Summary

GERD is a common, chronic, and relapsing condition that affects most Americans at some point in their life. In addition to standard pharmacotherapy with H2RAs and PPIs, botanical demulcents may serve as a reasonable adjunctive therapy for symptomatic improvement of heartburn and regurgitation.
Commonly used demulcents, including licorice, marshmallow, and slippery elm, as well as other natural products including ginger and apple cider vinegar, are generally regarded as safe and effective in the treatment of GERD.
While there is little rigorous evidence to support the use of lifestyle modifications in the symptomatic treatment of GERD, expert opinion recommends the encouragement of such changes.
Patients on chronic PPI therapy should be re-evaluated periodically to determine necessity of prolonged therapy, coupled with a discussion of potential risk associated with these medications.
Patients who experience any of the alarm signs or symptoms associated with GERD should be promptly referred to a gastroenterologist for an endoscopic evaluation.