Acid Reflux in Israel: Symptoms, Causes & Treatment | aihealz
GastroenterologymoderateICD-10 · K21.9
Acid Reflux.Care & specialists in Israel
In Israel, acid Reflux is managed by gastroenterologists. Gastroesophageal reflux disease (GERD) is a chronic condition in which stomach contents repeatedly move backward into the esophagus, producing heartburn, regurgitation, and — in some patients — atypical symptoms like chronic cough or chest pain. About 20% of US adults have weekly heartburn or regurgitation severe enough to meet GERD criteria, and another 30% experience occasional reflux.
Gastroesophageal reflux disease (ICD-10: K21; K21.0 with esophagitis, K21.9 without esophagitis) is defined by the Montreal Consensus as the condition that develops when reflux of stomach contents causes troublesome symptoms or complications. Reflux occurs in everyone briefly; GERD is its pathologic form. The dominant mechanism is transient lower esophageal sphincter relaxation (TLESR) — brief, non-swallow-related openings of the sphincter that allow gastric content into the esophagus. A weak resting sphincter tone, hiatal hernia, delayed gastric emptying, and impaired esophageal clearance amplify exposure.
key facts
Prevalence
~20% of US adults (weekly heartburn or regurgitation) — ACG 2022 estimate
Demographics
Men and women affected roughly equally; Barrett's esophagus and esophageal adenocarcinoma skew male
Avg. age
Peak prevalence in adults 40-60; rising in young adults with obesity
Global cases
~1.03 billion adults worldwide (GBD 2021); highest rates in North America and Europe
Specialist
Gastroenterology
ICD-10
K21.9
§ 02
How you might notice it
The key symptoms of Acid Reflux are: Burning sensation behind the breastbone (heartburn) that rises from the upper abdomen, classically 30-60 minutes after meals and worse when lying flat or bending over., Regurgitation of acidic or bitter fluid (and sometimes food particles) into the throat or mouth, often during sleep or when bending forward., Chest pain that can mimic cardiac angina — burning, retrosternal, sometimes pressure-like; cardiac causes must be excluded first in adults with risk factors., Acid-induced dysphagia (difficulty swallowing) developing gradually; sudden or progressive solid-food dysphagia raises concern for peptic stricture or malignancy., Odynophagia (painful swallowing), especially with severe erosive esophagitis, eosinophilic esophagitis, or pill esophagitis., Chronic dry cough that worsens at night or after meals; reflux is one of the top three causes of chronic cough alongside post-nasal drip and asthma., Hoarseness or voice changes, especially in the morning, from laryngeal acid exposure (laryngopharyngeal reflux)..
01Burning sensation behind the breastbone (heartburn) that rises from the upper abdomen, classically 30-60 minutes after meals and worse when lying flat or bending over.
02Regurgitation of acidic or bitter fluid (and sometimes food particles) into the throat or mouth, often during sleep or when bending forward.
03Chest pain that can mimic cardiac angina — burning, retrosternal, sometimes pressure-like; cardiac causes must be excluded first in adults with risk factors.
04Acid-induced dysphagia (difficulty swallowing) developing gradually; sudden or progressive solid-food dysphagia raises concern for peptic stricture or malignancy.
§ 03
How it’s diagnosed
diagnosis
GERD is most often diagnosed clinically — typical heartburn and regurgitation, no alarm features, response to a 4-8 week PPI trial — and empiric PPI therapy is itself a reasonable first diagnostic step in low-risk adults. The 2022 ACG guideline endorses this practical approach but specifies endoscopy for patients with alarm features (dysphagia, odynophagia, anemia, weight loss, GI bleeding, vomiting) or who fail empiric PPI. The 2020 Lyon Consensus formalized objective diagnosis using a combination of endoscopy, 24-hour pH or pH-impedance monitoring, and high-resolution esophageal manometry. Conclusive evidence of GERD includes LA grade C/D erosive esophagitis, biopsy-proven long-segment Barrett's esophagus, peptic stricture, or pH-metry acid exposure time greater than 6% on the distal probe. Endoscopy is also indicated for screening Barrett's in patients with chronic GERD plus three or more risk factors (male, age >50, white race, obesity, smoking, family history). High-resolution manometry rules out achalasia and major motility disorders before anti-reflux surgery. Empirical PPI failure (typically ≥8 weeks of double-dose PPI without adequate symptom control) is itself a diagnostic milestone — these patients need pH-impedance monitoring on or off therapy to confirm reflux is still the driver versus reflux hypersensitivity or functional heartburn. Atypical presentations (chronic cough, hoarseness, asthma) require multidisciplinary evaluation, often including ENT, pulmonary, and pH-impedance monitoring.
