Learn about medicine with Chula pharmacists: Treating acid reflux by changing your behavior

    One of the most common categories of medications people frequently purchase from pharmacies includes digestive aids such as antacids, stomachache relievers, carminatives, and other digestive system remedies. While occasional use of these medications typically doesn't pose a problem, frequent or prolonged use may indicate a deeper underlying issue, particularly with acid reflux.

    Acid reflux, a prevalent health issue among Thai people, occurs when stomach acid flows back into the esophagus, leading to symptoms like heartburn, sour or bitter burps, bloating, stomach tightness, indigestion, nausea, vomiting, chest pain, the sensation of a lump in the throat, chronic sore throat, dry cough, and hoarseness.

    Several factors can increase the likelihood of acid reflux or exacerbate its symptoms. These include eating late at night and lying down immediately afterward, which increases abdominal pressure and makes it easier for stomach acid to reflux into the esophagus. Consuming more Western-style foods, such as fast food, fried, and high-fat dishes, can slow digestion and increase abdominal pressure. Additionally, excessive intake of tea, coffee, and other caffeinated beverages can weaken the sphincter muscle between the stomach and esophagus, facilitating acid reflux.

    Stress also plays a significant role in affecting the digestive system, often leading to increased stomach acid production, which heightens the risk of acid reflux. Being overweight and lacking exercise are also important risk factors, as excess weight increases abdominal pressure, while regular exercise can help stimulate the stomach and intestines. Smoking and the use of certain medications, such as NSAIDs, can further worsen acid reflux symptoms.

    Diagnosing acid reflux is primarily based on a patient’s medical history and response to treatment. However, in cases where symptoms persist or worsen—such as difficulty swallowing, pain during swallowing, vomiting blood, or black stools—additional examinations, such as endoscopy or tests for digestive tract motility, may be necessary.

    Effective treatment of acid reflux often involves a combination of medication and lifestyle changes. The first behavioral adjustment is related to eating and sleeping habits. It is recommended to avoid eating heavy meals within three hours before bedtime. For example, if you usually go to bed around 10 p.m., the last meal or snack should be consumed no later than 7 p.m. The type and taste of food are also crucial; high-fat foods, spicy dishes, caffeinated beverages, soft drinks, and alcoholic drinks should be limited. If you are overweight, weight loss is advisable.

    The primary medications used to treat acid reflux are those that reduce stomach acid and drugs that improve gastrointestinal motility to expedite the movement of food and stomach acid.

    The most commonly used acid-reducing medications today are those that effectively inhibit acid secretion, providing good treatment outcomes. However, for these medications to work effectively, they must be taken correctly—typically 30 minutes to 1 hour before meals. It’s important not to crush, chew, or dissolve the medication, as proton pump inhibitors (PPIs) are specially formulated to protect the active ingredients from being destroyed in the digestive tract.

    Treatment with PPIs takes time, often requiring 1-3 months before noticeable improvements occur. It is essential for patients to follow their doctor’s instructions carefully, taking the medication as prescribed, and attending regular appointments to adjust the dosage. Patients should understand that symptoms may not improve immediately and must continue treatment as advised by their doctor.

    Even after successful treatment, there is a risk of recurrence, so patients must adopt lifestyle and dietary changes to prevent symptoms from returning.

Assoc. Prof. Dr. Nattada Areepiam and Assoc. Prof. Dr. Bodin Tiwasuwan

Faculty of Pharmacy Chulalongkorn University