Acid reflux - Treating heartburn and GORD

Heartburn and gastro-oesophageal reflux disease (GORD) can often be treated with self-help measures and over-the-counter medicines.

If these don't help, your GP can prescribe stronger medication or refer you to a specialist to discuss whether surgery may be an option.

This page covers:

Self-help for GORD

Medicines for GORD

Surgery for GORD

Self-help

You may find the following measures can help reduce heartburn and other symptoms of GORD:

• Eat smaller and more frequent meals, rather than three large meals a day‐ don't eat or drink alcohol within three or four hours before going to bed, and avoid having your largest meal of the day in the evening.
• Avoid anything you think triggers your symptoms ‐ common triggers include coffee, chocolate, tomatoes, alcohol, and fatty or spicy food.
• Don't wear tight clothing ‐ clothes that are tight around your tummy may make your symptoms worse.
• Raise the head of your bed by up to 20cm (8 inches) ‐ placing a piece of wood or blocks underneath one end of your bed may reduce symptoms at night; don't just use extra pillows, as this can put a strain on your tummy.
• Try to relax ‐ stress can make heartburn and GORD worse, so learning relaxation techniques may help if you're often feeling stressed.
• Maintain a healthy weight ‐ if you're overweight, losing weight may help reduce your symptoms.
• Stop smoking ‐ smoke can irritate your digestive system and may make your symptoms worse.

If you're taking medication for other health conditions, check with your GP to find out whether they could be contributing to your symptoms.

Different medicines may be available, but don't stop taking any prescribed medication without consulting your GP first.

Medication

A number of different medications can be used to treat symptoms of GORD.

Over-the-counter medicines

Over-the-counter heartburn and GORD medicines are available from pharmacies without a prescription. The main types are:

• antacids (such as Rennie) ‐ these neutralise the effects of stomach acid
• alginates(such as Gaviscon) ‐ these produce a coating that protects the stomach and oesophagus (gullet) from stomach acid
• low-dose proton-pump inhibitors (such as omeprazole) and H2-receptor antagonists (such as ranitidine) ‐ see below for more information about these

These medicines aren't suitable for everyone, so you should check the leaflet first. Ask a pharmacist for advice if you're not sure.

Proton-pump inhibitors (PPIs)

If your symptoms don't get better despite trying self-help measures and over-the-counter medicines, your GP may prescribe a PPI. These work by reducing the amount of acid produced by your stomach.

You'll usually be given enough medication to last a month. Go back to your GP if they don't help or your symptoms return after treatment finishes. Some people need to take PPIs on a long-term basis.

The possible side effects of PPIs are usually mild. They include headaches, diarrhoea or constipation, feeling sick, abdominal (tummy) pain, dizziness and a rash.

Your GP will prescribe the lowest dose that they think will control your symptoms to reduce the risk of side effects.

H2-receptor antagonists (H2RAs)

If PPIs don't control your symptoms, a medicine known as a H2RA may be recommended for you to take alongside them on a short-term basis, or as an alternative.

Like PPIs, H2RAs reduce the amount of acid produced by your stomach.

Side effects of H2RAs are uncommon, but can include diarrhoea, headaches, dizziness, a rash and tiredness.

Surgery and procedures

Surgery may be an option if:

• the above treatments don't help, aren't suitable for you, or cause troublesome side effects
• you don't want to take medication on a long-term basis

The main procedure used is called a laparoscopic Nissen fundoplication (LNF). Alternative techniques have been developed more recently, although these aren't yet widely available.

Laparoscopic Nissen fundoplication (LNF)

LNF is a type of laparoscopic or "keyhole" surgery. This means it's carried out using special surgical instruments inserted through small cuts (incisions) in the skin.

The procedure is used to tighten the ring of muscle at the bottom of the oesophagus, which helps to stop acid leaking up from the stomach. It's carried out in hospital under general anaesthetic.

Most people need to stay in hospital for two or three days after the procedure. Depending on your job, you may be able to return to work within three to six weeks.

For the first six weeks after surgery, you should only eat soft food, such as mince, mashed potatoes or soup. Some people experience problems with swallowing, belching and bloating after LNF, but these should get better with time.

Newer operations and procedures

In the last few years, several new techniques for treating GORD have been developed.

The National Institute for Health and Care Excellence (NICE) says these procedures appear to be safe, but not much is known about their long-term effects.

These techniques include:

• Endoscopic injection of bulking agents ‐ where special filler is injected into the area between the stomach and oesophagus to make it narrower.
• Endoluminal gastroplication ‐ where folds are sown into the ring of muscles at the bottom of the oesophagus to restrict how far it can open.
• Endoscopic augmentation with hydrogel implants ‐ where implants containing special gel are placed into the area between the stomach and oesophagus to make it narrower.
• Endoscopic radiofrequency ablation ‐ where a tiny balloon is passed down to the bottom of the oesophagus and electrodes attached to it are used to heat it and make it narrower.
• Laparoscopic insertion of a magnetic bead band (LINX) ‐ where a ring of magnetic beads are implanted around the lower part of the oesophagus to strengthen it and help keep it closed when not swallowing.

Speak to your surgeon about these techniques for more information.