Reflux: non-surgical treatment

Gastro-oesophageal reflux disease can be treated both surgically and non-surgically (conservatively). This section discusses surgical treatment.

• Weight loss is proven to be meaningful for patients who are obese or who have recently gained weight and is strongly recommended. Strive for an ideal weight.
• Avoid fatty or spicy foods, caffeine, chocolate, fizzy drinks, peppermint, etcetera. These foods promote the production of stomach acid or relax the oesophageal sphincter. Also avoid acidic foods such as concentrated tomato and fruit juices.
• The last meal should be consumed no later than two to three hours before going to bed. Eat with moderation and in relaxed conditions.
• Avoid strenuous physical effort immediately after meals.
• Stop smoking or smoke less. Tobacco may make reflux symptoms worse.
• Raising the head of the bed can be useful, especially for patients who have complaints at night or in case of coughing/hoarseness.
• Avoid constricting the stomach through corsets.

The majority of patients can be treated with medication that reduces the production of stomach acid or that neutralises the acid.

Antacids such as Rennie®, Maalox®, Antagel® and Gaviscon® are medications that neutralise the acidity of the stomach, leading to mild improvement of the complaints without actually avoiding reflux. They work in five minutes but only have a short-term effect of 30 to 60 minutes.

Proton pomp inhibitors (PPI) such as omeprazole (Losec®), rabeprazole (Pariet®), pantoprazole (Pantozol®) and esomeprazole (Nexium®) are the most powerful medication to reduce the production of stomach acid and deliver faster improvement of reflux complaints. They are the first choice for severe erosive oesophagitis, severe or frequent GORD symptoms that impact the quality of life or for Barrett's oesophagus.

Alginates (sucralfate) bind to the surface of the mucous membrane and form a kind of ‘film’, allowing for faster healing and reducing sensitivity of the oesophagus. In view of their short-term and limited effect compared to PPIs, they are only used to treat GORD in pregnant women or for oesophagitis that is difficult to treat.

General Surgery

General medicine

Digestive Centre

Gastroenterology, gastrointestinal diseases

Latest publication date: 23/01/2024
Supervising author: Dr Monsaert Els