Key tests
01
Empirical PPI trial (8 weeks of standard or double-dose PPI)Standard first-line diagnostic and therapeutic approach in patients with typical symptoms and no alarm features. Resolution of symptoms supports GERD; failure prompts further workup.
02
Upper endoscopy (esophagogastroduodenoscopy, EGD)Identifies erosive esophagitis (graded by LA system), Barrett's esophagus, stricture, hiatal hernia, eosinophilic esophagitis, peptic ulcer, and esophageal cancer. Required in patients with alarm features.
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Treatment & cost
medical treatments
✓Omeprazole 20 mg, esomeprazole 20-40 mg, pantoprazole 40 mg, or rabeprazole 20 mg once daily (PPI)
✓Vonoprazan 20 mg once daily (potassium-competitive acid blocker, PCAB)
Laparoscopic Nissen fundoplication (360° wrap)Long-term symptom control in 80-90% at 5 years; ~10-15% require resumption of PPI within 10 years. Gas-bloat syndrome and dysphagia are common early side effects.
Laparoscopic Toupet fundoplication (270° partial wrap)Comparable symptom control to Nissen in 5-year data (LOTUS trial); fewer side effects.
LINX magnetic sphincter augmentationSymptom control in ~85% at 5 years; dysphagia in ~5% requires balloon dilation or device removal.
Transoral incisionless fundoplication (TIF / EsophyX)Symptom improvement in ~60-70% at 5 years; 25-30% return to PPI.
The dominant mechanism. The LES briefly relaxes outside of swallowing, allowing reflux. TLESRs occur in everyone but are more frequent and prolonged in GERD. Vagally mediated and triggered by gastric distension.
Hypotensive lower esophageal sphincter
A persistently low resting LES pressure (<10 mmHg) allows free reflux even without TLESRs. More common in long-standing or severe GERD and after smoking, alcohol, fatty meals, or pregnancy.
Hiatal hernia
Displacement of the gastroesophageal junction above the diaphragm separates the crural diaphragm from the LES, removing an important anti-reflux barrier. Present in 50-80% of erosive GERD and a major factor in volume reflux during sleep.
Obesity and increased intra-abdominal pressure
Central adiposity raises intragastric pressure and widens the gastroesophageal junction. Each 5-unit increase in BMI raises GERD symptom risk by ~30%. Pregnancy produces similar physiologic changes in the third trimester.
Delayed gastric emptying
Slow gastric emptying — diabetic gastroparesis, narcotic use, post-vagotomy states, scleroderma — prolongs the period when reflux can occur and increases volume of refluxate.
Dietary and lifestyle triggers
Fatty meals slow gastric emptying; alcohol, coffee, chocolate, peppermint, and tomato- or citrus-based foods either reduce LES tone or directly irritate the mucosa. Late or large meals before lying down are a common trigger.
Medications that lower LES pressure
Calcium channel blockers, nitrates, anticholinergics, benzodiazepines, beta-2 agonists, and progesterone all reduce LES tone and worsen reflux. NSAIDs and bisphosphonates damage mucosa directly.
§ 06
Living with it
01Maintain a body mass index in the normal range; weight loss of 10% measurably reduces symptoms in overweight adults.
02Avoid eating within 3 hours of lying down; finish dinner at least 3 hours before bed.
03Sleep with the head of the bed elevated 6-8 inches if you have nocturnal symptoms (use blocks under the bed frame, not extra pillows under the head).
