Acid Reflux Treatments
Acid Reflux Treatments
So you've had enough, have you?
Tired of heartburn, regurgitation, and all the life interruptions that come from reflux?
Well if so, this guide is for you my friend.
Whether you're a once-a-week reflux person, or you have more advanced reflux, my goal in this blog is to review all the options you have for treatment out there and the pros and cons of each.
Sound good?
Cool, first I'll cover the standard lifestyle advice, helping you sort the wheat from the chaff as we dive into:
Food triggers
Behavioral modifications
Herbal remedies
Next I'll cover the medical treatment options, including:
Medications
Surgeries
Finally, I'll outline how you should approach a long-term, natural solution by outlining the root causes of acid reflux.
Standard Advice for Acid Reflux
Here's the run-of-the-mill advice you'll get if you search the internet. Unfortunately, much of this information has been circulated as a part of media sensationalism, more to grab eyeballs than to actually give good advice. The internet can than become like a game of telephone, passing the message along website to website until the integrity of the message is lost.
Let's sort out the noise!
Food Triggers
If you ask anyone about how to treat acid reflux, I'd lay good money the first thing out of their mouth is going to be about food triggers. It makes sense, since acid reflux is a digestive problem, so it's no surprise that food plays a crucial role.
The problem is... research is inconclusive on basically all foods. There's a lot of observational studies with people self-reporting their triggers but far fewer controlled trials. When researchers run controlled experiments they tend to come back with very conflicting results. For example, you can find a study that concluded fatty foods made heartburn worse and onset faster, and then an almost identical study where fat content made no difference. It's not just fatty foods - the same goes for most of the common food advice around reflux.
So the bottom line is I can give you a good place to start, but please keep in mind you'll have to carve your own dietary solution based on your own individual experience.
The fastest way to get you up to speed is my Acid Reflux Food Trigger Tier List below. It will help you prioritize food triggers when looking for short-term symptom relief from acid reflux.
I based this tier list on a couple key research papers¹,². These researchers did a meta-analysis, which is just a big review of research on diet and GERD. I then used my own experience in practice to further enhance the resource. If you are wondering, "why are there no alkaline foods listed" or you just want a deeper explanation of this resource, I'll publish a specific blog about it soon.
For those that might have trouble downloading the image, I'll write out the tiers here:
Definitely Avoid - Fatty, oily, fatty foods, alcohol, citrus
Probably Avoid - Carbonated beverages, spicy foods (includes garlic, leeks, onions), tomato products
Maybe Avoid - Coffee, tea, chocolate, mint
Definitely Add - Whole Fruits, Whole Vegetables, Whole Grains, Beans & Legumes
My main notes here are to focus as much or more on the additions as you do the subtractions. Yes, some of these foods trigger uncomfortable symptoms and may even have contributed to your reflux, but if you don't replace what you pull out of your diet, you will miss out on a lot of the healing and digestion calming effects diet can have.
Here's the thing no one tells you about food triggers! Look beyond the black and white of the list. You need to consider:
At what 'dosage' or quantity these foods trigger you
In what combinations with other foods they trigger you
Other non-food triggers at play (covered later)
In other words, don't just remember what you ate, but how much, with what else you ate it, and what was happening beyond your plate.
For example, you may find that hot salsa makes your reflux worse, but you can tolerate it as long as you don't have it in a big greasy meal. You may also find that a spoonful of the salsa is fine but if you put more of that, you're in for a long night. To make it even more confusing, you'll have to consider non-food factors like stress, meal timing, and other behaviors that can contribute to symptoms and severity.
Also to keep in mind: The longer you've had reflux, the more irritated, damaged, and inflamed your esophagus will be. A more sensitive esophagus means a broader range of foods are going to irritate it and potentially cause uncomfortable symptoms. It's not uncommon to experience reflux even eating all the right things, especially if your reflux is more advanced and/or you are just beginning dietary changes.
The bottom line is it is inherently tricky to get a clear signal on food triggers. However, it pays off to learn the boundaries of your body so you can have control. If you want to get some trained eyes to help with your situation, you can get in touch with us here.
