There is no cure for gastroesophageal reflux disease (GERD). Therefore, the focus of treatment is to ease symptoms and prevent damage to the esophagus and other organs.

Physicians typically recommend that patients prevent or treat mild GERD by making lifestyle changes, including:

• Avoid foods that cause reflux, such as spicy foods and fatty foods.
  
  
• Avoid eating meals too close to bedtime. Lying down makes the condition worse. Meals should be consumed at least three hours before bedtime.
  
  
• Raise the head of the bed 6 to 8 inches (15.2 to 20.3 centimeters). Elevating the head and shoulders over the stomach allows gravity to keep acid from refluxing. Propping the head up with pillows will not help reflux and may increase pressure on the stomach or esophagus.
  
  
• Avoid wearing tight clothing. This can put pressure on the stomach and worsen GERD.
  
  
• Promote salivation by chewing gum or using lozenges. This helps clear acid that has entered the esophagus.
  
  
• Eat smaller meals. This helps prevent the stomach from becoming too full, which causes reflux.
  
  
• Quit smoking.
  
  
• Avoid alcohol.
  
  
• Lose weight. Being overweight may worsen the condition.

Patients with more severe symptoms or symptoms that do not respond to lifestyle changes may be treated with medications, including:

• Antacids. They are available without a prescription and work by neutralizing stomach acid. However, antacids do not heal damage to the esophagus caused by stomach acid.
  
  
• Foaming agents. They are available without a prescription and work by covering the contents of the stomach with foam to prevent reflux. Like antacids, they do not heal damage from stomach acid.
  
  
• H2 blockers. Medications that reduce the acid levels in the stomach by blocking the chemical used to make acid. They are available over the counter and by prescription.
  
  
• Proton pump inhibitors. Medications that reduce the amount of acid in the stomach by inhibiting its production. They are more effective than H2 blockers and can relieve symptoms in almost any patient with GERD. They are available over the counter and by prescription.
  
  
• Prokinetics. Medications that strengthen the lower esophageal sphincter (LES) muscle, which helps food to pass through the digestive system more quickly. They do not affect the level of stomach acid produced.

Most cases of GERD respond well to lifestyle changes and medications. However, in cases that do not respond to other types of treatment, surgery may be performed. The standard surgical procedure performed on patients with GERD is called Nissen fundoplication. This involves wrapping the upper part of the stomach around the LES to strengthen it and prevent acid reflux. The procedure can be performed laparoscopically. A few tiny incisions are made in the abdomen and a laparoscope is inserted. The laparoscope is a thin tube with a video camera and it can be fitted with surgical instruments.

Other surgical procedures performed less frequently include Toupet fundoplication, Hill repair and Belsey Mark IV operation. These involve restructuring the LES to improve its strength and ability to prevent reflux.

In 2000, the U.S. Food and Drug Administration (FDA) approved two procedures to treat GERD with an endoscope (a thin flexible tube that is placed into the mouth and through the esophagus). The first procedure involves using a tool that resembles a miniature sewing machine. Stitches are placed in the stomach near the LES to prevent reflux.

The second procedure uses controlled radiofrequency energy to heat and burn tissues within the esophagus. It works by creating scar tissue and altering the nerves that respond to refluxed acid.

Both procedures can cause a sore throat or chest pain. Also, the long-term effectiveness of the procedures has not been evaluated.

In addition, research suggests that gastric bypass surgery may be more effective than medication alone in treating obesity and reducing related GERD symptoms.