04Identify and avoid personal trigger foods — common offenders include fatty meals, chocolate, peppermint, coffee, alcohol, citrus, tomato-based foods, and carbonated drinks.
05Stop smoking — tobacco lowers LES tone and reduces salivary clearance of acid.
06Limit alcohol to no more than one drink per day for women and two for men; less if it triggers symptoms.
07Review medications with your clinician — calcium channel blockers, nitrates, anticholinergics, and bisphosphonates can worsen reflux or cause esophagitis.
recommended foods
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When to seek help
why see a gastroenterology
Refer to gastroenterology for patients with alarm features (dysphagia, odynophagia, anemia, weight loss, GI bleeding, vomiting), failure of 8 weeks of optimized PPI, suspected Barrett's esophagus, chronic cough or asthma where reflux is suspected, refractory symptoms requiring pH-impedance or manometry, and any consideration of anti-reflux surgery. Patients with new heartburn at age 50 or older, or with chronic symptoms plus three or more Barrett's risk factors, should also be evaluated.
01Erosive esophagitis (LA grades A-D) — visible mucosal breaks; severe forms can bleed or progress to stricture. Detect by endoscopy in patients with persistent symptoms.
02Peptic stricture — fibrotic narrowing of the distal esophagus causing solid-food dysphagia. Treated with endoscopic balloon dilation plus ongoing PPI.
03Barrett's esophagus — specialized intestinal metaplasia in 5-10% of chronic GERD. Carries 0.1-0.3%/year risk of esophageal adenocarcinoma; requires surveillance.
04Esophageal adenocarcinoma — rare but rising. Risk factors include long-standing GERD, Barrett's, male sex, obesity, smoking. Early detection through surveillance dramatically improves survival.
05Aspiration pneumonia and asthma exacerbation — particularly with nocturnal regurgitation. Treat acid suppression aggressively in patients with refractory asthma or recurrent pneumonia.
Non-erosive reflux disease (NERD)Typical symptoms with normal endoscopy but objective evidence of reflux on pH-metry. Accounts for roughly 60-70% of GERD presentations. Responds less reliably to PPIs than erosive disease.
Erosive esophagitis (LA grades A-D)Visible mucosal breaks at endoscopy. LA-A and LA-B are mild and often resolve with 8 weeks of PPI; LA-C and LA-D require longer healing courses and surveillance for Barrett's.
Reflux hypersensitivityTypical symptoms with normal endoscopy and normal acid exposure but positive symptom-reflux association on pH-impedance. Often responds to neuromodulators (low-dose TCA) plus PPI.
Functional heartburnHeartburn symptoms with normal endoscopy, normal pH-metry, and no symptom-reflux correlation. Treated as a functional GI disorder; PPI response is typically poor.
Laryngopharyngeal reflux (LPR, 'silent reflux')Predominantly extra-esophageal symptoms (chronic cough, hoarseness, throat clearing, globus, postnasal drip) without typical heartburn. Diagnosis is harder; PPI response is variable and antireflux surgery less consistently effective.
Barrett's esophagusSpecialized intestinal metaplasia (presence of goblet cells) replacing distal squamous epithelium. Prevalence ~5-10% in long-standing GERD. Carries 0.1-0.3% per-year risk of esophageal adenocarcinoma; requires endoscopic surveillance.
Living with Acid Reflux
Timeline
Heartburn typically begins to improve within 2-3 days of starting a PPI and reaches steady-state effect by 4-7 days. LA grade A-B esophagitis heals in 4-8 weeks; LA grade C-D requires 8-12 weeks. After successful 8-week treatment, attempt step-down — many patients maintain on intermittent or on-demand PPI. After laparoscopic anti-reflux surgery, expect 4-6 weeks of soft-diet recovery; dysphagia from a tight wrap usually resolves within 8-12 weeks.