Behavior Modifications
Behavior modifications refers to some habits you can change or implement to help manage symptoms of acid reflux. I group them into two categories that make them easy to remember - Pressure & Gravity.
Anything that builds pressure on the abdomen or stomach is going to increase the risk for reflux. You can decrease pressure by:
Wear looser fitting clothing
Eat smaller, more frequent meals
Stop drinking carbonated beverages
Anything that changes the angle of your body so that gravity can no longer assist in keeping acid in your stomach will increase the risk for reflux. You can:
Don't eat within 3-4 hours of going to bed
Elevate your bed or body during sleep (image below)
Don't exercise on a full stomach
Laying down only on an empty stomach and elevating your whole torso during sleep will help to keep gravity on your side and acid in your stomach where it belongs. This recommendation is backed by research! If you exercise after you eat, you'll be prone to extra slosh and more reflux.
These aren't magic bullets! You can still have a reflux episode while standing still as a statue, upright, wearing your most spacious pajamas and eating just a snack. This is because your stomach is a muscle that moves around and 'chews' food during digestion. Making these behavior changes gives you the best environment to minimize symptoms, but doesn't actually fix the natural barriers that stop reflux.
Natural Remedies
There are some non-drug therapies that might help with reflux. While there is research that supports some of the health claims, there isn't much reliable research to confirm their effectiveness for acid reflux. But if it helps you, I'm all for it and it would be a huge win if one of these replaced a drug or similar therapy. I created the list below by aggregating two resources³,⁴.
Turmeric - anti-inflammatory properties of curcumin
Ginger - anti-inflammatory properties of ginger, digestive aid of antiquity
Flaxseeds - anti-inflammatory properties of omega-3 fatty acids, in a healthy seed package
Chamomile tea - popular digestive aid in antiquity, calming properties
Deglycyrrhizinated licorice - said to increase the mucous coating of the esophageal lining, helping it resist the irritating effects of stomach acid. Get the deglycyrrhizinated version if you plan to use it long-term.
Medical Options
Acid reflux has enjoyed lots of attention from pharmaceutical companies and medical research because it is such a common affliction in the US. Let's review the medications and surgeries available as treatment for acid reflux. Graphic created with two resources⁵,⁶.
Medications
There's four main classes of acid reflux medications. As always, consult your doctor on your unique situation.
Antacids
These are over-the-counter pills you can take to quickly reduce acid reflux symptoms. They work because they are chemical buffers that counteract your stomach acid to make it less potent/damaging to the esophagus. Some common brand names are:
Alka-Seltzer
Tums
Rolaids
I'd say that these are generally a pretty good line of defense with little downside in the short term (4-8 weeks) as long as used according to the directions on the bottle. You might even consider them somewhat natural, with bicarbonates being an important component of saliva and the chemical reactions they undergo in the stomach resulting in little more than electrolytes, water, and carbon dioxide.
There are medicines that use these chemical buffers alongside another active ingredient, alginates. Alginates in combination with specific antacids and acid in the stomach to form a bouyant "raft" on top of stomach contents. This raft helps to form a protective barrier between acid and the esophagus. Some brand names you might recognize are:
Gaviscon
Mylanta
The addition of alginates brings little by way of side effects - usually the side effects people experience are digestion related like constipation or diarrhea due to the specific antacid compounds containing magnesium or aluminum⁷ - but long-term effects such as poor nutrient absorption remain⁸.
Finally, while not true antacids, some medicines work as Coating Agents. They work primarily by coating stomach ulcers or other damage in the digestive track in a protective layer to block further damage or inflammation from stomach juices. Active ingredients include sucralfate or bismuth subsalicylate. Brand names you might recognize are:
Pepto-Bismol (bismuth subsalicylate)
Carafate (sucralfate, prescription only)
While they come with a relatively small chance of side effects, they have the benefit of potentially giving your esophagus tissues a break and heal.
