Lifestyle Changes | Medications | Surgery
Without effective treatment, ongoing acid reflux can damage the lining of your esophagus and cause serious problems. Depending on the severity of your symptoms, making a few changes to your lifestyle and diet can often control many acid reflux symptoms. Also, many over-the-counter (OTC) and prescription medications are effective. If these prove unsuccessful, surgery is an option that can fix the cause of the problem for those who qualify.

If you aren’t getting the relief you seek, or prefer not to take medication, Goshen Acid Reflux Center can help. Our multidisciplinary team of specialists use the most advanced diagnostic tools available to determine which of the following treatments may best suit your needs.

Lifestyle Changes
The first step in treating acid reflux often includes lifestyle and diet modifications. The following steps can be effective for relieving mild symptoms:
• Avoiding food, beverages and medications that can aggravate acid reflux symptoms, such as spicy foods, fried or fatty foods, chocolate, mint, alcohol, caffeine, cola, tomato products, citrus fruits or juices, ketchup or mustard or vinegar
• Decreasing portion sizes at mealtime
• Eating meals at least two to three hours before bedtime and going to sleep with an empty stomach
• Elevating the head of the bed four to six inches or using a wedge
• Losing weight
• Exercising with an empty stomach
• Avoiding tight clothing
• Stopping smoking
• Avoiding stress

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Medications
In addition to lifestyle changes, there are a number of OTC and prescription medications available to relieve moderate or severe acid reflux symptoms. Some of these medications neutralize stomach acid while others help stop acid production. For most, medications are effective, but they may require lifelong use for continued control of symptoms.

Antacids
Often the first drugs recommended to relieve heartburn, these over-the-counter medications neutralize acid in the stomach. Common antacids include TUMS®, Alka-Seltzer®, Mylanta®, Maalox®, Gaviscon®, Tritalac® and Rolaids®. Antacids work well for occasional or mild heartburn.

Side Effects. These can include diarrhea and constipation. Plus, long-term use of antacids have been found to block the absorption of calcium and other vitamins and minerals in some people, and reduce the effectiveness of certain anti-hypertensive drugs and antibiotics. They can also reduce the effectiveness of H2 blockers (listed below), and are best used alone.

H2 Blockers
Available in both OTC and prescription strength, these drugs include Pepcid®, Pepcid AC®, Tagamet HB®, Tagamet 75®, Tagamet®, Zantac® and Axid®. They work by decreasing acid production, and can provide short-term relief of heartburn. H2 blockers are effective for about half of those with acid reflux.

Side Effects. These could include diarrhea, dizziness, rash or headache. Famotidine, found in Pepcid®, is restricted for those with impaired kidney function, as it can affect the central nervous system and may result in anxiety, depression, insomnia or drowsiness and mental disturbances.

Proton Pump Inhibitors (PPIs)
These primarily prescription drugs (some are available in OTC strengths), which include Prilosec OTC®, Prilosec®, AcipHex®, Nexium®, Prevacid®, Protonix® and Capodex®, work by inhibiting the stomach molecules responsible for acid secretion (the gastric acid pump). PPIs are more effective than H2 blockers and relieve or improve symptoms in almost everyone with acid reflux, while healing the esophageal lining.

Side Effects. They are uncommon, but may include headache, diarrhea, constipation, nausea and itching. Long-term use of these drugs has been linked to an increased risk of osteoporosis, leading to hip, wrist and spine fractures. Pregnant women and nursing mothers should avoid PPIs, although recent studies suggest that they do not pose an increased risk of birth defects. PPIs may interact with certain drugs, including anti-seizure medications, (phenytoin), anti-anxiety drugs (diazepam) and blood thinners (such as warfarin and Plavix®).

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Surgery
Medications work in about 90 percent of those with acid reflux. However, they don't work for everyone and don't repair the cause of acid reflux. For moderate or severe acid reflux, surgery may be a treatment option if:
• You continue to suffer from persistent heartbur, or other reflux symptoms, while taking medication
• You are concerned about or develop adverse side effects such as osteoporosis as a result of taking medication
• Symptoms return when therapy is stopped
• Your esophagus is damaged (bleeding/stricture)
• You prefer not to take lifelong medication or feel you cannot afford to do so

In addition, medications only address the symptoms of acid reflux, not the cause, or stop its progression. Even if your symptoms improve or disappear when on medication, you could still have acid reflux, possibly damaging your esophagus and leading to other serious health problems. Plus, studies have shown that symptoms often return when PPIs are withdrawn, requiring lifelong treatment in many.

Surgery, on the other hand, repairs the stomach valve that is allowing acid or bile to leak into the esophagus. Moreover, only surgery reduces regurgitation, and is far more effective in improving asthma-like symptoms than drug treatment.

In most cases, a procedure called fundoplication, is performed to correct acid reflux. During this procedure, the upper portion of the stomach (fundus) is wrapped (plicated) around the lower portion of the esophagus reconstruct and lengthen the antireflux barrier.

Nissen fundoplication, a laparoscopic procedure, has long been proven to be an effective, longterm solution for acid reflux. This surgery is minimally invasive, requiring only small incisions and a brief hospital stay. A new, advanced procedure, called transoral incisionless fundoplication (TIF), is performed through the mouth, without the need for abdominal incisions, further reducing pain, recovery time and scarring in patients. TIF is now available in only a few progressive acid reflux centers in the country. Goshen Acid Reflux Center was the first in Indiana to successfully complete the surgery, and is the only facility in the area to offer TIF.