Alternatively, barium study with air contrast, although somewhat less sensitive, is usually reliable in diagnosing erosive esophagitis, ulceration or stricture. It has been suggested that GERD is a problem which is symptomatic by day but in which much damage is done by night. In many patients, GERD is a chronic, relapsing disease. Long term maintenance is the key to therapy. Alternatively, one may use an under mattress foam wedge to elevate the head about 6-10 inches.
Pillows are worthless for elevating the head.
Avoiding recumbancy for two hours after eating and not eating for at least two hours before bedtime. Relief of symptoms and healing of esophagitis is usually obtainable only in patients with mild to moderate symptoms or mild esophagitis. Unfortunately, recurrence is also common when they are tapered or discontinued and too often physicians tend to rely on pharmacologic measures while ignoring proven simple measures such as bed elevation and dietary precautions. The need for stricture dilation is also reduced with these agents. Omeprazole was recently approved for up to one year of maintenance therapy.