Once esophageal reflux has been clinically diagnosed you should put in place a plan of action.

First you should look at lifestyle changes. This includes stopping smoking, avoiding heavy meals, weight reduction, raising the head of the bed by about 10cm, avoiding hot drinks and alcohol before going to bed, avoiding certain drugs, and not eating at least 3 hours before going to bed.

If these general measures are ineffective then add an antacid or alginate. There is no evidence that one antacid is more effective than another. The choice is yours. Remember if there is esophagitis, these drugs although they will help neutralise stomach acid and reduce acid reflux, there is no evidence that they will heal esophagitis. So if you have adequate relief then it is likely you did not have esophagitis.

If there is no relief after four weeks of lifestyle changes and antacids or alginates then a trip to your doctor is necessary. You will have an endoscopy and biopsy. If there is no esophagitis, then the doctor will look for other possible causes and when excluded may suggest that you continue taking antacids or add an H2- antagonist such as ranitidine. This is available over the counter. Trials have suggested that long term use of these drugs are safe.

Esophagitis will require specific treatment. Omeprazole or other proton pump inhibitors, or ranitidine at a dose that should heal esophagitis will be prescribed. Omeprazole still remains the best medical treatment of acid reflux. With severe or recurrent symptoms maintenance treatment may be needed.

If these is no relief after six weeks then a repeat endoscopy and biopsy will be taken. It is very rare that esophagitis does not respond to proton pump inhibitors. There are, however, a rare few cases when omeprazole is not an effective acid reflux treatment. These patients are likely to have surgery and this is usually done before the age of 60.
Statistics have shown that if your first endoscopy was negative and you do not have esophagitis, subsequent endoscopies is likely to remain negative.

Dr. Phil Hariram,