Lifestyle
01Eat slowly, in smaller portions, and stop before feeling overfull
02Wear loose-fitting clothing around the waist; avoid tight belts and shapewear
03Chew gum (sugar-free, non-mint) after meals to stimulate salivary clearance
04Sleep on the left side rather than the right; right-side sleeping increases reflux events
05Track symptoms in a 2-week food and behavior log when starting treatment to identify personal triggers
06Discuss reflux during pregnancy with your obstetrician — antacids, sucralfate, and many PPIs are safe in pregnancy
07If you take PPIs long term, ensure adequate calcium, vitamin D, magnesium, and B12 from diet or supplementation as appropriate
Daily management
01
Complementary approaches
Alginate-antacid combination (Gaviscon Advance)Forms a physical raft over gastric contents that reduces postprandial reflux. Well-established adjunct to PPI in randomized trials.
Melatonin 3-6 mg at bedtimeSmall randomized trials suggest improvement in GERD symptoms versus placebo and equivalence with low-dose PPI for mild disease; mechanism includes LES tone modulation and antioxidant effect.
Choosing a doctor
Most GERD is treatable in primary care. For complex or refractory cases, look for a gastroenterologist with experience in pH-impedance monitoring, high-resolution manometry, advanced endoscopy (Barrett's surveillance with ablation), and a working relationship with foregut surgery. Bariatric and minimally invasive foregut surgery centers offer the broadest set of options for patients with concomitant obesity or anatomic abnormalities.
What is the difference between heartburn and GERD?▾▴
Heartburn is the symptom — a burning sensation behind the breastbone, often after meals or when lying down. GERD is the chronic disease state where reflux happens often enough or strongly enough to cause troublesome symptoms or complications. Occasional heartburn does not equal GERD; weekly symptoms for more than a few weeks usually does.
What does GERD feel like?▾▴
Typical GERD feels like a burning, hot, or sour sensation rising from the upper abdomen behind the breastbone, often 30-60 minutes after meals or when lying down. Many patients also taste acidic or bitter fluid in the back of the throat. Atypical presentations include chronic dry cough, hoarseness, and a lump-in-throat sensation.
How is GERD diagnosed?▾▴
Most cases are diagnosed clinically by typical symptoms and a 4-8 week trial of a proton pump inhibitor. Patients with alarm features (trouble swallowing, weight loss, bleeding, anemia) or PPI failure should have an upper endoscopy. Ambulatory pH or pH-impedance monitoring and high-resolution manometry are used in refractory cases or before surgery.
Are PPIs safe long-term?▾▴
PPIs are generally safe with a well-characterized side effect profile. Long-term concerns include small absolute increases in C. difficile infection, community-acquired pneumonia, fractures with prolonged high-dose use, and modest reductions in serum magnesium and vitamin B12. For most patients with valid indications the benefits outweigh these risks; use the lowest effective dose.
Can GERD cause chest pain?▾▴
Yes. Reflux can cause retrosternal pain that mimics cardiac angina. New chest pain in any adult should be evaluated for cardiac causes first. Once cardiac disease is excluded, reflux is one of the most common causes of non-cardiac chest pain and responds to PPI in 60-70% of cases.
What foods cause acid reflux?▾▴
Common triggers include fatty fried foods, chocolate, peppermint, coffee, alcohol, citrus juices, tomato-based foods, carbonated drinks, and very spicy foods. Triggers vary by person — a brief food and symptom diary often identifies your specific triggers more reliably than a generic list.
Can losing weight help acid reflux?▾▴
Yes, substantially. Each unit of BMI increase raises GERD risk by roughly 5-10%. Observational data from large cohorts show that a 10% reduction in body weight reduces heartburn frequency by 30-40% and often allows step-down of PPI dose. Bariatric surgery in BMI ≥35 resolves GERD in 85-95% of patients.
What is silent reflux?▾▴
Silent reflux, or laryngopharyngeal reflux (LPR), is reflux that reaches the larynx and throat without classic heartburn. Symptoms include chronic cough, hoarseness, throat clearing, lump-in-throat sensation, and post-nasal drip. Diagnosis is harder than typical GERD, and response to acid suppression is more variable.
