Heartburn, also known as gastroesophageal reflux disease, or GERD, affects 40 percent of Americans once a month, and some suffer from it daily. It usually causes a burning pain in the middle of the chest, and is often worse when the person is lying down. The condition also often comes with an acid, sour or bitter taste. GERD can cause asthma, chronic cough, morning hoarseness or chest pain.

What can help quell it? Lose weight and elevate the head of your bed about four to six inches.

Some doctors recommend that GERD sufferers avoid things that loosen the valve between the stomach and esophagus, such as smoking, chocolate, alcohol and mints. However, there have never been randomized trials (the most accurate kind of scientific study) on the effects of reducing coffee, alcohol or fatty food intake on GERD symptoms, so we don't know for sure if reducing consumption of these things would really work to ease the condition.

To avoid stimulating reflux, it's best to avoid tight clothing, particularly around the abdomen. Avoid anti-inflammatory drugs such as aspirin, ibuprofen and naproxen, which can irritate the gastrointestinal tract. Tylenol (acetaminophen), however, is OK.

You can try over-the-counter antacid medicines such as Pepcid, Tagamet, Zantac or, strongest of all, Omeprazole.

Six percent of people with significant heartburn have unrecognized pre-cancerous changes in their lower food tube, a condition called Barrett's esophagus.

Of people who have Barrett's esophagus, 1 percent to 2 percent will develop cancer each year. At highest risk are those who get GERD in their youth, or those who have severe symptoms.

To detect Barrett's, you're given a sedative, then an endoscope — a thin, flexible tube with a tiny camera — is inserted down your throat. Endoscopy should be done for those with continuous GERD symptoms. It's often done on people who have had frequent heartburn for 10 or more years, and is done as soon as possible on those who experience pain when swallowing, weight loss, anemia or bleeding.

What about laparoscopic surgery, in which the top part of the stomach is wrapped around the food tube, to strengthen the valve? Some experts feel that the risk of a complication or death, though small, outweighs its benefits compared with drug therapy.

Complications such as trouble swallowing, inability to belch, diarrhea and flatulence may develop in up to 30 percent of patients after surgery. Another study found that 62 percent of patients who underwent surgery were still taking heartburn drugs 10 years later. So I would stick with drugs if possible.

Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.