So you've avoided trigger foods such as chocolate, coffee, and alcohol, reduced portion sizes at dinner, and stopped snacking late at night to avoid a nightly bout of acid reflux. But as you retire to bed it's still there. Now what?

These behavior modification approaches help make a lot of people feel better and reduce acid reflux symptoms. But if they don't work (or stop working), a visit to the doctor is in order.

Medications That Minimize Nighttime Acid Reflux

Antacids such as Rolaids® or Tums® typically don't work for acid reflux. "They neutralize the acid in your stomach, but they're not the greatest for treating nocturnal heartburn," says Frank Gress, MD, chief of the Gastroenterology Division at SUNY-Downstate Medical Center in New York City. "Nowadays, there are over-the-counter acid suppression medications that effectively stop the acid and the heartburn."

Here's what he recommends instead:

H2 Blockers, such as Zantac®, Pepcid®, and Tagamet®. These medications, available over the counter in low doses, work to reduce the amount of acid production in the stomach.

Usually taken with the first meal of the day, people often take these medications before bed, too.

Proton Pump Inhibitors (PPI), such as Prilosec®, Prevacid®, and Nexium®. These medications are usually taken 30 minutes before a meal. They also reduce acid production in the stomach, and help repair damage to the lower esophagus.

The Best Time to Take Therapy

Acid suppression medication can be taken before dinner if symptoms appear at night. If symptoms occur hours after dinner, some people take it before bed. What Gress recommends to his patients is trying a low dose of an OTC H2 or PPI about 30 minutes before dinner. If that doesn't work, additional therapy or medication may be required before bed. See your doctor to determine your regime.

More Ways to Alleviate Nighttime Acid Reflex

Elevate the head of the bed. This not only prevents reflux, it's one way to treat it, says Gress. Forget propping up pillows, it's better to place a wedge (available at your pharmacy) in between your mattress and box spring.

Chew gum. When you chew a lot of gum, you secrete saliva, explains Gress. Saliva has mucus in it, and mucus has a protective effect on the lining of the esophagus, pushing the acid back into the stomach. He stresses that this will only help people with mild reflux that experience occasional symptoms.

Surgery. In some cases, surgery may be the best option. The most common approach is a laparoscopic technique.

For occasional bouts of nighttime acid reflux, products such as Mylanta®, Maalox®, Rolaids®, and Tums® will offer short-term relief. But if you continue to have symptoms, and it becomes a chronic problem, you need to see a doctor.

If symptoms don't respond to acid suppression therapies, you may be referred to a gastroenterologist, who will use tests such as an endoscopy and manometry to determine the next steps.

"Patients who have chronic acid reflux and have been treating with OTC products for years need to have an endoscopy to figure out what the ultimate culprit is," says Gress. In doing so, your doctor will be able to effectively treat your nighttime acid reflux—usually through a regular, adjusted dose of a PPI or even surgery.

Dr. Frank Gress reviewed this article.




Frank Gress, MD, Chief of Gastroenterology Division at SUNY-Downstate Medical Center.

Proton Pump Inhibitors. Medline Plus.

H2 Blockers. Medline Plus.