Acid Reflux and GERD Treatment in Southlake, TX

Chronic heartburn deserves a reason, not just a refill. Plenty of people have been on an acid blocker for a decade without anyone asking whether they still need it or what started it. We work out what is driving your reflux, treat it properly, then try to step you back down.

What we look at

Your symptoms, their timing and what triggers them tell us most of what we need. We ask specifically about nighttime symptoms, whether food gets stuck, hoarseness, chronic cough and dental erosion, because reflux shows up in places people do not connect to their stomach.

A cough that has lasted months with a normal chest exam is reflux surprisingly often, and it also worsens asthma.

We review your medications closely. NSAIDs, calcium channel blockers, nitrates, some asthma inhalers, bisphosphonates, iron and potassium supplements all worsen reflux or cause ulcers outright. Swapping one sometimes solves the whole problem without any new prescription.

Testing for H. pylori is worth doing in anyone with ongoing upper abdominal symptoms, particularly with a family history of stomach cancer or in patients from higher-prevalence regions. It is treatable and it is underdiagnosed.

Alarm features

Some symptoms mean skipping straight to gastroenterology rather than trying a medication first.

• Difficulty swallowing, or food catching on the way down
• Unintentional weight loss
• Persistent vomiting
• Anemia, or black or bloody stools
• New onset after age 60
• A first-degree relative with esophageal or gastric cancer

We refer these promptly rather than treating and waiting to see what happens.

Treatment

Weight loss makes the biggest difference for most people, particularly weight around the middle, which physically increases pressure on the stomach. See obesity.

Raising the head of the bed by six inches works better than extra pillows, which mostly bend you at the waist and make it worse. Nothing to eat for three hours before lying down. Sleeping on your left side genuinely helps and costs nothing.

Medication follows. A proton pump inhibitor works best taken 30 to 60 minutes before a meal, not at bedtime, which is where most people take it and where it works least well. That single timing correction fixes a meaningful number of people who thought their medication had stopped working.

Stepping back down

After eight weeks of good control we try to reduce.

Some people move to on-demand dosing, some to an H2 blocker at night, some off entirely. We taper rather than stop cold to avoid rebound acid. If symptoms return every single time, that is useful information and we say so plainly rather than cycling you on and off indefinitely.

Long-term PPI use, honestly

The observational associations between long-term PPIs and kidney disease, fractures, dementia and B12 deficiency have been widely reported and are weaker than the headlines suggested.

For someone with Barrett’s esophagus or severe erosive disease, the benefit clearly outweighs the risk and stopping would be a mistake. For someone who started one for a bad month in 2018 and never stopped, the calculation is different. The point is that somebody should actually make that calculation.

Reflux is followed through our chronic condition management program. See our primary care Southlake practice overview.