Ask the Doctor: Caitlin Houghton, M.D.

Q. I have been suffering from acid reflux for many years. I would like to stop taking my antacid medications but every time I try to my symptoms return. What are my options?

A. You are among 10 percent of the population who suffer from acid reflux on a daily basis and 40 percent who suffer from symptoms at least once a month. These symptoms are due to gastroesophageal reflux disease or GERD, which is the abnormal passage of gastric contents into the esophagus. Irritation from these gastric contents; including acid, bile and enzymes; not only causes discomfort but can also cause damage to the lining of the esophagus in the form of erosions, ulcers and strictures. Recurrent irritation can also lead to Barrett’s esophagus which is a precursor to esophageal cancer.

GERD occurs because the valve between the esophagus and stomach, or lower esophageal sphincter (LES), is weak. This weak valve does not close appropriately and therefore allows reflux of gastric contents into the esophagus. In some patients this is associated with a hiatal hernia. Medications such as antacids or PPI’s help reduce the acidity of the gastric contents and thus relieve the symptoms of reflux; however they do not address the reflux itself. Damage to the esophagus can be ongoing despite symptomatic relief.

In addition, recent research has questioned the long-term safety of PPI medications, a commonly used antacid. Long-term use has now been linked to pneumonia, heart attacks, kidney disease and dementia.

There are other options you can try to manage your GERD such as quitting smoking and making lifestyle changes. Maintaining a healthy weight helps reduce pressure on your abdomen, which prevents pushing on your stomach that can cause acid to back up into your esophagus. If you are currently overweight, ask your doctor for advice on how to achieve a healthy weight for you.

Additionally, it is important to maintain a healthy diet by eating smaller portions, not lying down for at least three hours after a meal, and avoiding food and beverages that may trigger heartburn. While everyone has different triggers, common ones include fatty or fried foods, alcohol and caffeine.

There are also surgical options that can fix the weakened valve and eliminate abnormal reflux from occurring, such as a Nissen Fundoplication or the LINX device. Both surgeries are performed laparoscopically through small incisions. The surgery starts by repairing any hiatal hernia that may be present, then reinforcing the valve. The Nissen uses that upper portion of the stomach to create a new valve while the LINX is a magnetic ring that augments your native valve, allowing it to close appropriately. Approximately 95 percent of patients are off medications after surgery.

Caitlin Houghton, M.D., joined Hoag in 2016 after completing her residency in General Surgery at UC Irvine and her Fellowship in minimally invasive surgery at UCSD. She is dedicated to addressing esophageal and gastric diseases including GERD, hiatal hernias, achalasia, and cancer.