H2 Blockers
These are the old-generation prescription acid reflux meds. Available over-the-counter in smaller doses, they work by reducing acid production in the stomach. Brand names include:
Axid (nizatidine)
Pepcid (famotidine)
Tagamet (cimetidine)
Proton pump inhibitors (PPIs)
These are the newer generation meds for acid reflux. Some are available over-the counter but some are prescription strength and available from your doctor. PPIs also work by reducing acid production in the stomach, though they accomplish this through a different pathway than H2 Blockers. Brand names include:
Prilosec (omeprazole)
Nexium (pantoprazole)
Protonix (pantoprazole)
For short-term, periodic symptom relief, these drugs are very effective. The main downsides to these meds come from chronic, long-term use.
Weaker stomach acid may make it harder for your body to break down and absorb essential nutrients like calcium, folic acid, B12, and more⁸. Long-term use has been associated with increased bone fracture potentially due to poorer nutrient absorption⁹. There is also a documented rebound effect¹⁰ when stopping some of these meds after prolonged use, making it difficult to get off the meds.
It also may reduce the natural germ-killing properties of your stomach acid, which has been associated with increased C-diff infections¹¹ and Small Intestine Bacterial Overgrowth (SIBO)¹².
So, if I was using them for longer that 4-8 weeks, I'd consider a discussion with my doctor. Please use your own judgement for your case.
P-CABs (Potassium Competitive Acid Blockers)
These newer drugs use a different mechanism for acid suppression. One is approved by the FDA for use in the United States. It's brand name is Voquezna and it can be prescribed by a doctor if first-line acid suppressors have been ineffective¹³. Studies suggest that they may be slightly more effective than PPI's at treating GERD symptoms, but this class of meds currently come at a pretty heavy price tag¹⁴.
Prokinetics
Instead of focusing on acid, prokinetics help the 'reflux' side of the equation. They work by stimulating nerves in your esophagus and stomach to increase contractions, which moves food down faster and makes the lower esophageal sphincter (LES) stronger. They can also accelerate gastric emptying so that there's less time that stomach contents can reflux into the esophagus.
The upside to this is they attempt to target more of the root causes of reflux, such as LES function, esophageal clearance and stomach motility.
The downside is that these are very powerful substances. One has already been removed from the market because they were causing serious heart issues¹⁵ (Cisapride), and another carries a "Black Box" warning (metoclopramide) for causing tarkive dyskinesia, a condition where you lose conscious control of some body movements such as lip smacking which often does not resolve when stopping the medication¹⁶. For these reasons, the FDA looks at them with a lot of skepticism and there are few available in the US, whether due to recalls or simply not applying for FDA approval to enter the US market.
If that weren't enough, acid reflux is considered an "off-label" use for the drugs still on the market. They are usually designed for motility issues in the lower gut and haven't been proven to help acid reflux more than the first line medications.
Some names of the FDA approved ones include:
Baclofen - Baclofen is a (GABA-B) receptor agonist, aka a muscle relaxer. Usually prescribed for things like multiple sclerosis and spinal cord injuries, in acid reflux it can reduce transient lower esophageal sphincter relaxations (TLESRs) and accelerate gastric emptying. It's prescribed for reflux when PPI's alone are ineffective. It has a relatively high incidence of adverse effects¹⁷,¹⁸ (maybe as high as 65% of people on therapeutic doses), and long-term use proves ineffective¹⁹. If you come off it too quickly, can cause seizures.
Bethanechol - A cholinergic agonist that increases contractile force. Has been shown to increase the pressure of the LES, though research is still unclear on if it actually increases healing better than conventional antacid therapy²⁰,²¹.
Erythromycin: An antibiotic, it is usually used as an antibiotic, but erythromycin is also a motilin receptor agonist, so it sometimes finds an off-label use as a prokinetic agent to treat conditions like gastroparesis. Its prokinetic effects may help reduce symptoms of acid reflux, though one can imagine the side effects to the gut from it's antibiotic effects.
Prucalopride - A serotonin agonist that stimulates intestinal contractions. It is approved by the FDA for chronic constipation that arises spontaneously, so application to acid reflux is an off-label use. When four women who also had GERD took prucalopride to improve constipation, they saw their GERD go away²². Evidence as to how this medication can help GERD is still in development.
Because of their powerful ability to alter key neurotransmitter within the body, prokinetics are reserved for when first line acid suppression fails or to be used in combination with acid suppression.
