid being refluxed into the esophagus.

In addition, by slowly eating and sitting down with a straight posture, you help remove stress from your lower esophageal sphincter (LES), which can occur if you are eating hunched over, while moving, or eating too quickly.

Your actions directly after eating – After you eat do you do any of the following…

- Lie down or go to bed?
- Exercise?
- Engage in vigorous activities including bending?

These activities slow down the digestion process which increases your chances of acid reflux, as well as other digestive problems including constipation.  The problem with slow digestion is it can cause delayed gastric emptying.  In other words, the food stays in the stomach too long before it is released into the small intestine.  Thus, there is a greater risk that the contents in the stomach will be pushed back up into the esophagus and result in heartburn.

It takes several hours for your food to digest, but the first hour or two after you eat is a crucial part of the process, because the food is still in your stomach.   While food remains in your stomach, there is a greater chance of acid reflux occurring.  That is why you should eat/drink at least 3 hours before going to bed, and why you should not lie down directly after you eat.

In addition, when you exercise (I.E. aerobics, vigorous walking, swimming, sit-ups, etc.), or excessively bend or move around directly after eating, you not only place stress on your LES, you are also slowing down the digestive process because you are taking blood (energy) away from your digestive tract, which is required to properly digest the food you’ve eaten.

What you wear – Believe it or not, but your favorite corset that helps slim your figure, or the tight belt that you wear for fashion or to help keep your pants secure, maybe causing you acid reflux symptoms.  Wearing tight garments, especially when you are eating, places a lot of pressure on you LES, encouraging acid reflux.  Therefore, loosen your belt, undo the button of your pants, and remove that garter belt or corset before sitting down to your next meal.  You will notice a difference in the way you feel during and after you eat.

Your level of stress – everyone needs a little stress in their life to help keep them motivated so they can get necessary tasks done.  However, when it comes to stress there is a happy medium.  Too much stress can have a negative effect on both your physical and mental wellbeing.    In fact, stress can lead to acid reflux by:

- Slowing down digestion.  When you are stressed your body responds to it by sending more blood to the muscles to help combat stress, taking energy needed for digestion.

- Embracing bad habits.  When stressed it is common for a person to eat salty, sweet and fatty foods, drink more alcohol, smoke more, or engage in other habits that increase the risk of acid reflux.

If you find that you are stressed, you need to apply stress management tactics (I.E. relax, vent to a friend, engage in an activity you enjoy, etc.) to combat stress.   If you do not find ways to release bottled up stress, it will find other ways to release itself, such as through acid reflux.

By sticking to your anti-acid reflux diet, changing the way you eat, and by applying some stress management tactics to your lifestyle, you’ll remove the cause of acid reflux symptoms, experiencing them less frequently or preventing them from occuring altogether.

How does acid reflux result in coughing?  When acid flows back up the esophagus, the esophagus reflexes which results in a spasm of the airways that can lead to shortness of breath and/or coughing.   A cough can also result when certain nerves within the esophagus related to the lungs are irritated, which triggers coughing.  Thus, acid reflux can cause coughing without ever passing into the throat. It is not uncommon for a cough to be the only acid reflux symptom a person experiences.

Those who suffer from chronic cough usually have frequent cases of reflux that are so severe that they can experience…

Throat and larynx inflammation and damage – If refluxed acid enters the throat and voice box it can cause inflammation which can lead to swelling of the throat tissue.  The inflammation and swelling can result in a sore throat and hoarsens, causing coughing.  Over time, the constant assault of acid on the throat can lead to damaged throat tissue.  When the throat is damaged or inflamed, the throat is irritated, and coughing can result.

Aspiration of acid into the lungs – refluxed acid that passes the larynx can invade the lungs.  When acid is refluxed into the lungs this is known as aspiration and can result in coughing and choking.  Over time, aspiration can cause damage to lung tissue which can lead to fibrosis (progressive scarring).  Aspiration can occur with or without symptoms, and can lead to lung infections that result in pneumonia.  Aspiration primarily occurs at night because the digestive processes that help to prevent reflux and the coughing reflex that is designed to protect the lungs are inactive.

Keep in mind; although it is clear that GERD (gastroesophageal reflux disease) can cause and/or exacerbate coughing, it is still not clear how often the symptom of coughing is directly related to acid reflux.

