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National Center for Complementary and Integrative Health

Gastroesophageal Reflux Disease (GERD) and Complementary Health Approaches

What’s the Bottom Line?

Talk to your health care provider if you experience symptoms such as heartburn or regurgitation (the feeling of food or liquid coming into the chest) that don’t get better.

  • Based on your symptoms, your health care provider may prescribe medications along with lifestyle changes.
  • If you have been diagnosed with gastroesophageal reflux disease (GERD), consult your health care provider before adding any complementary health products or practices to your management program.

How much do we know about the usefulness of complementary approaches for GERD?

A growing body of research shows that some complementary approaches, such as acupuncture, breathing exercises, and alginates (compounds found in brown algae or seaweed) may improve GERD symptoms and quality of life. 

Physical and Psychological Approaches

  • Acupuncture may be an effective treatment, alone or in conjunction with conventional therapies, to improve GERD-related symptoms such as heartburn and acid reflux.
  • Some studies suggest that breathing exercises, or diaphragmatic breathing training, can reduce GERD symptoms by strengthening the diaphragm and reducing acid in the esophagus, but more research is needed to be sure.
  • A few small studies suggest that hypnosis and relaxation techniques may improve GERD symptoms alone or in combination with medications for some patients. Larger, high-quality studies are needed to find out whether these methods are helpful in the long term.

Nutritional Approaches

  • Research shows that alginates, which are derived from carbohydrates found in brown algae or seaweed, are an effective treatment for reducing GERD symptoms by creating a foam or raft that rests over the gastric content in the esophagus to prevent reflux.
  • Only a few small studies have been conducted on melatonin for GERD symptoms, so there isn’t enough evidence to determine its effectiveness for this condition.

What do we know about the safety of complementary approaches for GERD?

  • Acupuncture is generally considered to be safe, and relatively few complications have been reported.
  • Diaphragmatic breathing has been shown to be a safe approach for managing GERD.
  • Alginates are considered to be safe, and no serious side effects have been reported.
  • Short-term use of melatonin supplements appears to be safe for most people, but information on the long-term safety of supplementing with melatonin is lacking. There’s not enough information yet about possible side effects of high-dose melatonin supplements to have a clear picture of overall safety.

What Is Gastroesophageal Reflux Disease (GERD)?

Gastroesophageal reflux disease (GERD) is a chronic digestive disorder that causes stomach contents to back up from the stomach into the esophagus. It happens when a muscle at the end of the esophagus, the tube that carries food from the mouth to the stomach, doesn’t close properly.

The most common symptoms of GERD are a burning sensation in the chest or back of the throat, called heartburn, and stomach contents coming back up through your esophagus and into your throat or mouth, called regurgitation. Many people experience both symptoms, but some can have one without the other. Other symptoms can include a dry cough, asthma symptoms, or trouble swallowing. 

More

Approximately 20 percent of the U.S. population has GERD. While almost everyone will experience heartburn from time to time, symptoms that occur more than twice a week are usually GERD and should be discussed with a health care provider.

Lifestyle modifications are the first steps for treating GERD. These include changing eating habits or avoiding certain foods, elevating the head of the bed for sleeping, reaching and maintaining a healthy weight, and quitting smoking. Over-the-counter antacids, histamine-2 (H2) blockers, and proton pump inhibitors (PPIs) can relieve heartburn symptoms. Read the labels carefully and talk with your health care provider about any prescription medications you use because of potential interactions. Contact your health professional if using over-the-counter medicines more than 2 weeks as prescription H2 blockers and PPIs may be necessary.

Several severe complications can occur for people with ongoing GERD, including:

  • Peptic stricture—This is a narrowing of the esophagus that causes difficulty swallowing and food “sticking” in the throat.
  • Barrett’s esophagus—The pink, smooth, flat lining of the esophagus changes to a thick, red lining. This condition can be a risk factor for esophageal cancer.
  • Esophageal cancer—If left untreated, GERD is a major risk factor for esophageal cancer.

Stress and anxiety can increase GERD symptoms, especially among people who do not respond well to PPI therapy.

About Complementary Health Approaches

Complementary approaches can be classified by their primary therapeutic input (how the therapy is taken in or delivered), which may be:

  • Nutritional (e.g., special diets, dietary supplements, herbs, probiotics, and microbial-based therapies).
  • Psychological (e.g., meditation, hypnosis, music therapies, relaxation therapies).
  • Physical (e.g., acupuncture, massage, spinal manipulation).
  • Combinations such as psychological and physical (e.g., yoga, tai chi, dance therapies, some forms of art therapy) or psychological and nutritional (e.g., mindful eating).

Nutritional approaches include what the National Center for Complementary and Integrative Health (NCCIH) previously categorized as natural products, whereas psychological and/or physical approaches include what was referred to as mind and body practices. 

What the Science Says About the Effectiveness and Safety of Complementary Health Approaches for GERD

Research has shown promising results for some complementary and integrative health approaches for treating GERD, especially in conjunction with conventional therapies.

