From the Guidelines
Apple cider vinegar is not recommended as a treatment for acid reflux due to its acidic nature and lack of scientific evidence supporting its effectiveness. For acid reflux management, proven approaches include lifestyle modifications such as avoiding trigger foods, eating smaller meals, not lying down after eating, elevating the head of your bed, maintaining a healthy weight, and quitting smoking 1. According to the AGA clinical practice update on the diagnosis and management of extraesophageal gastroesophageal reflux disease, lifestyle modification measures including avoidance of refluxogenic foods, food avoidance for at least 2–3 hours before recumbency, positional changes during the sleep period, and weight loss have been proposed for management of GERD 1.
Some key lifestyle modifications that can help manage acid reflux include:
- Avoiding food intake before recumbency
- Elevating the head of the bed
- Sleeping in the left lateral decubitus position
- Weight loss, as obesity is significantly associated with reflux symptoms and erosive esophagitis 1
- Avoiding trigger foods that consistently and predictably lead to worsening of symptoms
Over-the-counter medications like antacids, H2 blockers, or proton pump inhibitors are effective for symptom relief, and work by either neutralizing stomach acid or reducing its production 1. If reflux symptoms persist for more than two weeks despite these measures, it's essential to consult a healthcare provider as chronic reflux can lead to complications like esophageal damage. A precision approach to escalation of management is suggested for patients with ongoing symptoms despite these measures, which should be driven by integrity of the anti-reflux barrier, presence of visceral hypersensitivity and hypervigilance, confirmation of PPI refractory-GERD, symptom profile, body mass index, and esophageal motor function 1.
From the Research
Apple Cider Vinegar and Reflux
- There is limited research on the effectiveness of apple cider vinegar in treating gastroesophageal reflux disease (GERD) 2.
- A 2019 study published in Current Gastroenterology Reports mentions apple cider vinegar as a popular remedy for esophageal symptoms, including reflux, but notes that there is a substantial gap between anecdotal and empirical understandings of its effectiveness 2.
- The study suggests that apple cider vinegar may have potential benefits, but more research is needed to fully understand its effects on GERD symptoms.
Treatment Options for GERD
- Proton pump inhibitors (PPIs) are the most common treatment for GERD, but long-term use has raised concerns about potential adverse effects 3, 4.
- Lifestyle changes, such as weight loss and smoking cessation, can also be effective in managing GERD symptoms 4.
- Surgical options, including laparoscopic fundoplication, are available for select patients, but are typically considered after other treatments have failed 4.
Pathophysiology of GERD
- GERD is a complex disorder involving an interplay of chemical, mechanical, psychologic, and neurologic mechanisms 5.
- The pathogenesis of GERD involves factors related to the refluxate, esophageal defenses, and factors that promote pathologic reflux into the esophagus 5.
- Understanding the pathophysiology of GERD is essential for developing effective treatment strategies.