Treatment of reflux pharyngitis is divided into three levels, primary treatment: meal and lifestyle modification + acid suppressants; secondary treatment: primary treatment + histamine H2-receptor antagonists such as cimetidine, ranitidine, famotidine; tertiary treatment: anti-reflux surgery such as fundoplication, proton pump inhibitor (PPI) therapy such as omeprazole, emeprazole, lansoprazole, pantoprazole, rabeprazole. Details are as follows.
Primary treatment: anti-reflux therapy (ART).
A. Dietary modification.
1. Abstain from eating and drinking 3 hours before bedtime.
2.Avoid overfeeding or resting immediately after meals.
3.No fried food, less fat diet.
4.Avoid coffee, tea, chocolate, mint and carbonated drinks.
5.Avoid other foods and drinks containing caffeine.
6.Avoid drinking alcohol, especially in the evening.
7.Avoid other foods that may induce the disease.
B. Lifestyle modifications.
1.Elevate the head of the bed.
2. Avoid wearing tight clothes and scarves.
3. Quit smoking.
C. Antacid solution orally four times a day (one tablespoon after three meals and at bedtime).
Secondary treatment: medication + ART.
A. Primary treatment above + B or C (below).
B. Initial therapy: H2-receptor antagonist twice daily C. Treatment failure add-on: increase H2-receptor antagonist to 2x dose four times daily or use proton pump inhibitor (PPI).
Tertiary therapy: proton pump inhibitors or anti-reflux surgery.
A, Primary therapy above + B or C (below).
B, Proton pump inhibitor twice daily (morning and 5 pm, initial course of treatment for 6 months, with increased dose for overweight patients. (Patients must have improvement in symptoms for more than 2 months).
C. Anti-reflux surgery (fundoplication).