How is chronic cough caused by acid reflux treated?  If you suspect that your chronic cough is caused by acid reflux, the best way to treat your cough is to treat your acid reflux.  Understand, if your chronic cough is the result of acid reflux, taking over-the-counter medications designed to treat cough due to colds or allergies won’t be beneficial to you.  Your goal is not simply to treat coughing symptoms as they occur, it is to prevent the cough by preventing acid reflux.  Therefore, the following are some suggestions on how you can attempt to ease a chronic cough:

Lifestyle change:  A lifestyle change involves –
Alter eating habits - avoiding foods that are known to trigger acid reflux (I.E. fatty and spicy foods, chocolate, caffeinated beverages, citrus juice and fruits, alcohol, etc.), as well as eating smaller and frequent meals.
- Lose weight – if you are overweight, losing weight will take pressure off your lower esophageal sphincter (LES), which reduces the risk of reflux.  Engage in exercises such as walking, swimming and cycling.  These exercises will not place pressure on your stomach or LES.  You should wait for at least an hour after eating before exercising.
- Stop smoking – Smoking increases your risk of acid reflux, but it can also exacerbate chronic bronchitis, which could be something you are suffering from if you are a smoker.
- Prevent acid reflux while sleeping - Acid reflux is more common when we sleep, because the defenses in the digestive system that help to prevent acid reflux are inactive.  Thus, to help stop acid reflux from occurring while sleeping, make sure you avoid eating and drinking two to three hours before you lie down.  You should also elevate your head approximately 4 inches when lying down to prevent acid from traveling up your esophagus.

It is important to note that while lifestyle changes can be very effective, improvement in your cough symptoms may be slow, and it may take months before your cough is completely cleared.

Medications for Acid reflux: - Taking medications that prevent and block the production of acid such as antacids (Tums) and H2  blockers (Zantac) can help alongside lifestyle changes in alleviating acid reflux symptoms.  Another medication known as a proton pump inhibitor is beneficial for those with GERD because it not only stops acid production, it also allows the esophagus healing time.  Medications designed to relieve acid reflux symptoms are generally safe for long-term use, but you should speak to you doctor first, as well as be monitored by your doctor if you decide to take any medications.

Other treatment:  If your chronic acid reflux cough is still not easing after trying methods to prevent and relieve acid reflux, it’s time for you to seek the help of your doctor.  He or she may prescribe a medication known as a bronchodilator which helps to relax the air passages in your lungs to sooth coughing.  This medication or another kind may be provided while the doctor runs tests to see if they can determine the cause of your cough, so that they can provide you with the best treatment method.

First, let’s take a look at the different factors that can cause acid reflux:

Relaxed LES: This is when the LES (lower esophageal sphincter) weakens and loses tone causing it to malfunction. A relaxed LES does not close as it is supposed to after food is emptied into the stomach, which allows food to backup into the esophagus.

Delayed stomach emptying: Known as gastroparesis, delayed or impaired stomach emptying occurs when the stomach muscles have weakened and can no longer act spontaneously, causing impaired motility (movement). As a result, the contents in the stomach take too long to empty into the small intestine, and can reflux back into the esophagus.

Too much or too little stomach acid: Too much stomach acid (hyperhydrochlorhydria) can cause acid reflux because sometimes not all of the acid is “dumped” into the small intestine, and can backup into the esophagus. Likewise, too little stomach acid (hypochlorhydria) can cause acid reflux because a certain level of acidity is required for the stomach to empty into the intestines. If there is not enough acid, the valve at the bottom of the stomach called the pyloric valve, does not open, and the contents of the stomach can reenter the esophagus.

Esophagus abnormalities: These are abnormalities and conditions that are linked to GERD.
- Motility abnormalities of the esophagus: This is a problem that effects the spontaneous muscle action within the esophagus known as peristalsis. Peristalsis moves food down the esophagus, but when it functions abnormally, the contractions are slowed and hinder the process. When reflux occurs peristalsis, along with gravity and salvia, helps to wash the acid back into the stomach. If there are abnormalities associated with peristalsis the acid can remain in the esophagus causing damage and bringing on symptoms.

- Adult-ringed esophagus: This is condition that is characterized by small rings in the throat that make swallowing difficult. As a result, food tends to become stuck in the esophagus, and in the same way that motility abnormalities can encourage acid reflux symptoms, adult ringed esophagus can hinder the removal of acid from the esophagus.

Hiatal Hernia: The hiatus is a tiny hole located in the diaphragm, and its purpose is to secure the passageway between the esophagus and the stomach, keeping the organs separate from one another. If the hiatus is weakened, it can result in a hiatal hernia. The hernia occurs when a portion of the stomach protrudes up into the chest through the diaphragm. It is believed that a hiatal hernia can cause the LES to relax.

Asthma: It is thought that many asthma sufferers experience acid reflux due to the coughing and wheezing of asthma attacks which changes chest pressure and triggers acid reflux.

Diabetes: Diabetics are prone to gastroparesis (delayed stomach emptying) due to their increased blood sugar levels effecting the vagus nerve, which controls the stomach emptying process.

Over-reactive immune response: In some cases, acid reflux/GERD symptoms are the result of the immune system attacking itself, which is caused by the immune systems hyperactive response to an irritant within the esophagus. The over-reactive response triggers the release of certain elements that actually inflames the esophagus and can lead to injury and acid reflux.

Obesity: Excessive body weight puts additional pressure on the stomach which decreases the volume of the stomach and forces food back up the esophagus.

Pregnancy – Women who are in the third trimester of their pregnancies are highly susceptible to heartburn as the growing uterus increases pressure on the stomach, which can force food back into the esophagus.

