BASED on an extensive analysis of medical research conducted between 1960 and 2011, in March, the American College of Gastroenterology released updated clinical guidelines for treating gastroesophageal reflux disease (GERD) - a common, distressing condition that affects millions of Americans, says the August 2013 issue of the Johns Hopkins’ Medicine Health After 50.

GERD symptoms include heartburn, regurgitation of stomach acid, chest pain and difficulty swallowing.

GERD can also cause hoarseness and asthma.

Because of lack of sufficient evidence showing benefit from the old advise to GERD sufferers of making wide-ranging dietary changes, such as eliminating coffee, spicy foods, citrus fruits and tomatoes - although for some patients with specific reflux triggers, dietary changes may still be helpful - the new guidelines nix those restrictions, notes the health letter.

Also, the new guidelines no longer dissuade individuals from smoking, solely to relieve GERD - of course, there are many more reasons to quit smoking, adds the health letter.

The management of GERD consists of:

I. The new guidelines highlights three key lifestyle modifications as a first step:

1) Lose weight if you are overweight or have recently gained weight.

2) Elevate the head of your bed 6-8” at night with blocks or a foam (not pillows, which can cause an unnatural bend in the body and increase pressure to the stomach), if you suffer from nighttime GERD.

3) Avoid high-fat meals within two to three hours of bedtime.

II. If lifestyle interventions alone don’t stop GERD symptoms, three classes of drugs are recommended, which include:

A. H2 blockers - Over-the-counter and prescription H2 blockers like Tagamet, Pepcid and Zantac can reduce acid production and provide temporary relief.

B. Antacids - Antacids such as Alka-Seltzer, Maalox, Mylanta, Tums, Rolaids can neutralize stomach acid and relieve heartburn and mild symptoms but can cause side effects like diarrhea or constipation.

C. Proton pump inhibitors (PPIs) - Over-the-counter PPIs like Prevacid, Prilosec and Zegerid provide the most effective heartburn relief and are best at healing erosive esophagitis - inflammation of the esophagus - caused by GERD, and are just as effective as prescription PPIs (Dexilant, Kapidex, Nexium).

For best results, most PPIs should be taken once a day, 30 to 60 minutes before meals, over eight weeks.

Some individuals need maintenance therapy - low doses of PPIs over the long term - if symptoms recur or don’t lessen.

While PPIs are considered as generally safe, they may increase the risk for intestinal infection by bacteria like Clostridium difficile, so individuals with a weak immune system should avoid them.

The guidelines also deem PPIs as safe for most individuals with osteoporosis, a condition that can cause bones to weaken and fracture easily, adds the health letter.

(PPIs were once thought to increase risk for fractures.)

III. Surgery should be reserved for:

Individuals a) with chronic GERD, b) who can’t tolerate drugs, c) who don’t want to face a lifetime of taking drugs, d) who have a large hiatal hernia or e) who develop complications - but individuals who don’t respond to PPIs are unlikely to have a successful response to surgery.

Obese patients should consider gastric bypass, or weight-loss surgery, which may be more effective than GERD surgery.

The LINX Reflux Management System - a surgically implanted device which helps keep the sphincter muscle at the bottom of your esophagus closed when you’re not eating or drinking that prevents stomach contents from flowing upward - is a new option for treating GERD, but it wasn’t included in new recommendations because it hadn’t been adequately studied at the time the guidelines were written.

The LINX device is less operator-dependent than other GERD-related surgeries and appears to be effective:

A study of 100 patients with chronic GERD who had the LINX device implanted showed that, after three years, 93 percent reported a significant decrease in the need for PPIs.

While the device is considered safe, it can produce adverse effects, such as pain and difficulty swallowing - also, since it contains magnetic beads, you won’t be able to have MRIs, concludes the health letter.