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Gastroesophageal reflux disease (GERD) represents a major medical and financial burden for countries and health systems. Worldwide, cases have risen from 441 million to 784 million in the last three decades, generating not only an incredible cost in terms of doctor’s visits, diagnostic tests, and treatments but also the explosion of a million-dollar industry of over-the-counter drugs to treat its symptoms.

Latin America and Central America have some of the highest rates of GERD in the world, with more cases in women.

In addition to its pervasiveness, new studies are tackling questions about antacids that treat the most common symptom of GERD, heartburn. For many scientists, many of these questions still lack clear answers. For example, how safe are these medications? And who should use them?

Proton pump inhibitors (PPIs) are primarily indicated to control GERD, eradicate Helicobacter pylori (in combination with antibiotics), prevent NSAID-induced gastrointestinal hemorrhage, and treat peptic ulcers. The most commonly used PPIs are:

• Omeprazole (Prilosec), available over-the-counter (without a prescription)
• Esomeprazole (Nexium), available over-the-counter and with a prescription (depending on the dose)
• Lansoprazole (Prevacid), available over-the-counter and with a prescription (depending on the dose)

Researchers say that there is widespread overprescribing of PPIs in terms of indication and duration. Despite its favorable short-term safety profile, there are observational associations of adverse effects with long-term PPI use, including:

• Poor nutrient absorption
• Enteric infections
  
• Cardiovascular events
  

Since PPIs are widely used, their long-term safety profile is clinically relevant.

Acid suppression is the backbone for treating heartburn and other reflux symptoms. The World Gastroenterology Organization has developed guidelines for community-based treatment of common gastrointestinal symptoms. They recommend antacids, alginates, and histamine H2 receptor antagonists (H2RA) as over-the-counter treatment options for infrequent, mild, or moderate heartburn symptoms.

Antacids provide quick, temporary, short-term relief for heartburn. But experts say that they are used with little—or no—medical oversight.

An analysis by Cleveland Clinic stresses that for most patients, the first step to treat GERD symptoms should be lifestyle changes rather than a pharmacological approach. The article indicates some behavioral habits that can be changed to prevent GERD:

Diet. Weight loss can help reduce and eliminate GERD symptoms. A prospective cohort study found that 81% of patients with obesity who completed a structured weight loss program had reduction in GERD symptoms, and 65% had complete resolution of symptoms. Another large retrospective study with over 15,000 patients demonstrated an association between decrease in body mass index (BMI) and improvement of GERD symptoms.

Food. Many studies have focused on finding out which foods exacerbate reflux symptoms. Historically, patients are advised to avoid chocolate, carbonated beverages, spicy foods, fatty foods, citrus fruits, mint, coffee, alcohol, and large meals.

Tobacco. Not smoking—or quitting—helps reduce GERD symptoms or prevent them from developing. A study found that current smokers were 23% more likely to have GERD than nonsmokers.

Sleeping position. Studies have found it helpful to elevate the head of the bed, sleep on your left side, and, for those people with nighttime GERD symptoms, avoid eating 2-3 hours before bedtime. A positional sleep therapy device has been shown to reduce acid exposure times and improve nighttime reflux symptoms. This device helps maintain the person in the correct position, sleeping on the left side, a strategy that appears to have been shown to be effective.

Mental health. A study in 9,631 adults between ages 35 and 65 found that people with a diagnosis of depression were 46% more likely to develop GERD.

This story was produced using content from original studies or reports, as well as other medical research and health and public health sources cited in links throughout the article.