Medications to avoid
You should limit the use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) like ibuprofen and aspirin. Of course, if you use any of the above meds, make sure there are no interactions with any of your current medications.
There's also a lot of medications that can cause or worsen acid reflux. You can find a full list reflux causing meds here. If you are taking something on that list, it could be causing or contributing to your acid reflux.
Surgeries
Fundoplication is the primary surgery done for severe acid reflux cases. The procedure wraps the stomach around the esophagus to reinforce the sphincter.
You may get a different version of the surgery depending on your case. For instance, Nissen Fundoplication is preferred in standard cases where you have normal esophagus motility. It wraps the stomach 360 degrees for more reinforcement. Toupet or Dor Fundoplication are preferred when you have weak esophagus motility to reduce the chance the procedure makes swallowing difficult. These versions wrap the stomach 270 or 180 degrees respectively to support the stomach valve.
These procedures are traditionally done through open surgery, laparoscopically, or even through the chest cavity.
Nissen Fundoplication
Pros:
low risk of death (<1% 30 day mortality)²³
high long term patient satisfaction (80%+ are satisfied they did the procedure in follow up studies 10+ years post procedure)²⁴
Some studies have documented complete remission of heartburn and regurgitation in the majority of cases (58%), though it's unclear what role continued medication use plays in those results²⁴
Cons:
~15% of people need another surgery, either due to failure of the surgery to hold, or revision needed such as the initial wrap was too tight²³
around half end up back on ppi meds in long-term (4.5 years and up)²³,²⁴
~18% may have new onset diarrhea, with maybe 86% of them having no resolution after 2 years²³
inability to burp or vent gas from the stomach means potential for increased flatulence (12-88%) and bloating, though the majority of bloating resolves in the first year²³
maybe as many as 3-24% will have difficulty swallowing that persists beyond 3 months and requires additional intervention²³
Nissen fundoplication is the most common, it's the full wrap of the stomach around itself to reinforce the valve. It's been the standard procedure for a long time in chronic cases of reflux where meds do not control the heartburn or other symptoms. Because it's been around a while, there's a decent body of research on the short and long-term outcomes of the surgery. The good news is that the vast majority of people who have the surgery done are happy with their results, even as long as 20 years post operation. It is also well-trodden territory when it comes to safety. However, that doesn't mean it's all sunshine and roses - there are a lot of recurrent symptoms, many will need to incorporate acid suppressing medication at some point, and there's a decent chance the surgery won't hold and you'll need a revision surgery (a failure rate of 10-20% is commonly reported). Still, this procedure provides a reliable avenue to symptom management and even recovery in severe cases of acid reflux.
Transoral Incisionless Fundoplication
TIF is a newer procedure that where the surgeon essentially reinforces your stomach valve without cutting you open, but instead by sticking a camera and tools down your throat. To 'rebuild' your valve, they will pull the esophagus down (and the stomach too, in the case of hiatal hernia), then fold the upper stomach over the esophagus, then secure the fold with plastic that stays in the body.
Pros
Less invasive than open fundoplication or laparoscopic fudoplication surgery
High technical success rate
Almost identical effectiveness to traditional fundoplication, according to current research
Cons
Improvements lost over time, long-term effectiveness unclear
Post-procedure care requires several weeks of significant diet modification to allow healing²⁵
Not everyone qualifies, TIF is only suitable for a portion of cases
Studies show a successful procedure in 99% of patients, with just 2% experiencing issues during or after the procedure such as a tear or internal bleeding²⁶,²⁷. Some studies have shown 80% of people are able to completely get off PPI's at a 6 month follow up²⁸, but that study also showed that long-term 22% of cases needed to convert to laparoscopic fundoplication²⁹. Another study showed 61% of people were able to completely discontinue PPIs at 6 months, but that percentage dropped to just 30% by 6 years³⁰. While more research is needed, the long term efficacy appears almost equivalent to conventional Nissen laparoscopic fundoplication but is less invasive. However, not all people will qualify for it (hiatal hernia >2cm, BMI > 35, previous endoscopic interventions)³¹.