Foods that trigger acid reflux: Certain foods carry a higher risk for acid reflux. These foods include:
- Fried and fatty foods (also slows digestions and increases pressure on stomach)
- Spicy food
- Onions
- Tomatoes and tomato based products
- Citrus fruit and citrus fruit juices
- Chocolate
- Mint (hard candy or herbal tea)
- Caffeinated beverages (coffee, tea, soda, energy drinks, etc.)
- Decaffeinated coffee
- Alcohol (also increases production of stomach acid)

Have a look at the food lists for more details on trigger foods.

People who suffer from food allergies or food intolerances such as gluten and dairy may also experience acid reflux in response to their inability to properly digest the specific food(s) they are intolerant to.

Poor Eating habits: Poor eating habits can slow down the digestive process, and put pressure on the stomach and can lead to acid reflux. Common poor eating habits include:
- Eating heavy meals/overeating
- Eating quickly
- Snacking before going to bed
- Eating while lying down, hunched over, or moving around
- Engaging in rigorous activities too soon after eating (I.E. exercise)

Smoking: The chemicals in cigarette smoke reduces the muscle function of the LES, impairs the throat’s muscle reflexes, increases acid secretion, and decreases saliva production which helps to counteract acid.

Stress: When the body is stressed it distributes more blood into the muscles to help cope with stress. Hence, blood is taken from the digestive system, which can cause the digestive process to slow down, leading to acid reflux. Stress can also contribute to the various other causes of acid reflux because when stressed we tend to indulge in behaviors that trigger acid reflux (I.E. eating fatty foods).

Exercise: Rigorous exercises (I.E. jogging, high-impact aerobics, etc.) and stomach exercises can cause acid reflux in some people. Stomach exercises such as stomach crunches or sit-ups cause excessive contracting of the stomach muscles, placing a lot of pressure on the stomach and LES which can cause food to be refluxed into the esophagus.

Tight fitted clothing: Clothing that hugs tightly around the abdomen (I.E. tight pants, belts, corsets, etc.) squeeze the stomach and can force food up against the LES which can cause reflux into the esophagus.

Medications: Heartburn is a side effect of many medications including, but not limited to:
- Nonsterodial anti-inflammatory medications (NSAID’s) – I.E. aspirin, ibuprofen, etc.
- Calcium channel blockers – treatment for high blood pressure and angina
- Asthma inhalers
- Anticholinergics – treatment for allergies, urinary tract disorders and glaucoma.
- Beta adrenergic agonists – treatment for asthma and obstructive lung diseases.
- Bisphosphonates – treatment for osteoporosis
- Dopamine – treatment for Parkinson disease
- Anxiety medications
- Sedatives
- Antibiotics
- Iron pills
- Potassium

Note: Most medications with heartburn as a side effect usually need to be ingested on a frequent basis in order to produce acid reflux symptoms, or increase the chances of developing GERD. Make sure you talk to your doctor about medication side effects if you have GERD or are prone to acid reflux.

There is no single acid reflux cure, but there are many treatments that can help alleviate and prevent it from occurring. That being said its important to understand that you need to discover which treatment methods are best suited to your lifestyle and will provide you with the most relief.

Lifestyle Changes include:
- Stopping smoking
- Avoiding alcohol and other foods that trigger acid reflux (refer to the trigger foods list)
- Improve eating habits:
*Eat frequent small meals instead of fewer large meals
*Don’t lie down for 3 hours after eating
*Don’t eat before bedtime
*Don’t exercise directly after eating
*Don’t bend for long periods of time after eating
- Maintain a healthy weight. Learn what your target BMI (body mass index) is, and design a healthy plan to lose weight if you are overweight.
- Slightly elevate your head when sleeping to encourage food to stay in your stomach.
- Wear lose fitted clothing
- Practice stress management
- Engage in low impact exercises such as walking, swimming and moderate cycling to stay in shape.

Alternative therapies: These include a variety of different all-natural healing remedies such as:

- Homemade herbal remedies: This can include herbal teas such as teas containing lavender and anise, aromatherapy, or taking Active Manuka Honey or other herbal recipes for healing.

- Homeopathy: A healing method based on the belief that specially prepared natural substances used in small amounts restore health.

- Acupressure and acupuncture: These are ancient Chinese healing methods that focus on stimulating certain pressure points of the body to promote healing in the esophagus and preventing acid reflux.

Medications: There are a number of different over-the-counter medications and prescription drugs that can help prevent and alleviate acid reflux/GERD symptoms. Medications are primarily designed for two purposes:

1. Control the stomach’s production of gastric acids. Medications include:
- Antacids (I.E. Zantac, Tums, Alka-Seltzer, etc.) – to neutralize stomach acid
- H2-receptor antagonists – reduce acid production and helps to heal esophagitis (an inflamed esophagus).
- Proton pump inhibitors – reduce stomach acid production and helps heal esophagitis.