Can GERD cause cancer?▾▴
Long-standing GERD is the principal risk factor for esophageal adenocarcinoma, but most people with GERD never develop cancer. The intermediate step is Barrett's esophagus, present in 5-10% of chronic GERD and progressing to cancer at roughly 0.1-0.3% per year. Surveillance endoscopy detects neoplastic changes early.
Can babies and children get GERD?▾▴
Yes. Infants frequently regurgitate (physiologic GER) without GERD. Symptoms warranting evaluation in babies include poor weight gain, feeding refusal, recurrent pneumonia, and back-arching during feeds. In older children, classic symptoms resemble adults and respond to lifestyle modification plus PPI or H2 blocker if needed.
Is heartburn during pregnancy normal?▾▴
Yes. About half of all pregnancies are complicated by heartburn, most often in the third trimester, due to progesterone-mediated lower esophageal sphincter relaxation and mechanical pressure from the uterus. It usually resolves after delivery. Antacids, sucralfate, H2 blockers, and most PPIs (except omeprazole as first choice) are considered safe.
When should I have an endoscopy for GERD?▾▴
Endoscopy is recommended for any patient with alarm features (dysphagia, odynophagia, anemia, weight loss, GI bleeding, persistent vomiting), failure of 8 weeks of PPI, or for screening Barrett's in patients with chronic GERD plus three or more risk factors (age over 50, male sex, white race, obesity, smoking, family history).
Does sleeping position affect reflux?▾▴
Yes. Sleeping flat increases nocturnal reflux. Elevating the head of the bed by 6-8 inches (using blocks under the bed frame, not extra pillows) reduces nocturnal acid exposure by roughly 30%. Sleeping on the left side reduces reflux compared with right-side sleeping in pH-metry studies.
Is GERD curable with surgery?▾▴
Anti-reflux surgery (Nissen fundoplication, Toupet partial wrap, LINX magnetic ring, TIF) provides durable symptom control in 80-90% of carefully selected patients at 5 years, but 10-15% return to PPI by 10 years. Bariatric surgery (gastric bypass) is the most effective option in obese patients, with 85-95% symptom resolution.
What is vonoprazan?▾▴
Vonoprazan is a potassium-competitive acid blocker (PCAB) approved by the FDA in 2022 for erosive esophagitis and in 2023 for non-erosive GERD. It produces faster and more sustained acid suppression than PPIs, is taken once daily independent of meals, and shows superior healing rates in severe erosive disease.
Can stress cause acid reflux?▾▴
Stress does not cause GERD directly, but it amplifies perception of reflux symptoms and can trigger behavior changes (large late meals, alcohol, poor sleep) that worsen reflux. Cognitive-behavioral therapy and mindfulness reduce symptom severity in reflux hypersensitivity and functional heartburn.
Why does my reflux get worse at night?▾▴
Reclining loses the protective effect of gravity, the upper esophageal sphincter relaxes, and salivary clearance falls during sleep. Late or large meals before bedtime are the dominant modifiable factor. Sleeping with the head of the bed elevated and finishing dinner 3 hours before bed reduces nocturnal symptoms by 30-50%.
Can probiotics help GERD?▾▴
Evidence for probiotics in GERD is limited and inconsistent. Some small trials suggest a modest benefit on bloating and regurgitation with specific strains. Probiotics are not recommended as a primary or sole treatment, but they are generally safe to try alongside standard therapy if symptoms include bloating or distension.
What is Barrett's esophagus?▾▴
Barrett's esophagus is a precancerous change in the lining of the lower esophagus, in which normal squamous epithelium is replaced by intestinal-type columnar cells with goblet cells. It develops in 5-10% of chronic GERD patients and raises esophageal adenocarcinoma risk to 0.1-0.3% per year. Surveillance endoscopy is recommended.
Can I take PPIs forever?▾▴
PPIs can be taken long-term when there is a valid indication — Barrett's esophagus, severe erosive disease, persistent symptoms despite step-down. Use the lowest effective dose, monitor magnesium and B12 periodically, and consider bone density on prolonged high-dose therapy. For mild intermittent GERD, on-demand or step-down dosing is preferred.