LINX
A LINX device is a ring of magnets connected by a titanium wire they install to act like your stomach valve. These magnets are strong enough to close the esophagus to prevent reflux, but weak enough to allow food and liquid to pass through under normal swallowing conditions. In many ways it is an improvement over fundoplication because it's a shorter procedure and it doesn't require a special meal plan as the stomach heals because the stomach doesn't undergo any change.
LINX isn't without limitations. You aren't a candidate if you have a hiatal hernia greater than 3 cm. Additionally, if you don't have good esophageal strength then pushing food past the device could be compromised.
Of course you have the usual surgery risks: Infection, bleeding, injury to surrounding organs like the esophagus, spleen, or stomach, adverse reactions to anesthesia, death.
But having the device in your body (with the intention that it stays there for life) carries risks too³²
Other important considerations:
MRI scans can cause serious harm with the device implanted. Newer ones are safe for 1.5-Tesla scans
Complications could require surgery to take the device out of your body
If you have other implants (i.e. a pacemaker), LINX has not been evaluated for safety alongside such implements
According to the FDA's Summary of Safety and Effectiveness Data³³ on LINX devices, 86/100 in a clinical trial reported >= 50% reduction of daily PPI usage at 24 months. 76 had adverse effects, 10 had severe effects. Most of the issues came from difficulty swallowing, most of which resolved without consequence. 18 people needed esophageal dilation for dysphagia, odynophagia, regurgitation or burning sensation in throat, 12 had at least 2 dilations and 10 continued to have symptoms. 5/100 had the device removed.
So, in short, you are likely to experience at least mild discomfort at some point within the first 90 days of getting the device implanted. There's also close to a 1 in 5 chance you'll have enough trouble swallowing that you'll undergo esophageal dilation. We can also roughly say there's at least a 5% chance you'll have to reverse the treatment either due to intolerable adverse effects or other complications.
The Natural Approach to Long-term Resolution
Doctors and researchers make one crucial error when it comes to health issues in general... they get too wrapped up in the medical solutions that they can't see the big picture.
Ok, maybe it's not an 'error' per se. But in my experience, they definitely lean way in to pills and procedures when there is an easier, safer, more elegant solution glaring them right in the face. At the risk of sounding off my rocker - Sometimes the best answer isn't a chemical or intervention external to your body, but rather a change that comes from within.
For those who prefer changing themselves and the way they approach life to a lifetime of meds and body-altering surgeries, I'm pleased to say there is a path for you. Read on!
Root Causes of Acid Reflux
If you were to google 'what is the root cause of acid reflux' it will tell you it's a malfunction of the Lower Esophageal Sphincter (LES).
It's wrong.
I know, who am I to challenge the almighty and all-knowing internet (and literally every research journal out there). But think about it for long enough and the same question will pop into your head as it did mine...
"Why?"
"Why does it malfunction?"
Maybe I'm just that kid that asks why a million times just to be annoying, but if we can answer that question, we'll have a roadmap to fix the 'root root causes' and get back to normal living.
As it turns out, the leading factors to acid reflux disease are well-charted territory. I'm going to call these factors 'predictors' as they precede acid reflux and set us up for LES failure. They fall into two broad categories. First, the things that build pressure in the abdomen and strain the sphincter over time. Second, the things that neurologically disrupt the sphincters function.
This will not be an exhaustive list but rather a collection of the predictors that you have control over.
Predictor 1: Weight
People who are overweight may be twice as likely to have GERD compared to the general population³⁴. In fact, even incremental weight gain can increase reflux symptoms³⁵.
One explanation is that extra weight means more pressure in the abdomen³⁶, and over time that wears out the protective valve. It also makes herniation of the diaphragm more likely, changing the anatomy at that junction to promote reflux. Additionally, fat tissue, especially visceral fat tissue, is also known to throw hormones out of whack and increase low-grade inflammation, which may destroy the mucus lining that protects the esophagus from acid damage³⁷.
Whatever the exact mechanism, the answer is clear: Healthy weight loss is one of the best things you can do for GERD.
I found a study that followed 300 men and women with chronic acid reflux through a 6 month weight loss program. The group lost an average of ~4.75lbs per month with a goal of 10% body weight loss, resulting in symptom improvement in 81% of them and complete resolution of reflux symptoms in 65%. Additionally, the researchers found that more weight lost meant less reflux symptoms³⁴.
