–by Dr. Peng E. Wang
Introduction
What does acid reflux feel like? Symptoms such as heartburn, sore throat, cough, bad breath, and hoarseness are associated with acid reflux. Acid reflux is nearly synonymous with GERD (gastroesophageal reflux disease) nowadays, a phrase commonly used in Western culture, and up to 20% of adults have GERD symptoms weekly (ACG). What are some of the acid reflux remedies, including both over-the-counter and prescribed acid reflux medicines? How about home remedies for acid reflux? This article discusses the best way of approaching this health issue from practice experience.
Acid Reflux
GERD is the prolonged reflux of stomach acid into the esophagus caused by various reasons. Although it’s interchangeably used with acid reflux, both terms do not clarify the symptoms that can be associated with it.
Related article: 5 Symptoms of Acid Reflux
1. Lifestyle adjustments
Most of the time acid reflux is short-lived and episodic, so if there are lifestyle changes you can make to minimize the need for medications, that would be the best approach. No medication is usually the best medicine. With the onset of acid reflux, ask these questions
- Did you have a late meal within two hours of bedtime?
- Did you have alcohol within four hours of bedtime?
- Did you have caffeine within four hours of bedtime?
- Did you have a stimulating meal with excessive spices?
- Did you have sour foods in excess? Including soda?
- Did you start a new diet regimen?
- Did you start a new medication?
- Did you fast for more than four hours?
Looking like common sense, but the last question may surprise you. Contrary to common belief, intermittent fasting is not a great way to lose weight, and it can cause acid reflux. Humans are not designed to fast for more than four hours, and it’s better to have regular intakes with smaller portions to maintain or lose weight. Fasting may get your weight down quickly; however, it’s not a lifestyle you maintain. Other lifestyle adjustments you have probably figured out based on the questions above. Do not eat within three hours of bedtime is best, and keep alcohol and caffeine four hours away from bedtime when you will be supine (lying down).
2. Histamine blocker (antihistamine type 2)
This subclass of antacids works with the histamine receptor type 2 to reduce acid production. This class of indirect cough medication reduces acid reflux and thus cough (“tickle in the throat”).
Over the counter
- Pepcid, the active ingredient is famotidine, has a fast onset in 1 hour, lasts 10 hours, and can be taken with food
- Zantac, whose active ingredient is ranitidine, was taken off the market due to cancer concerns
Prescription
- Pepcid liquid, the active ingredient is famotidine, 40mg, more effective and easier absorption
Type 2 antihistamines reduce acid production in the stomach, by reducing gastric parietal cells secretions via the histamine type 2 receptors.
Histamine receptors are not just in your respiratory tract. Commonly, healthcare consumers associate antihistamines with allergies, including Zyrtec, Claritin, Allegra, and Xyzal. Histamine receptors are also in your stomach, stimulating gastric parietal cells that increase acid production. This mechanism is protective, such as controlling harmful bacteria and aiding food digestion. However, a balance of stimulating these cells is needed to prevent the onset of acid reflux, ulcers, and indigestion symptoms. When you overstimulate these cells with drastic lifestyles acid reflux symptoms are common.
3. Proton Pump Inhibitors (PPI)
This subclass of antacids provides the ultimate acid reduction, but it carries more long-term effects and must be taken on an empty stomach. If you tried the antacids noted above in “antihistamines type 2″ and it did not help, you can try these medications. However, these types of antacids (PPI) must be taken on an empty stomach.
Over the counter
- Prilosec OTC, active ingredient is omeprazole, widely available over the counter as 20mg
- Nexium OTC, active ingredient is esomeprazole, available over the counter as 20mg
- Prevacid, the active ingredient is lansoprazole, widely available over the counter
Prescription
- Prilosec, active ingredient is omeprazole, 40mg
- Nexium, active ingredient is esomeprazole, 40mg, marginally more effective than Prilosec
- Protonix, the active ingredient is pantoprazole, has less interactions with other meds, effective
If you have persistent acid reflux despite lifestyle changes and using antihistamines (Pepcid), it would be reasonable to set an eight-week-long trial of using a PPI medication. However, this should raise the suspicion of anatomical and pathological changes in your stomach and esophagus. While you feel the symptoms are perfectly controlled, consider a diagnostic evaluation with a GI specialist (gastroenterologist).