2. Strengthen the LES to prevent the backflow of stomach contents. Medications include:
- Prokinetics

Medications vary in price, effectiveness and side effects. Therefore, it is highly recommended that you consult with your doctor before taking any medications to treat your acid reflux/GERD symptoms so you can be properly informed and monitored.

Surgery: If you have GERD and natural remedies and medications do not alleviate symptoms, your doctor may suggest surgery as treatment option.

Remember that the type of treatment you use depends on the cause of your acid reflux, how frequently you experience acid reflux, and whether or not you have GERD or other health conditions. It is usually best to opt for natural remedies first and make lifestyle changes before turning to medications and surgery as all medications and surgical procedures carry a certain level of health risk.

Be sure to talk to your doctor about the cause of your acid reflux before making any major lifestyle changes or adopting other acid reflux cures.

The purpose of fundoplication surgery is to prevent and reduce the occurrence of acid reflux by tightening the LES.

What is Fundoplication? Fundoplication refers to folding or wrapping, which is exactly what the surgery involves. During the surgical process, the upper curve of the stomach, known as the fundus, is gathered up and wrapped around the lower portion of the esophagus, and sutured in place. The procedure enables the lower portion of the esophagus to pass through a small tunnel that has been constructed from the stomach muscle. The surgery strengthens the LES (lower esophageal sphincter – the valve between the stomach and esophagus) which helps to stop stomach acid from gaining easy access to the esophagus. In addition, during the procedure, if present, hiatal hernias are also treated.

There are currently two types of fundoplication surgeries that are performed:

1. Laparoscopic fundoplication – This is the most common procedure for fundoplication surgery and involves the use of a laparoscope, a thin lighted tube that carries a videocamera. The laparoscope is inserted though a small incision in the abdomen. Once inserted, four additional pinpoint incisions are made in the upper abdomen. Needle-like instruments are inserted into the tiny incisions so the surgeon can perform the fundoplication surgery.

2. Open fundoplication – This is a procedure that involves making wide surgical incisions in the abdomen or chest. The surgeon will then perform the fundoplication surgery and sew up the patient’s incisions. This technique is generally used on obese patients as laparoscopic surgery is not possible or if there are complications during the laparoscopic technique.

What is the recovery time for fundoplication surgery? Recovery time depends on the surgical procedure a patient has undergone. For laparoscopic fudoplication surgery, recovery time is minimal. Patients usually remain in the hospital for 1 – 2 days, and are required to eat a soft diet for 1 – 2 weeks. However, most patients usually return to their normal activities within a week of the operation.

Open surgery fundoplication, on the other hand, has a much longer recovery time. Patients who undergo this surgery usually remain in hospital for between 4 and 6 days, and require 2 weeks of recovery time at home with specific soft diet instructions. After 3 – 4 weeks, the patient is typically able to return to work and engage in normal activities. Overall, the expected recovery time for this surgery is about 6 weeks.

Is fundoplication painful? Regardless of the type of surgery, all patients are given a general anesthetic during the operation, so there is no pain during the actual procedure. Those who undergo the laparoscopic surgery usually have minimal pain due to the fact that they have only received 5 tiny incisions that appear as minor blemishes. Though the area may be tender for the first day, pain medication is generally not needed 2 days after surgery.

Open fundoplication is more painful due to the fact that the patient has a large incision that needs to heal. These patients will likely take pain medication for two weeks, and will be instructed to refrain from certain activities to avoid causing pain or accidentally opening stitches.

Do acid reflux symptoms improve after surgery? For many patients, symptoms do improve, but not everyone experiences the same results. The following are a few facts to help you understand the overall success rate of fundoplication surgery:

- Some studies have found that approximately 50% - 90% of patients who undergo fundoplication performed by an experienced surgeon have successful relief from GERD symptoms and esophagus inflammation.

- While other studies have discovered that in more than 50% of cases, patients still require the use of GERD medications to control their remaining symptoms. However, medications are not always required on a regular basis and symptoms appear less severe.

- Although some studies have indicated that fundoplication surgery can improve symptoms in most patients, no study has yet been able to prove that fundoplication surgery can effectively maintain the long term healing of the esophagus or the prevention of acid reflux.

- Some studies have found that a small fraction of patients (about 10% – 20%) who have had the surgery, continue to have symptoms or develop new health complications that may or may not respond to medical treatment. Additionally, other patients who did not respond well to surgery required a second surgery within a decade of receiving the first, because of complications from the original operation.

Are there complications? Yes, complications can occur. Risk factors accompany any surgery or medical procedure. The complications that can occur after fundoplication surgery include:

- The risks of major surgery and anesthesia which can include breathing problems caused by the anesthetic, bleeding, and infection. Although rare, there have been incidences of patients who have had this surgery dying from surgical complications or anesthesia.

- Swallowing difficulty can occur because the stomach was been wrapped too tightly or too high on the esophagus. This is a complication more commonly found for those undergoing the laparoscopic procedure.

- The esophagus can slide out of the wrapped part of the stomach. If this occurs, the LES is no longer supported and acid reflux can reoccur.