Does drinking water help reflux?▾▴
Drinking a small glass of water during or after a reflux episode can wash acid back into the stomach and provide quick relief. It does not prevent reflux. Avoid large volumes of water with meals, which expand the stomach and may provoke more transient relaxations of the lower esophageal sphincter.
05Odynophagia (painful swallowing), especially with severe erosive esophagitis, eosinophilic esophagitis, or pill esophagitis.
06Chronic dry cough that worsens at night or after meals; reflux is one of the top three causes of chronic cough alongside post-nasal drip and asthma.
07Hoarseness or voice changes, especially in the morning, from laryngeal acid exposure (laryngopharyngeal reflux).
08Sensation of a lump in the throat (globus) and excessive throat clearing.
09Worsening dental erosion on the lingual surfaces of upper molars — often the first visible long-term sign noted by dentists.
10Disturbed sleep with nocturnal awakening from heartburn or coughing.
early warning signs
•Heartburn occurring more than twice a week for more than 4 weeks
•New regurgitation while lying flat that requires an extra pillow at night
•Heartburn that wakes you from sleep
•Throat clearing or hoarseness on most mornings
•Heartburn appearing for the first time during pregnancy or after a 5-10 kg weight gain
● emergency signs
•Sudden chest pain with radiation to the arm, jaw, or back, sweating, or shortness of breath — rule out myocardial infarction before assuming reflux
•Hematemesis (vomiting blood or coffee-ground material) or melena (black tarry stools) — possible upper GI bleed; emergency department immediately
•Sudden progressive dysphagia, especially with weight loss — concern for peptic stricture or esophageal cancer; urgent endoscopy
•Inability to swallow saliva (food bolus impaction) — emergency endoscopy
•Unintentional weight loss of more than 5% over 6 months in a patient with heartburn — alarm feature warranting urgent workup
03
Ambulatory 24-hour pH monitoring (or pH-impedance) — off or on PPIQuantifies acid exposure time and correlates symptoms with reflux events. Acid exposure time >6% is conclusive. pH-impedance also detects non-acid reflux.
04
High-resolution esophageal manometryRequired before anti-reflux surgery to rule out achalasia, ineffective esophageal motility, or aperistalsis (scleroderma). Measures LES pressure, peristaltic integrity, and esophagogastric junction morphology.
05
Barium swallow / esophagramAnatomic study used when stricture, large hiatal hernia, or paraesophageal hernia is suspected. Useful for surgical planning but less sensitive than endoscopy for mucosal disease.
06
Gastric emptying study (4-hour solid-meal)Detects gastroparesis in patients with persistent symptoms despite acid suppression, especially in diabetics or those on opioids.
Outlook
GERD is a chronic relapsing condition for most patients; symptoms recur in 60-80% within 6 months of stopping a PPI. Long-term outlook is excellent when symptoms are controlled — most patients live normal lives on intermittent or daily acid suppression, with no shortening of life expectancy. Erosive esophagitis heals in >90% with 8 weeks of PPI; severe (LA C/D) disease heals in ~75% by 8 weeks and 90% by 12 weeks. The principal long-term complication is Barrett's esophagus, which develops in 5-10% of chronic GERD and progresses to esophageal adenocarcinoma at 0.1-0.3% per year. Surveillance endoscopy at 3-5 year intervals (more often with low-grade dysplasia, more aggressive endoscopic ablation for high-grade dysplasia) detects neoplastic progression early. Anti-reflux surgery offers durable control in carefully selected patients but carries a 10-15% rate of long-term PPI resumption and a 5-10% rate of side effects like dysphagia or gas-bloat. Refractory GERD in obese patients has the most favorable outcome with bariatric surgery, with 85-95% symptom resolution and substantial added cardiometabolic benefit.
Impaired esophageal acid clearance
Reduced peristalsis (ineffective esophageal motility, scleroderma) and decreased salivary bicarbonate (smoking, anticholinergics, Sjögren's) prolong contact time between refluxate and mucosa.
risk factors
Obesity (BMI ≥30)modifiable
Strongest modifiable risk factor. Each 5-unit BMI increase raises GERD risk by ~30% and erosive disease risk by ~50%. Weight loss of 10% measurably reduces symptoms and PPI dose.
