A variety of options are available for your patients presenting with reflux. For more information on the available interventions you can use, explore the sections below.
- Adjusting medications that are known to cause reflux and regurgitation
- Avoiding foods that aggravate reflux symptoms (e.g. spicy food, wine, etc.)
- Weight reduction
- Reducing alcohol intake
- Smoking cessation
- Reducing the size of meals
- Avoiding meals within the 2 hours before bedtime
- NICE. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. September 2014. (last accessed January 2019).
Antacids offer a cheap and convenient treatment for patients experiencing mild and intermittent symptoms of heartburn. They function differently to alginates by neutralising the acid in the stomach, providing modest, short-term improvements in reflux. These are often used as an overthe-counter medication.
Alginates function by forming a gel-like raft that sits on top of the stomach contents, acting as a physical barrier to reflux. In order for them to work effectively, alginates should be taken regularly after meals.
The strength of an alginate can differ depending on its polysaccharide content. Upon contact with calcium ions, guluronic polymers in the alginate cross-link to form the raft. Alginates with a higher concentration of guluronic polymers form stronger rafts.
- Lee KY and Mooney DJ. Prog Polyn Sci 2012;37:106–26.
- Reimer C, et al. Aliment Pharmacol Ther 2016;43:899–909.
Proton pump inhibitors
Proton pump inhibitors (PPIs) work by irreversibly binding to active proton pumps on the parietal cells, preventing the secretion of HCl.
PPIs are associated with some limited side effects. These can range from diarrhoea (common) to gastrointestinal infections and electrolyte disorders (rare).
It is important to remember that PPIs can be used in combination with certain alginates. They can be prescribed on the same day; however, their time of use differs. PPIs should be taken before meals whilst alginates should be taken afterwards.
Medications in this class function by binding to H2 receptors on parietal cells, blocking the action of histamine in the stomach. By doing so, they reduce parietal cell-mediated acid secretion.
Although they act in a similar way to PPIs (i.e. reduce acid secretion), H2-receptor antagonists are often less effective, although their use can be considered when use of PPIs is undesirable.
H2-receptor antagonists are susceptible to tachyphylaxis, meaning their prolonged use is often ineffective.
For some patients, surgery may be appropriate.