I am a 37-year-old with acid reflux disease. I take Prevacid every day. It works well, with no side effects. However, when I try to go off it, I get heartburn again. Do you think I will need to take this medication for the rest of my life? I have been told there are no long-term side effects, but I'm worried about taking a medication daily for 40 or 50 years.

Bill

Your doctor should have discussed with you the lifestyle changes you can make to reduce your acid reflux, in which stomach contents flow back up into the esophagus (swallowing tube), causing heartburn and other problems. (For more information, see my column on gastroesophageal reflux disease.) Now, brace yourself, because you are about to embark upon a HEALTHY LIFESTYLE.

1. Because reflux is more likely to occur when you are lying down, allow at least three, preferably four, hours to pass between your evening meal and bedtime. During this interval, you may drink water but nothing else. Your stomach is a stupid organ. When the least bit of food hits it, the stomach responds by producing an abundance of acid and digestive enzymes. By allowing a few hours to pass after your evening meal, you will give time for the stomach to empty before you are horizontal.
   
2. Modify the character of your evening meal. If possible, make your noon meal your heavy meal, so that you will be content with a lighter evening meal. Avoid fried or other fatty foods, because fat stimulates the stomach to secrete acid and digestive enzymes.
   
3. There is a muscular ring, or sphincter, between the stomach and the esophagus. It is called the "lower esophageal sphincter," or LES. Several substances are known to relax the LES. Caffeine, nicotine, chocolate and mint are the main culprits. Avoid all of these substances for at least four hours before bedtime. Alcohol is also a no-no.
   
4. Obesity contributes to the problem. If you are overweight, lose weight.
   
5. Elevate the head of your bed by putting books or cinder blocks under the two feet closest to the head. The goal is to elevate your esophagus and throat above the level of your stomach, so that gravity works in your favor. Sleeping on extra pillows will not help, because this usually serves only to flex the neck. You would get nothing but a stiff neck and a poor night's sleep for your troubles.
   

So, give up smoking, drinking, caffeine, chocolate and fatty foods, and lose weight! Some folks also recommend that you not wear tight-fitting clothes, but unless you wear a girdle or are trying to emulate John Travolta's character in Saturday Night Fever, I don't imagine that tight clothes contribute much to your reflux problem. Some experts also suggest avoiding acidic foods, such as tomato sauce or orange juice. Most people do not consume these foods in large quantities for their evening meal, so, as long as you take them in moderation, I think you will do all right.

Now let's say you do all of these things, and yet you still are dependent on medication to avoid heartburn. Will you need to stay on the medication for the rest of your life? Perhaps, but there are other options.

The usual recommendation is that you should be on Prevacid (lansoprazole) or Prilosec (omeprazole), medications that do an excellent job of blocking stomach acid production, for no more than three months before transitioning to a less "macho" reflux medication (with guidance from your doctor, of course). If you implement all the lifestyle changes noted above AND you are unable to get off Prevacid or Prilosec, further testing is warranted, because you may in fact have some serious condition causing (or caused by) reflux. If testing indicates that is the case, your doctor may recommend that you see a general surgeon for further care. It is impossible for me to predict what the surgeon would recommend in your case, but suffice it to say that general surgeons have, in their arsenal, surgical "fixes" for most reflux-related problems.