Managing acid reflux with less

Q: I have had acid reflux off and on, but it has been better recently. About a year ago, a doctor looked into my esophagus and stomach (upper endoscopy). My esophagus was inflamed, and I was told to take Aciphex indefinitely. I rarely have heartburn. I don't want to take this medicine forever.

A: Aciphex is a proton pump inhibitor. Drugs in this class are the most potent acid inhibitors. Other proton pump inhibitors include generic omeprazole, generic pantoprazole, Prilosec, Protonix, Prevacid and Nexium.

There is no simple yes or no answer to your question, but here is how I approach this common situation:

My recommendation depends on more detail. Was the heartburn present for a long time before the endoscopy? Did you start the Aciphex, which is a proton pump inhibitor that is a potent stomach acid blocker, many weeks before the endoscopy?

The reason for these questions is to get a better picture of the severity of your esophageal inflammation (esophagitis). If your reflux was severe or you had been on treatment for a few weeks before the endoscopy, I likely would recommend continuing acid blocker therapy.

If the inflammation was severe, then prolonged therapy with a proton pump inhibitor, such as Aciphex, is warranted. Treating esophagitis is not just about controlling symptoms. Persistent inflammation of the esophagus from acid reflux can lead to scarring and narrowing of the lower esophagus. It also increases your risk of developing Barrett's esophagus, which can lead to cancer.

Most people with acid reflux, however, can step down to less potent anti-acid medications. If you and your doctor decide it's the right time to make a change from Aciphex, you will want to wean yourself off the medication. You don't want to just stop it abruptly because you would likely get rebound heartburn; your body is used to the acid blocker.

If you take Aciphex, or another proton pump inhibitor, twice a day, your doctor may suggest decreasing it to once per day. If you already take it once per day, you might take it every other day instead. On the "off" days, use an H2 blocker or antacids. Continue to slowly taper the medications.

Losing weight, not lying down after eating, and avoiding foods that typically cause your heartburn often helps.

Assuming the heartburn does not return when you taper off the medication, you and your doctor can decide if another endoscopy is warranted to make sure the esophagitis has healed.

Today's Medicine Cabinet was written by Howard LeWine, M.D., chief medical editor of Internet Publishing at Harvard Health Publications, Harvard Medical School. For more on consumer health, , visit health.harvard.edu.