GERD treatment follows a stepwise approach: lifestyle changes first, then medications to reduce stomach acid, and surgery for people who don’t respond to either. Most people get significant relief from a combination of the first two, and only a small percentage ever need a surgical procedure. The right treatment depends on how severe your symptoms are, how long you’ve had them, and whether acid has already damaged your esophagus.
Lifestyle Changes That Actually Help
Not all lifestyle advice for GERD is equally supported by evidence. Two changes have the strongest backing: losing weight and elevating the head of your bed. Both have been shown to improve acid exposure in the esophagus and reduce symptoms. Even modest weight loss can make a meaningful difference, particularly if symptoms started or worsened after weight gain.
Elevating the head of your bed by about six inches (using a wedge pillow or blocks under the bedframe, not just stacking pillows) helps gravity keep acid from traveling up while you sleep. This is especially useful if your worst symptoms are nighttime heartburn or regurgitation.
Beyond those two, the evidence gets thinner. Foods like coffee, chocolate, citrus, fried food, and spicy food are frequently reported as triggers, but well-controlled studies show little impact from these specific items on objective acid exposure measurements. That doesn’t mean they can’t bother you individually. If a particular food consistently causes symptoms, avoiding it makes sense. But blanket dietary restrictions aren’t strongly supported. Alcohol can worsen reflux symptoms, though a direct cause-and-effect link hasn’t been firmly established either.
Over-the-Counter Medications
When lifestyle changes aren’t enough on their own, medication is the next step. Three categories of drugs are available without a prescription, and they work differently.
- Antacids neutralize acid that’s already in your stomach. They work within minutes but wear off quickly, making them best for occasional, mild heartburn rather than daily symptoms.
- H2 blockers reduce the amount of acid your stomach produces. They have a quick onset and can be taken as needed, which makes them a good option for predictable symptoms, like heartburn after a heavy meal.
- PPIs are the most potent acid suppressors available. They permanently disable the acid-producing pumps in your stomach lining, so your body has to make new ones before acid production returns to normal. This means they take a day or two to reach full effect, but the relief lasts longer and is more complete. For frequent symptoms (two or more days per week), PPIs are the standard first-line treatment.
PPIs are typically taken once daily, 30 to 60 minutes before a meal, for an initial course of four to eight weeks. Many people can step down to an H2 blocker or as-needed use after their symptoms are controlled.
Risks of Long-Term Acid Suppression
PPIs are safe for most people when used appropriately, but long-term use has been linked to several concerns. These include a higher risk of a specific type of gut infection (C. difficile), reduced bone density, and poor absorption of certain vitamins and minerals. A 2025 population-based study across five Nordic countries also examined a possible association between long-term PPI use and stomach cancer risk.
These risks don’t mean you should stop taking a PPI if you need one. They do mean it’s worth periodically reassessing whether you still need daily acid suppression or whether you can manage with a lower dose, an H2 blocker, or lifestyle measures alone.
When Standard Treatment Doesn’t Work
If symptoms persist despite optimized PPI therapy and lifestyle changes, the diagnosis itself may need a second look. Refractory GERD is defined as ongoing symptoms with objective evidence of acid damage despite adequate treatment. The evaluation typically involves an upper endoscopy to look directly at the esophagus, followed by specialized testing if the endoscopy looks normal.
Two tests are particularly useful at this stage. Impedance-pH monitoring measures how much acid actually reaches your esophagus over a 24-hour period, with a composite score above 22 considered abnormal. Esophageal manometry checks whether the muscles of your esophagus and the valve at the bottom are working properly. Together, these tests help distinguish true acid reflux from other conditions that mimic it, like functional heartburn (where the nerves in your esophagus are overly sensitive, but acid levels are normal).
This distinction matters because the treatments are completely different. If testing confirms ongoing acid reflux, surgery becomes an option. If the esophagus is hypersensitive rather than acid-damaged, nerve-targeting medications are a better path.
Surgical Options
Surgery is reserved for people with confirmed, objective GERD who either can’t tolerate medications or prefer a permanent fix over lifelong pills. The two most established procedures are fundoplication and the LINX device.
In a fundoplication, the surgeon wraps part of your stomach around the bottom of your esophagus to reinforce the weakened valve. The full version (Nissen fundoplication) wraps the stomach all the way around, while partial versions wrap it partway. Both are done laparoscopically through small incisions. Long-term data is strong: partial fundoplication shows success rates above 85 percent at 10 to 20 years, with acid levels normalizing in over 90 percent of patients in early testing. About 10 to 15 percent of people who get the full Nissen procedure report side effects like difficulty swallowing, bloating, or excess gas, though most are satisfied overall. Durability has been confirmed out to 20 years.
The LINX device is a ring of magnetic beads placed around the lower esophagus. It’s designed to be strong enough to keep the valve closed against reflux but weak enough to open when you swallow. It’s a newer option, and early data hasn’t matched the results of partial fundoplication. There are also unresolved concerns about the device eroding into the esophagus over time, a complication seen with other devices placed in this area. Long-term data won’t be available for at least another several years.
A Less Invasive Alternative: TIF
Transoral incisionless fundoplication is performed entirely through the mouth, with no external incisions. It recreates the valve between the esophagus and stomach using fasteners applied from the inside. Candidates need to have a hiatal hernia of 2 centimeters or smaller (or ideally none), a BMI under 35, and no prior stomach surgery. It’s a good middle ground for people who want more than medication but want to avoid traditional surgery.
Recovery After Surgery
If you do have a fundoplication, expect a structured diet progression. For the first one to two weeks, everything needs to be blenderized. In week two, you’ll move to soft foods. By week three, most regular foods can return, with two exceptions: bread and solid meats, which are typically held until six weeks after surgery because they require more forceful swallowing that could stress the surgical repair.
Most people return to normal eating and daily activities within six to eight weeks. The swallowing difficulty that some patients experience early on usually improves as the surgical site heals and the tissue becomes more flexible.