- Heartburn returns

- Excess gas

- The inability to burp which causes a buildup of gas that results in bloating and other discomfort.

Finally, keep in mind that fundoplication cannot be reversed, and that not all complications can be fixed with a second surgery or medical treatment.

Are there medical alternatives to this surgery? Yes, there are alternatives including medications such as proton pump inhibitors that work to reduce stomach acid. This medication can be effective for many GERD sufferers.

Another alternative is endoscopic methods. An endoscope is a small, long flexible tube with a video camera that is swallowed by the patient so the doctor can view the inside of the esophagus. The endoscope also features different channels in which the doctor can insert various instruments to provide the necessary treatment. One endoscopic method is called the Stretta procedure, which is designed to tighten the LES through the use of an electric current.

Who is eligible for fundoplication surgery? This surgery is primarily recommended for GERD suffers who have severe heartburn/acid reflux that does not respond to medications or natural treatments such as lifestyle changes or herbal/alternative remedies. Surgery is also recommended for those who suffer from:
- Erosive esophagitis - Severe inflammation of the esophagus caused by acid reflux
- Esophageal stricture – narrowing of the esophagus caused by acid reflux
- Para-esophageal hernia – the upper part of the stomach protrudes through the opening of the diaphragm (hiatal hernia)
- Chronic lung inflammation (I.E. pneumonia) that results from inhaling gastric fluids that backup into the throat

Who is not eligible for fundoplication? Not everyone is a candidate for fundoplication surgery. Those who cannot undergo fundoplication include:
- Older adults with additional health problems to GERD
- Those who have unusual symptoms that could worsen with surgery such as weak peristalsis (food moves too slowly down the esophagus to the stomach)
- Esophageal cancer or suspected cancer of the esophagus
- Pregnancy

Others who can experience surgical difficulties that may exclude them from fundoplication include those with:
- A shortened esophagus
- Previous extensive surgery involving the upper abdomen
- Extreme obesity

What is the cost of fundoplication surgery? The cost of fundoplication surgery can range anywhere from $4,000 to $15,000. The cost will vary depending on different factors such as:
- If you will be undergoing laparoscopic or open surgery
- Where you have the surgery
- If complications occur
- How long you remain in the hospital
- Medications or follow-up treatments that may be prescribed after surgery

Does insurance pay for the surgery? Most insurance companies, such as Medicare, cover surgical treatment for GERD. However, it is imperative that you check with your insurance company first. This is important because you not only need to find out if you are covered, but also if there is a limit on coverage. You also need to obtain authorization from your insurance company prior to treatment.

If you believe you may be able to benefit from fundoplication surgery as a form of acid reflux treatment discuss your options with your doctor.

The answer is that stress can cause acid reflux. However, in the vast majority of cases, stress doesn’t actually trigger acid reflux; stress exacerbates its other causes.

How can stress directly cause acid reflux? When you are stressed, your body naturally sends more blood to your muscles in an effort to help provide them with the additional energy needed to better manage your stress.

Unfortunately, when this occurs, the body is robbing blood from other vital areas such as your digestive system. Without the necessary amount of blood required for normal digestion, the digestion process slows down. This causes food and harsh digestive acids to stay in your stomach longer, which increases your risk of acid reflux and heartburn, as well as other discomforts such as bloating and constipation.

How does stress contribute to other causes of acid reflux? When we are stressed we tend to disregard healthy living and adopt self-destructive behaviors. For instance, some of us…
- Eat “comfort” foods – chocolate, fatty, fried or spicy foods
- Eat faster or “on the run”.
- Drink more caffeine
- Use stress as a reason not to exercise
- Take more over-the-counter medications such as NSAIDs (I.E. ibuprofen, aspirin, etc.) for headaches and other stress-related bodily aches and pains.
- Resort to excessive drinking and/or smoking to help ease the pressure we feel.

All of these behaviors have the potential to lead to acid reflux, and the longer the behaviors last, the higher your risk.

Therefore, it is essential that you eliminate stress to help prevent acid reflux. Relieving stress is simply a matter of alleviating your worries by practicing stress management. Of course, this is often easier said than done, which is why it is important that you find a stress relief approach that works for you. To help you on your path to reduce stress levels, the following are some suggestions.

Tips for managing stress

- Discover the root of your stress – You need to face the issues causing your stress, and either work on fixing the problem(s), or let it go. Unless your stress is caused by something you can change, you need to ask yourself if your health is worth worrying about something you cannot change or have no control over?

- Talk to someone – Talking to someone about your problems can help alleviate your stress. Knowing that someone else cares and is willing to listen makes us feel less alone and more important.

- Make healthy food choices – You need to avoid the foods and beverages that are known to trigger heartburn including: foods high in fat, spicy foods, chocolate, mint, onions, tomatoes, citrus fruit, caffeinated beverages (coffee, tea, and soda), decaffeinated coffee (has low levels of caffeine and is still very acidic), alcohol, and citrus juices. For more details take a look at the Acid Reflux Food Lists.

