People with heartburn should first try lifestyle and dietary changes. In one study, 44% of patients who experienced symptoms of GERD reported improvement after changing their diet. People with heartburn should avoid or reduce consumption of foods and beverages that contain caffeine, chocolate, peppermint, spearmint, alcohol, and fat. Both caffeinated and decaffeinated coffee increase acid secretion. All carbonated drinks increase the risk for GERD.

Lying flat can produce intense acid reflux. After meals, chronic heartburn sufferers should take a walk or, at the very least, remain upright. Bedtime snacks should be avoided. To help keep acid in the stomach at night, a patient may need to raise the bed at an angle using four- to six-inch blocks at the head of the bed or a wedge-support that elevates the top half of the body so that the patient's body is tilted up. Extra pillows that only raise the head actually increase the risk for reflux.

Because saliva helps neutralize acid and contains a number of other factors that protect the esophagus, chewing gum 30 minutes after a meal has been found to help relieve heartburn and even protect against damage caused by GERD. In fact, chewing on anything at all can help, since it stimulates production of saliva.

Many physicians advise GERD patients to avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Motrin, Advil,) or naproxen (Aleve), among others. Tylenol (acetaminophen) is a good alternative.

Quitting smoking is, of course, essential. People who are overweight should try to reduce. People with GERD should avoid tight clothing, particularly around the abdomen.

During feeding, and for a while after, any infant should be positioned vertically and burped frequently. If a baby with GERD is fed formula, a mother should ask the doctor about making it thicker to help prevent splashing up from the stomach. Because food allergies may trigger GERD in children, parents may want to discuss with their physicians a dietary plan that starts with a formula using non-allergenic proteins and then adds other foods back one at a time until symptoms are triggered. Studies have found that infants with gastroesophageal reflux who spend prolonged periods of time in infant seats, including car seats, have more than those who spend waking time on their stomachs. Parents of infants with GERD should discuss their baby's sleeping position with their pediatrician. Experts strongly recommend that all healthy infants sleep on their backs to help prevent sudden infant death syndrome. For babies with GERD, however, lying on the back may obstruct their airways. If the physician recommends that such babies sleep on their stomachs, parents should be sure that their infant's mattress is very firm and possibly tilted up at the head, that there are no pillows, and that the baby's head is turned so that the mouth and nose are completely unobstructed.

Harvey Simon, M.D., Editor-in-Chief
Massachusetts Institute of Technology; Physician, Massachusetts General Hospital

Masha J. Etkin, M.D., Gynecology
Harvard Medical School; Physician, Massachusetts General Hospital

John E. Godine, M.D., Ph.D., Metabolism
Harvard Medical School; Associate Physician, Massachusetts General Hospital

Daniel Heller, M.D., Pediatrics
Harvard Medical School; Associate Pediatrician, Massachusetts General Hospital; Active Staff, Children's Hospital

Irene Kuter, M.D., D. Phil., Oncology
Harvard Medical School; Assistant Physician, Massachusetts General Hospital

Paul C. Shellito, M.D., Surgery
Harvard Medical School; Associate Visiting Surgeon, Massachusetts General Hospital

Theodore A. Stern, M.D., Psychiatry
Harvard Medical School; Psychiatrist and Chief, Psychiatric Consultation Service, Massachusetts General Hospital