While they didn't measure medicine usage, these results are comparable to the surgery results above - without the price tag, risks, or post-operation tradeoffs one has to live with for life.
Predictor 2: Gut Health
If these predictors were roadsigns, Gut Health would be an obnoxiously bright electronic billboard with flashing arrows saying "Acid Reflux Ahead!"
The link between generally poor gut health and acid reflux is undeniable³⁸. Researchers have found considerable overlap between GERD and other GI issues to varying degrees³⁹,⁴⁰, and at least one study has linked reflux symptoms to bad bacteria living in the gut⁴¹.
While this connection is well established, the mechanisms and causal relationship aren't yet crystal clear. One possibility is that other gut issues like constipation or bloating can contribute to pressure in the abdomen. Another angle is that having a colony of 'bad' bacteria in your intestines also increases low-grade inflammation, which may disrupt sphincter function⁴² or reduce the protective mucus lining as we learned earlier. Even the gut's deep integration with your emotional wellbeing can play a role in the proper function of smooth muscle contractions in your esophagus, sphincter, and stomach, causing reflux symptoms.
The important thing is that we take our general digestive health seriously. Nourishing a healthy gut can reduce pressure buildups and improve motility through the esophagus and stomach, both of which would help with reflux.
Predictor 3: Other Disease
Certain diseases in particular increase the chance of reflux. Asthma is a big offender here. Increased strain while breathing or chronic coughing may change the pressure gradient between the chest and abdomen, or medicines taken to manage asthma may weaken the LES⁴³. A vicious cycle can form where asthma coughing and wheezing stimulates reflux which irritates the lungs and airways, which bring on more coughing in a self-perpetuating loop. Reflux has also been known as a major cause of asthma symptoms.
Diabetes is also an independent cause of many GI issues including acid reflux⁴⁴. Acid reflux occurs at an almost 3x greater rate in diabetics than the general population⁴⁵. The belief is that high blood sugars damage the nerves and smooth muscles that operate the sphincter, esophagus, and stomach, which leads to reflux.
Proper management of these issues is crucial to control of reflux.
Predictor 4: Alcohol and Tobacco
I'm sure it comes as no surprise - alcohol and smoking aren't your friends when it comes to acid reflux.
Most studies have shown a positive relationship between smoking and GERD⁴⁶. Smoking may affect the body in a multitude of ways, from relaxing the LES, chemical changes in saliva, abrupt changes in abdominal pressure, reduced esophageal clearance⁴⁷. It's also pretty clear that smoking triggers symptoms and negatively affects other measurable factors in reflux like esophageal pH and LES pressure.
Multiple studies on 24 hour cessation of smoking showed no significant change in reflux. However, studies where participants succeeded in quitting for a year showed significant improvement in acid reflux symptoms in 46% of participants, though there were some significant limitations to the study⁴⁸.
Alcohol is best thought of as a trigger to reflux symptoms but is likely not risk factor in developing GERD. Experts have noted alcohol's various negative effects, such as its noxious effect on esophageal mucosa, which predisposes to acidic injury⁴⁹. Alcohol is also well-known to negatively impact the gut in a variety of ways. Colloquially it is also known as a contributor to weight gain. Removing it can only help reflux and can improve reflux through overall better health.
What does this mean you should do?
All in all, while diet research sometimes tells a contradictory tale, it does seem to subtly point to a broader conclusion... the answer isn't black and white on any individual food, but rather to take a big picture view on general dietary habits.
In other words, you need to be thinking about lifestyle change, not just tips, hacks, teas, single-food modifications, and the like.
Conclusion
I hope this article on acid reflux treatments was useful for you. If you're considering some guidance to create a more structured plan for your acid reflux, we have a full course on how to master acid reflux here, or you could sign up for our online community/app here to get access to all of our courses as well as monthly live workshops.