4. Home remedies
Not all treatments need to entail medication, some of the home remedies you can also try to alleviate acid reflux symptoms including
- Did you try elevating the head of the bed by 30 degrees using a folded blanket under the mattress?
- Did you try to eat more than four hours apart from lying down?
- Did you try to keep alcohol and caffeine more than four apart from bedtime?
- Did you snack between meals so you are not fasting for more than four hours?
- Did you try to eat smaller meals but more frequent intakes?
- Did you stick with a GERD diet?
Over-the-counter remedies
- Mylanta, the active ingredients are calcium carbonate, magnesium hydroxide
- Tums, the active ingredient is calcium carbonate
Natural remedies
- Apple cider vinegar?
- Ginger?
- Gingerale?
- Milk?
- High-fiber foods (bananas)
- Alkaline foods (nuts)
You can try lifestyle modifications first, and you can also try Tums or Mylanta. However, keep in mind that too much Tums or Mylanta can cause dehydration and it can cause kidney damage. Most of the natural remedies listed here have question marks because these are anecdotal reports from people who have tried these and found them helpful, so it’s subjective, no studies to correlate proven mechanisms.
5. Upper scope (EGD)
No treatment is complete with only therapeutics while ignoring diagnostics to find the underlying reasons; particularly if you have persistent symptoms. The benefits vs. risk ratio of blindly using medications long-term is not justified. With persistent symptoms despite treatments suggested in this article, ask these questions
- Do your symptoms recur within 1-2 days after you stop the medication?
- Do your symptoms still occur while taking a daily antacid?
- Did you try both Pepcid and Prilosec (or equivalents)?
- Did you try to treat for eight weeks with medications?
- Did you stay consistent with a GERD diet?
- If all else has failed, have you contacted your doctor to consider an upper scope (EGD)
It’s becoming a common trend and nearly acceptable to take a daily antacid, and many healthcare consumers are asking for the medications to be prescribed to stay symptom-free. While it’s reasonable to treat acid reflux so you can function, you should minimize medications if possible because they all carry side effects. An upper scope can provide some insights or even a potential fix (Nissen) for an anatomical defect (hiatal hernia).
Potential causes of acid reflux
| Acute (< 3 months) | Chronic (>3 months) |
| Indigestion -viral infection -food poisoning Changes in eating habits -FASTING >4 hours -Large meals before bed -Stimulating meals (spicy, sour) -Caffeine -Alcohol -Pregnancy Allergies and drainage | Gastroesophageal reflux (GERD) –Hiatal hernia (sliding of the stomach above the diaphragm) –Barrett’s Esophagus (precancerous) –Sleep apnea (CPAP use ) –Radiation esophagitis -weak sphincter/muscle (LES) due to –>Smoking, alcohol, caffeine, obesity, medications Blockages, loosening of esophagus –Stricture (tightening) -esophageal mass (tumor) –Schatski’s Ring (horizontal web) –Zanker’s Diverticulum (outpouching of esophagus) Ulcerations (Peptic Ulcer Disease) -Infectious due to Helicobacter pylori -Medications such as NSAID (ibuprofen) |
Conclusion
Acid reflux treatment is becoming a trend in Western culture, and much of it is due to lifestyle changes. More availability of stimulating foods, thus larger meals, technology providing screentime to keep you up for late snacks, and consumption of alcohol and caffeine in endless forms. You should be aware that all pharmaceutical treatments carry long-term side effects. While they can provide symptom relief, they rarely optimize your health. You should focus on healthier lifestyles and minimize the medications. Also, keep in mind that this article only addressed the non-smoker population; smoking is another major contributing factor to GERD and persisting symptoms.
Bonus: Decongestants, why you should avoid it
Can decongestants make you have more acid reflux? Yes. The mechanism is more open airway by compressing the arteries lining the airway, thus allowing more space for drainage and more stomach upsets. Decongestants also cause rebound congestion, with elevated heart rate and blood pressure to a dangerous level. The difference between a vein and an artery is the amount of smooth muscle they are made of. Arteries have three layers of smooth muscle, and veins only have one. Veins are more elastic and compliant. Arteries are not very compressible. If you forcibly squeeze arteries by using decongestants, rebound congestion ensues. Bottles of nasal decongestants, such as Afrin (oxymetazoline), and others like phenylephrine in cold remedies, it’s best to avoid it.
Related article: 5 Acid Reflux Symptoms