Hiatal hernianon-modifiable
Present in 50-80% of erosive GERD. Larger hernias (>3 cm) correlate with higher acid exposure and worse response to PPIs alone.
Pregnancynon-modifiable
Progesterone-mediated LES relaxation plus mechanical pressure from the gravid uterus causes heartburn in ~50% of pregnancies, peaking in the third trimester. Usually resolves postpartum.
Smokingmodifiable
Smoking lowers LES tone, reduces salivary bicarbonate clearance, and slows esophageal motility; doubles GERD severity in heavy smokers.
Alcohol consumptionmodifiable
Reduces LES pressure and directly irritates mucosa. Dose-related effect; binge drinking is the most reflux-provoking pattern.
Large or late evening mealsmodifiable
Eating within 3 hours of bedtime triples nocturnal reflux events; large meal volumes provoke more TLESRs.
Diabetes mellitus with gastroparesismodifiable
Delayed gastric emptying in 20-40% of long-standing diabetics doubles GERD prevalence and complicates treatment.
Certain medications (CCBs, nitrates, anticholinergics, benzodiazepines, beta-2 agonists)modifiable
Each lowers LES tone or impairs esophageal motility; review at every visit when GERD is refractory.
Lean protein, vegetables (especially leafy greens), whole grains, and legumes
•Low-fat dairy and high-fiber foods, which empty more quickly and produce fewer reflux events
•Ginger root or non-caffeinated herbal teas for symptom relief
•Water with meals rather than carbonated or alcoholic beverages
•Smaller frequent meals rather than 1-2 large meals if you have delayed gastric emptying
foods to avoid
•High-fat fried foods, heavy cream sauces, and fatty cuts of meat — slow gastric emptying and trigger TLESRs
•Chocolate, peppermint, and spearmint — all lower LES tone
•Coffee (regular and decaf), tea, and other caffeinated drinks if they trigger symptoms
•Alcohol, especially red wine and spirits, which lower LES tone and irritate the mucosa
•Citrus juices, tomato-based sauces, and very spicy foods if they reliably trigger symptoms
06Laryngitis, chronic cough, dental erosion — extra-esophageal complications of long-standing reflux. Multidisciplinary management with ENT, dentistry, and pulmonology improves outcomes.
choosing the right hospital
01Gastroenterology service with on-site upper endoscopy, pH-impedance, and high-resolution manometry
02Advanced endoscopy program with Barrett's surveillance, radiofrequency ablation, and endoscopic submucosal dissection
03Foregut surgical team with laparoscopic, robotic, and bariatric capability
04Multidisciplinary refractory-GERD clinic (GI, surgery, ENT, pulmonology where indicated)
05Diagnostic imaging including fluoroscopy and gastric-emptying scintigraphy
Asthma
Asthma and GERD both cause cough and can trigger each other; asthma adds wheeze and reversible airflow obstruction on spirometry. About 30-40% of asthma patients have GERD, and treating reflux improves asthma in selected cases.
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Take PPI 30-60 minutes before the first meal of the day; the same time each day improves adherence
02Use on-demand antacid or alginate for breakthrough symptoms — they work within minutes
03Keep dinner small and finish at least 3 hours before bed
04Elevate head of bed by 6-8 inches at the frame for nocturnal symptoms
05Reassess at 8 weeks — if symptoms are controlled, attempt step-down to lowest effective dose
06If symptoms persist on PPI, return to gastroenterology rather than self-escalating
07Track food, weight, and symptoms during the first 8 weeks to identify personal triggers
Exercise
Regular moderate exercise reduces GERD risk and supports weight loss. Avoid high-impact exercise immediately after eating and choose activities with less intra-abdominal pressure (walking, swimming, cycling) over heavy weightlifting or inverted positions in yoga. Wait 2-3 hours after meals before vigorous exercise.