- Stop smoking – if you smoke cigarettes, you may feel that smoking helps you manage your stress by calming your nerves. However, smoking has been proven to disrupt sleep, which is detrimental to your health and can increase the impact of stress. So, despite how smoking may make you feel the health risks far outnumber the fleeting comfort.

- Stretch and Breathe – Stand up every once in a while and do a few stretches along with some deep breathing exercises to encourage blood flow, release tension, rejuvenate your muscles, and your brain.

- Exercise – Staying active not only encourages a healthy weight and appetite, it also makes you feel good about yourself and puts you in a great mood. However, if you suffer from frequent acid reflux or GERD, you need to be careful what exercises you choose to engage in, as some exercises can aggravate your acid reflux symptoms. Good examples of heartburn friendly exercises include the following low impact activities: Walking, moderate cycling, swimming, ballroom dancing, and even housework (that last one’s optional!)

- Relax and enjoy some “me” time – Take the time to enjoy doing things you like. Everyone deserves a break and some time to engage in their hobbies or play. Do something that makes you smile and laugh.

- Get a good night sleep – Sleep is important to your overall mental and physical functioning. Insomnia or broken sleep is a symptom of stress. To help get a good nights sleep, don’t eat a few hours before you go to bed, and spend an hour or two before going to bed relaxing and unwinding by reading a book, taking a bath, drinking herbal tea (not peppermint as it can cause acid reflux), etc. Your goal is to shut your mind off.

Remember, before engaging in any exercise or diet program to tackle causes of stress, consult your doctor first.

It is estimated that almost 50% of acid reflux sufferers can trace the condition back to their genes. However, researchers are still not sure what the exact genetic factors are. Nevertheless, it is thought that those with family members, who have muscular or structural problems in the stomach or esophagus, are more susceptible to suffering the same issues, which tend to result in acid reflux and GERD.

The following are some acid reflux/GERD causes that could be considered genetic factors:

Relaxed LES – The lower esophageal sphincter (LES) is a group of muscles connected to the stomach and the esophagus. When functioning properly, the LES opens to allow food from the esophagus into the stomach and closes. When the LES malfunctions, due to the weakening of muscles, it relaxes and is no longer able to fully close, allowing some of the stomach contents to backup into the esophagus causing reflux.

Whether or not someone can be born with a weak LES is yet to be determined, but there are many factors you could have “inherited” from your parents, such as poor eating habits, food intolerance, a hiatal hernia, or obesity, that can weaken the LES and make you more susceptible to relaxed LES.

Gastroparesis (impaired or delayed stomach function) – This is an abnormal nerve or muscle function that occurs in the stomach, and is present in more than half of GERD sufferers. This abnormality causes the slow digestion of stomach acid, which causes the stomach to delay emptying its contents into the intestines. As a result, there is an increase in stomach pressure which increases the risk of acid reflux. Gastroparesis is a common condition in about 20% of people with type 1 diabetes and is also not uncommon in those with type 2 diabetes. Both types of diabetes are considered hereditary.

Esophagus abnormalities – Malformations in the esophagus are believed to be a factor for GERD sufferers. One of the malformations is motility abnormalities that affect the peristalsis. Peristalsis is a group of smooth muscle contractions that are designed to move food down the esophagus. When the peristalsis becomes abnormal, the muscle contractions slow which causes food to become stuck or move too slowly down the esophagus. This can cause lead to acid reflux symptoms as peristalsis helps to wash any refluxed acid from the esophagus. When these contractions are hindered the acid can sit in the esophagus for longer, causing damage and increasing severity of symptoms.

Another abnormality is known as adult-ringed esophagus. This is a condition in which many small rings line the throat and also makes swallowing difficult. It is not certain what causes these malformations in the esophagus, but there could be a genetic link.

Hiatal hernia – This is a problem that occurs in the hiatus, which is a small hole in the diaphragm. The esophagus fits through the tiny opening to join the stomach. The hole is usually tight, but for some people, the hiatus can weaken and enlarge. This can result in some of the stomach protruding into it and is a condition known as Hiatal hernia. This hernia is believed to impair LES function and can increase GERD symptoms. Some studies suggest that a person, who has family members with hiatal hernia, is at greater risk of developing the problem too.

Asthma – This is a respiratory disease that tends to run in families, and many experts believe that asthma is connected to acid reflux, because approximately more than half of asthmatics also have GERD. However, it is not known if asthma causes GERD, or if GERD is the cause of asthma in these individuals. It is possible that an asthma attack triggers pressure changes in the chest, which may encourage acid reflux.

Obesity – many medical studies have found obesity to have an hereditary link, and other studies have linked obesity as a risk factor for acid reflux and GERD. Excess body fat compresses on the stomach and can force stomach contents backup the esophagus. Those with obesity are also more prone to hernias, poor eating habits, and ingesting foods high in fat which trigger acid reflux. However, the precise link between obesity and GERD has yet to be discovered.