Physical and Psychological Approaches

Acupuncture

There is some evidence that acupuncture, alone or in combination with medication, may reduce GERD symptoms.

  • A 2017 review of 12 studies with a total of 1,235 participants determined that participants who received acupuncture combined with standard medication had superior improvement of GERD symptoms and lower recurrence rates compared to those who received only standard medication.

Safety

  • Relatively few complications from using acupuncture have been reported. However, complications have resulted from use of nonsterile needles and improper delivery of treatments.
  • When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs, and injury to the central nervous system.
  • The U.S. Food and Drug Administration (FDA) regulates acupuncture needles as medical devices and requires that they be sterile and labeled for single use only.

Diaphragmatic Breathing

There is some evidence that diaphragmatic breathing exercises, a type of respiratory physiotherapy, can relieve mild GERD symptoms by strengthening the diaphragm and improving the function of the antireflux barrier.

  • A 2023 review of 11 studies found that diaphragmatic breathing and other respiratory physiotherapy improves GERD symptoms and, in some cases, may reduce PPI use.
  • A 2016 review of four prospective controlled trials found that breathing training had a positive effect on strengthening the diaphragm and reducing GERD symptoms. However, there is a lack of consensus on overall effectiveness due to differences in training methods and ways of measuring results.

Safety

  • Diaphragmatic breathing is considered to be a safe and cost-effective treatment for mild GERD with few side effects.

Other Physical and Psychological Approaches

  • A few small studies suggest hypnosis, relaxation techniques, and cognitive behavioral therapy (CBT) may help improve symptoms for some people who do not respond well to PPIs and may also have anxiety disorders or depression. 
  • A small study of 39 people with GERD and supragastic belching, which can have a significant impact on quality of life, found CBT relieved symptoms for up to 12 months.

Safety

  • Hypnosis, relaxation techniques, and CBT are considered to be safe.

Nutritional Approaches

There is limited research on the effectiveness of nutritional approaches for treating GERD, including alginates, melatonin, probiotics, dietary supplements, and Chinese herbal medicine.

Alginates

There is evidence that alginates, which are derived from carbohydrates found in brown algae or seaweed, may control and relieve GERD symptoms. 

  • A 2017 review of 14 studies found alginate-based therapies were superior to either placebo or antacid therapy in 9 studies but were less effective compared to PPIs and H2 blockers used to treat GERD symptoms in 5 studies.

Safety

  • Alginates are considered to be safe, and no serious side effects have been reported.

Melatonin

There has been some interest in melatonin for treating GERD symptoms because it is synthesized in the gastrointestinal tract and aids in the movement of food through the body. 

  • Two small studies suggest that melatonin may be as or more effective than 20 mg of the PPI omeprazole in reducing symptoms. 
  • A separate small study suggests that combining 3 mg a day of melatonin with 20 mg a day of omeprazole may be more effective than omeprazole alone.

Safety

  • For melatonin supplements, particularly at doses higher than what the body normally produces, there’s not enough information yet about possible side effects to have a clear picture of overall safety. Short-term use of melatonin supplements appears to be safe for most people, but information on the long-term safety of supplementing with melatonin is lacking.
  • As with all dietary supplements, people who are taking medicine should consult their health care providers before using melatonin. In particular, people with epilepsy and those taking blood thinner medications need to be under medical supervision when taking melatonin supplements.
  • The 2015 guidelines by the American Academy of Sleep Medicine recommend against melatonin use by people with dementia.

More To Consider

  • If you have GERD, you may have to try a few treatments—lifestyle changes, medicines, physical/psychological approaches—to see what works best for you. See what your health care provider recommends.
  • If you’re considering a practitioner-provided complementary health practice such as acupuncture, ask a trusted source (such as the health care provider who treats your GERD or a nearby hospital) to recommend a practitioner. Find out about the training and experience of any practitioner you’re considering. NCCIH’s website offers some tips on how to find a complementary health practitioner.
  • Keep in mind that some dietary supplements can interact with medications or other dietary supplements. They also may contain ingredients not listed on the label. Your health care provider can advise you about potential interactions. If you’re pregnant or nursing a child, or if you’re considering using a dietary supplement for a child, it’s especially important to consult your (or the child’s) health care provider.
  • Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.

For More Information

NCCIH Clearinghouse

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226

Telecommunications relay service (TRS): 7-1-1

Website: https://www.nccih.nih.gov

Email: info@nccih.nih.gov (link sends email)

Know the Science

NCCIH and the National Institutes of Health (NIH) provide tools to help you understand the basics and terminology of scientific research so you can make well-informed decisions about your health. Know the Science features a variety of materials, including interactive modules, quizzes, and videos, as well as links to informative content from Federal resources designed to help consumers make sense of health information.

Explaining How Research Works (NIH)

Know the Science: How To Make Sense of a Scientific Journal Article

Understanding Clinical Studies (NIH)

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Health Information Center

The NIDDK Health Information Center provides information on diabetes, obesity and metabolic, endocrine, kidney, urologic, liver and gastrointestinal diseases.