JAMA Network, Kaltenbach - lifestyle and GERD meta-analysis
National Institutes of Health, Heidarzadeh-Esfahani - diet and GERD risk meta-analysis
NIH Herdiana - the anti-inflammatory properties of natural remedies listed
Harvard Medical School - licorice for reflux
DRHC Healthcare - first source for step ladder of acid reflux meds
BMC Gastroenterology, Raja Ali et al. - second source for step ladder of acid reflux meds
Drugs.com - antacid side effects
National Institutes of Health, Heidelbaugh - Weaker stomach acid may hinder nutrient absorption
National Institutes of Health, Maideen - PPI use and bone fracture
New Zealand Medicines and Medical Devices Safety Authority - Rebound effects after acid suppressing medicine
National Institutes of Health, Maideen - PPI use and Cdiff infections
National Institutes of Health, Su et al. - PPI use and SIBO
Gastroenterology, Patel et al. - when Voquezna can be prescribed
ManagedHealthcareExecutive.com, Myshko - pricing of Voquezna
American Journal of Gastroenterology, Wysowski - Cisapride removed from market
Cleveland Clinic - metoclopramide can cause tarkive dyskinesia
Drugs.com - baclofen side effects
National Institutes of Health, Dease - baclofen has an adverse effects rate of 10-65%
Journal of Clinical Gastroenterology, Dong - baclofen is ineffective long term
Annals of Internal Medicine, Thanik et al. - Bethanechol shown to increase LES pressure
Gastroenterology, Saco et al. - Research unclear on if Bethanechol actually increases healing better than conventional antacid therapy
National Institutes of Health, Nennstiel et al. - Prucalopride case study of 4 women with GERD
Perspectives in Clinical Gastroenterology and Hepatology, Richter - fundoplication mortality rates, failure rates, reasons for revision surgeries, long-term effectiveness, and side effects of surgery
National Institutes of Health, Salvador - fundoplication success stats
Massachusetts General Hospital - post TIF surgery requires special diet for several weeks
John's Hopkins Medicine - TIF success rates
Georg Thieme Verlag KG Struttgart, McCarty et al. - TIF success rates
Journal of the American College of Surgeons, Bell et al. - 80% of TIF patients able to completely get off PPI's at a 6 month follow up
National Institutes for Health, Mohan - 22% of TIF cases needed to convert to laparoscopic fundoplication
Current Opinion in Gastroenterology, Sami Trad - discontinuation of PPI's dropped from 61% of TIF patients at 6 months to just 30% by 6 years
National Institutes for Health, Mohan et al. - qualifications for TIF
FDA's Summary of Safety and Effectiveness Data - LINX device risks
FDA's Summary of Safety and Effectiveness Data - on LINX devices
National Institutes of Health, Singh et al. - study found 37% of people had GERD in overweight and obese cohort
National Institutes of Health, Jacobson et al. - even incremental weight gain can increase reflux symptoms
Gastroenterology, Pandolfino et al. - extra weight means more pressure in the abdomen
American Journal of Physiology-Gastrointestinal and Liver Physiology, Paris et al. - how visceral fat inflammation might impact mucousal protection
National Institutes of Health, Hosseini et al. - undeniable connection between GERD and other GI disorders
National Institutes of Health, Alshammari et al. - overlap between GERD and other GI issues
National Institutes of Health, Lee et al. - considerable overlap between GERD and other GI issues
National Institutes of Health, Wang et al. - bacteria living in the gut linked to reflux symptoms
National Institutes of Health, D'Souza et al. - low-grade inflammation from bacteria in gut may disrupt sphincter function
National Institutes for Health, Sontag et al. - chronic coughing may weaken the LES
Diseases of the Esophagus, Natalini et al. - diabetes is an independent cause of acid reflux
National Institutes of Health, Wang et al. - acid reflux occurs in 40% of diabetics compared to 14% in the general population
National Institutes of Health, Sadafi et al. - most studies have shown a positive relationship between smoking and GERD
National Institutes of Health, Kang et al. - physical changes due to smoking that may drive reflux
National Institutes of Health, Kohata et al. - quitting smoking for a year led to significant improvement in acid reflux symptoms in 46% of participants
National Institutes for Health, Ness-Jensen et al. - alcohol's noxious effect on esophageal mucosa, which predisposes to acidic injury
