What are the best treatments for heartburn / acid reflux?

In response to a question on healthshare.com.au

Treatments for acid reflux need to address both the symptoms of heartburn and regurgitation and the potential future health risks such as narrowings or cancers of the oesophagus.

Heartburn - the burning sensation or acid taste that can accompany reflux - can be treated symptomatically with antacids and lifestyle measures, as long as it is only an occasional problem.

Frequent heartburn symptoms - several times per week - are better treated with proton pump inhibitors (PPIs) to prevent long-term acid damage to the oesophagus. For many people with mild symptoms, an initial treatment course of 1-2 months is often enough to allow lifestyle changes (eg. weight loss and dietary modification) to take effect.

Regurgitation or volume reflux symptoms - where fluid comes up, or where someone wakes up coughing with reflux - may require surgery if PPIs and lifestyle changes are ineffective. Surgery (fundoplication) minimizes the amount of fluid coming up from the stomach into the oesophagus, whereas PPIs decrease the acid content of the fluid that comes up. PPIs are effective at relieving the burning caused by the acid, but not at stopping regurgitation.

New reflux symptoms, particularly when they occur in the 40s age group or older, can occasionaly be caused by cancers of the stomach or oesophagus. Other danger signs include difficulty swallowing, pain swallowing, unexplained weight loss, vomiting blood, or black bowel actions. If any of these occur it is important to see your doctor to look for the underlying cause, rather than treating the symptoms alone.

Lifestyle changes that can help include weight loss, avoiding smoking, avoiding alcohol, avoiding eating late at night, and decreasing the fat content of meals.