Other factors that may not be directly linked to your genetics, but are family factors that probably influenced your lifestyle include:

Food intolerance/Food allergies – acid reflux can be a symptom of food intolerance, or a food allergy, two issues that may run in your family. If you suffer from food intolerance, such as dairy intolerance, you are usually unable to digest those foods due to the lack of particular enzymes. On the other hand, if you have a food allergy, such as an allergy to shellfish, your body may overact and have a hypersensitive reaction to the substance you are allergic too. In both cases, acid reflux can be a resulting symptom of your body’s inability to digest foods due to allergy or intolerance.

Poor diet and eating habits: In many cases, the foods we eat, the amount of food we eat, and the way we eat our food, stems from our childhood and our parent’s eating habits. If you grew up eating spicy food, fried fatty foods, or foods high in fat, your chances of following this eating pattern is high, increasing the likelihood of acid reflux. Likewise, if you grew up eating large meals, and eating before bed, your acid reflux risk is also high.

Age – Although acid reflux typically occurs in matured adults, as the older we get the greater the risk there is of developing it, acid reflux is a condition that does not discriminate and can affect any woman, man or child of any ethnicity, at any time during their life. However, it is believed that genetic factors are ones of the causes of GERD in children and young adults who experience frequent cases of acid reflux and GERD.

What is involved in the Stretta procedure? Stretta procedure is performed using an endoscope (a small flexible tube with a lens and light that has different channels where additional medical instruments can be inserted), and a Stretta device (a very thin catheter that features a balloon at the end). After being given a local anesthetic, the patient swallows the endoscope that travels into the esophagus and remains just above the stomach.

The catheter is then guided through the endoscope, and the balloon is inflated. Four sharp probes are exposed on the outside of the balloon. The purpose of the probes are to discharge controlled levels of radio frequency energy into the LES (lower esophageal sphincter) muscle and the gastric carida (uppermost portion of the stomach). The radio frequency energy creates thermal lesions on the targeted areas. When these lesions heal, the LES muscles tighten reducing the possibility of stomach acid refluxing into the esophagus. Hence, the purpose of Stretta procedure is to strengthen the LES muscle to reduce the occurrence and severity of acid reflux.

What is the recovery time for Stretta procedure? The average recovery time is between 1 -2 days. Patients usually remain in a hospital recovery room between 2 and 3 hours, but are released the same day as the procedure. Most patients are able to return to their normal activities the next day.

Is Stretta procedure painful? Stretta procedure typically causes discomfort rather than actual pain. During the procedure the patient remains conscious and is administered a local anesthetic. Some patients experience abdominal cramping during the procedure, but this discomfort is often alleviated during the process, and passes when the procedure is finished.

After the procedure, patients generally feel an overall tenderness in their upper abdomen. This tenderness usually subsides within 3 – 5 days. Pain medication is not normally prescribed.

Does the procedure improve symptoms? Many studies reported in several medial journals, have found that acid reflux symptoms improve in as many as 80% patients. Most patients tend to experience a decrease in heartburn and other acid reflux symptoms within one month of Stretta procedure. Patients who experience this success were able to stop taking acid-blocking medications with little discomfort.

However, the most effective improvement of symptoms usually does not occur until about 6 months after the procedure is performed. It was also found that in many of these patients, symptoms were further improved or non-existent 12 months after the procedure.

Most patients discontinue their heartburn medication 1-2 months after surgery. However, individual results may vary. Caution, never stop taking prescription medication without first consulting your physician.

Are there complications? Complications of Stretta procedure are minimal as there is no cutting or incisions during procedure. The two most noted, but rare complications include:
- Transient odynophagia (painful swallowing lasting for a brief time)
- Chest pain

Studies have found complications only occur in about 10% of patients, and complications tend to be minor. However, this doesn’t mean serious complications cannot occur, as everyone responds differently to treatment.

Are there alternatives to Stretta procedure? Yes. It is recommended that acid reflux/GERD sufferers attempt natural treatments such as lifestyle changes and alternative therapies (I.E. acupressure, acupuncture, homeopathy, etc,) first, before opting for medical treatments such as medications, procedures and surgery.

If natural treatment does not work, the use of medications such as proton pump inhibitors is usually the next step to reduce stomach acid to alleviate and prevent acid reflux.

Aside from Stretta procedure, another endoscopic option that is been approved for GERD treatment is The Bard EndoCinch Suturing system. This is a procedure that places stitches in the LES to create small pleats to help strengthen the muscle. However, like Stretta, this procedure may not benefit those with severe GERD.

Finally, if you suffer from severe GERD symptoms (I.E. Severe acid reflux/heartburn, inflamed and damaged esophagus) you may want to consider Fundoplication surgery. This is a surgery that involves gathering and wrapping the upper curve of the stomach around the lower part of the esophagus and sewing it in place. This allows the lower part of the esophagus to pass through the small tunnel that has been made from the stomach muscle. The surgery is designed to strengthen the LES and prevent the occurrence of acid reflux. Refer to the Treatment post about Fundoplication for more information.

