Conservative Treatment

• According to S.J. McPhee and M.A. Papadakis in "Current Medical Diagnosis and Treatment," some foods, such as those with caffeine (coffee, tea and chocolate), may increase reflux, which causes heartburn, especially after meals or during the night. Highly acidic foods, such as oranges and tomatoes, may irritate the lower esophagus and increase symptoms of heartburn. You should eliminate these foods from your diet to reduce reflux. Food high in fat slows the emptying of the stomach so that the stomach stays full longer, so your diet should be low in fat. Milk increases acidity, so you should especially avoid milk products in the late evening. Obesity puts pressure on the stomach and the LES, increasing reflux, so weight control may also alleviate symptoms.
  
  You should avoid eating large meals and eating late in the evening to ensure the stomach is empty before you go to bed. When you lie flat, gravity allows gastric fluids to backflow, so you may need to elevate the head of your bed on 6- to 8-inch blocks and sleep with two to three pillows.
  
  

Medical Treatment

• Some drugs (anticholinergics) increase reflux, so you may need to combine those drugs with reflux treatment. According to Merck Manuals, drug therapy for reflux usually begins with over-the-counter antacids (Maalox, Mylanta, Tums), which neutralize the hydrochloric acid in the stomach. Some antacids (Gaviscon) contain alginic acid, which forms a thick liquid barrier that floats on the gastric fluids, preventing reflux. Other protective drugs include sucralfate (Carafate), which protects against acid.
  
  If symptoms persist or are severe, medications that decrease secretion of gastric acids, such as histamine-2 receptor blockers (Tagamet, Zantac, Pepcid) are necessary. If these are ineffective, then stronger medications, such as proton pump inhibitors (Prilosec, Nexium, Prevacid), which also decrease secretion of gastric acids, may relieve symptoms. In some cases, your doctor may start you with the PPIs first to control symptoms and then place you on less potent drugs, such as H2R blockers. If stomach emptying is slow, medications to increase emptying of the stomach (Reglan) may reduce reflux.
  
  

Surgical Treatment

• Hiatal Hernias
  
  Reflux is often associated with hiatal hernia, and in severe cases, surgical repair is necessary to control reflux because repeated reflux can cause Barrett's esophagus (precancerous cell changes). Most surgical repairs strengthen the LES. According to the Mayo Clinic, one common procedure is the Nissen fundoplication, in which part of the stomach is wrapped around the lower esophagus and sutured in place to tighten the LES and repair hiatal hernias. Some surgeons may use endoscopic procedures during which repair is done through a tube inserted down the esophagus. The EndoCinch procedure includes sewing the LES to tighten the sphincter. Another procedure implants a device called the Plicator at the LES to narrow the opening.