I have had GERD for 12+ years. In my experience, you KNOW if you need the meds or not. I personally feel like I have a cotton ball stuck in my throat, I cough and cough, If I inhale too hard then I can feel the acid being inhaled too. I wake in the middle of the night coughing and vomitting. I lose my voice for long periods of time due to the acid irritating my vocal cords. I have even gotten chemical pneumonia from the stomach acid getting in my lungs.
My reflux has gotten worse with my surgery, so I avoid any tight clothes, all citrus and tomato products. No caffeine. And take two 40mg Prilosec a day. I knew it was a risk it would get worse, and I still feel the surgery was totally worth it!