Phone Number: 1-800-860-8747

Website: https://www.niddk.nih.gov

Email: healthinfo@niddk.nih.gov (link sends email)

PubMed®

A service of the National Library of Medicine, PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Approaches on PubMed.

Website: https://pubmed.ncbi.nlm.nih.gov/

Key References

Other References

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  • Andersen LPH, Gögenur I, Rosenberg J, et al. The safety of melatonin in humans. Clinical Drug Investigation. 2016;36:169-175.
  • Auger RR, Burgess HJ, Emens JS, et al. Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24-hour sleep-wake rhythm disorder (N24SWD), and irregular sleep-wake rhythm disorder (ISWRD). An update for 2015: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2015;11(10):1199-1236.
  • Badillo R, Francis D. Diagnosis and treatment of gastroesophageal reflux disease. World Journal of Gastrointestinal Pharmacology and Therapeutics. 2014;5(3):105-112.
  • Bäumler P, Zhang W, Stübinger T, et al. Acupuncture-related adverse events: systematic review and meta-analyses of prospective clinical studies. BMJ Open. 2021;11(9):e045961.
  • Chan MWC, Wu XY, Wu JCY, et al. Safety of acupuncture: overview of systematic reviews. Scientific Reports. 2017;7(1):3369.
  • Chandran S, Raman R, Kishor M, et al. The effectiveness of mindfulness meditation in relief of symptoms of depression and quality of life in patients with gastroesophageal reflux disease. Indian Journal of Gastroenterology. 2019;38(1):29-38. 
  • Costello RB, Lentino CV, Boyd CC, et al. The effectiveness of melatonin for promoting healthy sleep: a rapid evidence assessment of the literature. Nutrition Journal. 2014;13:106.
  • Dai YK, Wu YB, Wen H, et al. Different traditional herbal medicines for the treatment of gastroesophageal reflux disease in adults. Frontiers in Pharmacology. 2020;11:884.
  • Freeman MP, Fava M, Lake J, et al. Complementary and alternative medicine in major depressive disorder: the American Psychiatric Association task force report. Journal of Clinical Psychiatry. 2010;71(6):669-681.
  • Glasinovic E, Wynter E, Arguero J, et al. Treatment of supragastric belching with cognitive behavioral therapy improves quality of life and reduces acid gastroesophageal reflux. The American Journal of Gastroenterology. 2018;113(4):539-547.
  • Grigg-Damberger MM, Ianakieva D. Poor quality control of over-the-counter melatonin: what they say is often not what you get. Journal of Clinical Sleep Medicine. 2017;13(2);163-165.
  • Herxheimer A. Jet lag. BMJ Clinical Evidence. 2014;2014:2303.
  • Kandil TS, Mousa AA, El-Gendy AA, et al. The potential therapeutic effect of melatonin in gastro-esophageal reflux disease. BMC Gastroenterology. 2010;10:7.
  • Malekpour H, Noori A, Abdi S, et al. Is the addition of sublingual melatonin to omeprazole superior to omeprazole alone in the management of gastroesophageal reflux disease symptoms: a clinical trial. Turkish Journal of Gastroenterology. 2023;34(12):1206-1211.
  • Mandel KG, Daggy BP, Brodie DA, et al. Review article: alginate-raft formulations in the treatment of heartburn and acid reflux. Alimentary Pharmacology & Therapeutics. 2000;14(6):669-690.
  • MedlinePlus. GERD (gastrointestinal reflux disease). Accessed at medlineplus.gov/gerd.html on August 2, 2023.
  • Pereira RS. Regression of gastroesophageal reflux disease symptoms using dietary supplementation with melatonin, vitamins and aminoacids: comparison with omeprazole. Journal of Pineal Research. 2006;41(3):195-200.
  • Teschke R, Wolff A, Frenzel C, et al. Herbal traditional Chinese medicine and its evidence base in gastrointestinal disorders. World Journal of Gastroenterology. 2015;21(15):4466-4490.
  • U.S. Food and Drug Administration. Over-The-Counter (OTC) Heartburn Treatment. U.S. Food and Drug Administration website. Accessed at fda.gov/drugs/understanding-over-counter-medicines/over-counter-otc-heartburn-treatment on November 22, 2023.
  • Xu S, Wang L, Cooper E, et al. Adverse events of acupuncture: a systematic review of case reports. Evidence-based Complementary and Alternative Medicine. 2013;2013:581203.
  • Zhu J, Guo Y, Liu S, et al. Acupuncture for the treatment of gastro-oesophageal reflux disease: a systematic review and meta-analysis. Acupuncture in Medicine. 2017;35:316-323.

Acknowledgments

NCCIH thanks D. Craig Hopp, Ph.D., and David Shurtleff, Ph.D., NCCIH; Susan Boswell-Maier, National Institute of Diabetes and Digestive and Kidney Diseases; and Michelle Dossett, M.D., Ph.D., M.P.H., University of California at Davis, for their review of this fact sheet. 

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.

Last Updated: August 2024