Acid reflux (GERD) results from LES dysfunction that allows stomach acid and enzymes to flow into the esophagus, causing heartburn and related symptoms. Common triggers include certain foods, alcohol, smoking, and obesity. Initial management focuses on lifestyle measures and OTC remedies - antacids and alginates for immediate relief, H2 blockers for short-term acid suppression, and PPIs for healing and long-term control under medical supervision. Prokinetics have limited use due to side effects, and surgical or device options (fundoplication, LINX) are available for refractory cases.
What is acid reflux (GERD)?
Gastroesophageal reflux disease (GERD), commonly called acid reflux or heartburn, happens when the lower esophageal sphincter (LES) does not close properly. Stomach contents, including hydrochloric acid and digestive enzymes such as pepsin, flow back into the esophagus. The acid irritates the esophageal lining and causes a burning sensation behind the breastbone or a sour taste at the back of the throat.
Common triggers and risk factors
Triggers vary by person but often include citrus fruits, tomatoes, coffee, carbonated drinks, fatty or spicy foods, chocolate, peppermint, alcohol and smoking. Being overweight increases abdominal pressure and the risk of reflux. Lying down soon after eating also makes reflux more likely; most guidelines recommend staying upright for 2-3 hours after meals and elevating the head of the bed (about 6-8 inches) if nighttime reflux is a problem.
Symptoms to watch for
Typical symptoms include heartburn, regurgitation, sore throat, hoarseness, or chronic cough. Frequent or severe symptoms warrant evaluation because chronic acid exposure can damage the esophagus (esophagitis) or lead to complications such as Barrett's esophagus.
Over-the-counter options and short-term relief
Antacids (for example, calcium carbonate or magnesium/aluminum combinations) neutralize stomach acid and relieve symptoms quickly. Side effects depend on the ingredients: magnesium can cause diarrhea, aluminum can cause constipation, and calcium can sometimes produce belching.
Alginate-based products (branded examples include Gaviscon) form a physical raft that reduces reflux into the esophagus and can be effective for immediate symptom control.
H2-receptor blockers (famotidine, cimetidine) reduce acid production and are available OTC for short-term use. Note that ranitidine products were withdrawn in many markets due to contamination concerns in 2019-2020.
Proton pump inhibitors and medical management
Proton pump inhibitors (PPIs) such as omeprazole and esomeprazole are the most effective drugs for healing esophagitis and suppressing acid long term. Because long-term use carries potential risks (nutrient deficiencies, increased infection risk, and others), patients should use PPIs at the lowest effective dose and under medical supervision.
Prokinetic agents (for example, metoclopramide) can speed gastric emptying and increase LES tone but have limited use because of side effects. Some older drugs (cisapride) were withdrawn for cardiac risks; domperidone is not widely available in the U.S.
Procedures and surgery
For people whose symptoms do not respond to medical therapy, surgical or device-based options exist. Laparoscopic fundoplication (Nissen) and magnetic sphincter augmentation (LINX) are among the procedures used to strengthen the LES.
Practical advice
Start with lifestyle steps: avoid personal trigger foods, lose weight if needed, stop smoking, limit alcohol, eat smaller meals, and avoid lying down for a few hours after eating. Use OTC antacids or alginates for occasional symptoms and seek medical evaluation for frequent or severe reflux to discuss prescription treatments or further testing.