• Burning behind the breastbone; sour taste or regurgitation
• Worse after large or late meals; bending or lying down
• Throat clearing, cough, hoarseness; bad breath
• Night wakings, disturbed sleep, morning sore throat

GERD vs. heart pain

Reflux and cardiac pain can overlap. If pain is new, severe, or with breathlessness, sweating, or radiating to jaw/arm, treat as cardiac until proven otherwise.

• Large meals; lying down within 2–3 hours after eating
• Fried/fatty foods; spicy foods; chocolate; mint
• Coffee/tea, cola, alcohol; citrus and tomato products
• Tight belts/waistbands; constipation straining

Initial approach

• History, exam, and a trial of lifestyle changes ± medicines
• Check for red flags that need early endoscopy

Tests (when needed)

• Upper endoscopy (EGD) for alarm features or long-standing symptoms
• pH monitoring (with/without impedance) to confirm reflux
• Esophageal manometry before surgery or if motility issue suspected

Lifestyle foundation

• Smaller, earlier dinners; avoid lying down for 2–3 hours after meals
• Weight reduction if advised; gentle walking after meals
• Elevate the head of the bed 6–8 inches (blocks or wedge pillow)
• Stop tobacco; limit alcohol; loosen tight waistbands

Medicines

• Antacids for quick relief
• Alginates (raft-forming) after meals/bedtime for regurgitation
• H2 blockers (e.g., at night for mild symptoms)
• PPIs (mainstay for frequent symptoms/esophagitis; take before breakfast)
• Step-down to lowest effective dose once controlled

Procedures (selected cases)

• Laparoscopic fundoplication or magnetic sphincter augmentation when anatomy/symptoms fit
• Discuss benefits/risks; testing guides candidacy

• Dinner at least 3–4 hours before bed; light snack if needed
• Head-of-bed elevation (blocks under legs or wedge pillow), not extra pillows
• Sleep on the left side to reduce nocturnal reflux

Gentle choices

• Oatmeal, bananas, melons, yogurt/curd, lean proteins, steamed veggies
• Whole grains; soups that aren’t tomato-based
• Herbal teas (non-mint), ginger infusions

Consider limiting

• Deep-fried/fatty foods, chocolate, peppermint
• Tomato/citrus-heavy meals, onion/garlic for some
• Coffee/tea/cola and alcohol if they worsen symptoms

Polypharmacy & interactions

• PPIs can reduce absorption of B12, iron, and affect some drugs
• Space thyroxine, bisphosphonates, and some antibiotics away from antacids
• Ask before combining with clopidogrel or diuretics

Safety

• Frequent night reflux raises aspiration risk — elevate bed, left-side sleep
• Persistent difficulty swallowing or food sticking needs evaluation

• Esophagitis and bleeding; strictures (narrowing)
• Barrett’s esophagus in some long-standing cases
• Chronic cough, asthma flares, dental enamel wear

How long to try a PPI?

Many plans use a 4–8 week trial; if better, step down to the lowest dose that maintains control.

Are alginates different from antacids?

Yes. They form a floating raft on stomach contents to reduce regurgitation — useful after meals and at bedtime.

Do I need lifelong medicine?

Not always. Many can control symptoms with lifestyle plus the lowest effective medication dose or on-demand use.

Does weight loss help?

Even a modest reduction can lower reflux pressure and improve symptoms, especially night reflux.