* Milk and milk-based products contain calcium and fat, so should be avoided before bedtime.

* Avoiding food for 2 hours before bedtime and not lying down after a meal are frequently recommended lifestyle modifications.

* Elevation to the head of the bed is the next-easiest to implement. Products are also available as seen on tv that will elevate the head of your bed through the use of an inflatable mattress lifter. This is an ideal low cost solution for relief from acid reflux.

You can also accomplish the correct elevation by placing cinder blocks as noted above or with other items: plastic or wooden bed risers which support bed posts or legs, a bed wedge pillow.

The height of the elevation is critical and must be within the range of 6 to 8 inches in order to be as effective as possible in hindering the backflow of gastric fluids. Elevating the bed is also known as "positional therapy".

Drug treatments

A number of drugs are registered for the treatment of acid reflux, and they are among the most-often-prescribed forms of medication in most Western countries. They can be used in combination with other drugs, although some antacids can impede the function of other medications.

* Antacids before meals or symptomatically after symptoms begin can increase the pH and reduce gastric acidity. Alginic acid may coat the mucosa as well as increase the pH and decrease reflux.

* Gastric H2 receptor blockers such as ranitidine or famotidine can reduce gastric secretion of acid. These drugs are technically antihistamines. They relieve complaints in about 50% of all patients.

* Proton pump inhibitors such as omeprazole are the most effective in reducing gastric acid secretion, as they stop the secretion of acid at the source of acid production, i.e. the proton pump.

To maximize effectiveness of this medication the drug should be taken a half hour before meals. Prokinetics strengthen the lower esophageal sphincter and speed up gastric emptying. Cisapride, a member of this class, was withdrawn from the market for causing Long QT syndrome.

If one implements pharmacologic therapy in combination with food avoidance before bedtime and elevation of the head of the bed over 95% of patients will have complete relief.

Surgical treatment

The standard surgical treatment, sometimes preferred over longtime use of medication, is the Nissen fundoplication. The upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the sphincter and prevent and to repair a hiatal hernia. The procedure is often done laparoscopically.

An obsolete treatment is vagotomy, the surgical removal of vagus nerve branches that innervate the stomach lining. This treatment has been largely replaced by medication.

Disclaimer The information presented here should not be interpreted as medical advice. If you or someone you know suffers from acid reflux, please seek professional medical advice for the latest treatment options.

This article is Copyright © 2006, Heather Colman. Find more acid reflux resources at acid-reflux-press.info.