Who is eligible for the procedure? Stretta procedure is generally considered safe for most GERD suffers regardless of their age. However, to be more specific, Stretta procedure is recommended for:
- People who don’t want to continue taking medications for GERD
- People who have drug intolerance
- People who have difficulty finding treatments that alleviate their symptoms
- People who would like to try a less invasive treatment method as an alternative to medications and instead of fundoplication surgery.

Who is not eligible for the procedure? Stretta procedure is not recommended to those who suffer from:
- Severe GERD
- Large hiatal hernias (hernias larger than 2 cm or 0.78 in) – a condition where the stomach protrudes up into the diaphragm through a small hole known as the hiatus.
- Esophagus abnormalities such as a narrowed esophagus and adult-ringed esophagus that causes limited or difficulty swallowing.

What is the cost of Stretta procedure? Stretta procedure ranges between $2,000 and $3,000.

Does insurance pay for the surgery? Most insurance companies (I.E Medicare) cover Gastroesophageal Reflux treatments such as Stretta procedure. However, it is important that you first check with your insurance company to see if you are covered, and also to obtain authorization prior to the procedure. Also, don’t forget that even though your insurance may cover the treatment, there may be a coverage limit.

Although taking common over-the-counter or prescribed H2 blockers or proton pump inhibitors can help alleviate your sore throat by combating and preventing acid reflux, did you know that there are many natural remedies you can try first to help relieve your irritated throat?  Remedies such as:

Drink plenty of fluids – Drink plenty of hydrating fluid, especially water, to keep your body hydrated and the back of your throat moist.  This will provide comfort to the irritated tissue.  Another excellent drink that helps relieve throat irritation is herbal tea.  Herbal teas that contain anise and lavender soothe painful swallowing, aid in digestion, and help to reduce stomach acid, alleviating acid reflux.

In addition to herbal tea and water, drinking warm water with a teaspoon of honey is also a soothing and safe remedy.

The key is to drink fluids regularly throughout the day. Try always having a glass or bottle of water to hand to encourage you to stay hydrated.

Gargle with warm salt water – Gargling a mixture of warm water and salt can help reduce the swelling that comes with a sore throat.  The swelling of an irritated throat is the result of a higher water concentration in the cells that line the throat.  Warm salt water helps to draw out some of the extra water, which decreases swelling.  Here is what you need to know about gargling with warm salt water:
1. Only gargle with a light mixture that consists of ½ teaspoon of table salt per 1 cup of warm water.  Too much salt will only further harm the stressed mucus glands of your throat.
2. Mix salt and water well.
3. Gargle for thirty seconds several times a day.  Gargling only once or twice will not have a significant effect on your sore throat.

Humidifier or cool mist vaporizer – The dryness in the air can aggravate an already irritated throat making it feel very dry, scratchy, and raw.  Humidifiers and cool-mist vaporizers are machines designed to add moisture to the air.  Air with moisture will reduce throat irritation.  Keep in mind that these devices should be placed in an area where you will be spending the most time.

Hard candy – non-medicated throat lozenges or mild tasting hard candy (I.E. butterscotch and fruit flavors – avoid chocolate or peppermint candies as they tend to aggravate acid reflux) can provide relief of both sore throats and acid reflux.  Hard candy helps to eliminate dryness, the burning feeling in the throat, and gives the throat extra moisture.  This is because hard candy increases the production of saliva, and saliva contains bicarbonates that work to neutralize acids that may remain in the throat.

Active manuka honey – Active manuka honey can provide relief from sore throats, alleviate acid reflux, and even prevent it.  However, in the case of painful swallowing here is how you can use active manuka honey as a natural remedy:
1. Take 1 teaspoon of honey
2. Do not swallow immediately.  Let the honey melt in your mouth and then swallow to allow the mouth and throat to be better coated.
3. Do not eat or drink for 15 minutes after swallowing to keep the manuka honey concentrated
4. If you have a persistent sore throat this remedy can be repeated every few hours, up to 4 times per day.  Note: if you are a diabetic you need to watch your sugar intake, and will need to alter this remedy accordingly.

Sleep – Rest always helps the body heal.  Remember to keep your head propped up with pillows or raise the head of your bed to prevent acid from traveling up your esophagus to your throat during sleep.

Control eating habits – Not only do you need to avoid foods and beverages that can cause acid reflux, you also need to ensure you are eating properly.  This means eating small quantities slowly, and in an upright position.   You should also limit activities after eating, and avoid lying down for at least 2 hours to encourage proper digestion.

Finally, although natural remedies can be very beneficial for treating your symptoms, it is imperative that you carefully monitor your irritated throat and make sure that the sore throat and difficulty swallowing you are experiencing is a symptom of acid reflux and not something else like strep throat or tonsillitis. If your sore throat worsens, has not improved in five days, you notice a coating of pus on the surface of your tonsils, or have difficulty breathing you should immediately see your doctor.