Gastroesophageal Reflux Disease Treatment Options
There are four types of treatments for GERD: lifestyle measures, medication, surgery, and endoscopic procedures. Treating GERD is important. Untreated GERD can lead to serious complications, such as
- esophageal ulcers (non-healing mucosal defects)
- esophageal strictures
- Barrett's esophagus (a disorder of the cells lining the esophageal mucosa, which may lead to cancer)
- esophageal cancer
Lifestyle Measures to Treat GERD
The treatment of GERD starts with lifestyle measures, which may eliminate symptoms in some people with mild reflux. Traditionally, doctors recommend avoiding large meals that can increase pressure in the stomach and promote reflux. Acidic foods (tomato-based products and citrus fruits, for example) and spicy foods can irritate an inflamed esophagus. Peppermint, spearmint, chocolate, cinnamon, coffee, and tea can reduce the pressure in the lower esophageal sphincter and promote reflux. Carbonated beverages can worsen reflux by increasing pressure in the stomach.
Conflicting studies about the effects of these foods on GERD, however, have cast some doubt on the subject. The only lifestyle interventions that consistently relieve GERD symptoms are sleeping with the head of the bed elevated and losing weight. It also may help to avoid lying down for three hours after a meal; eat small, frequent meals instead of fewer, larger ones; and wear loose-fitting clothing.
Medication to Treat GERD
If lifestyle modifications do not eliminate all of your symptoms, your doctor will recommend that you take medication to neutralize or decrease acid production in the stomach. These medications include
- histamine H2-receptor antagonists (also known as H2-blockers)
- foaming agents
- mucosal protectants
- proton pump inhibitors
- promotility agents
Sometimes a single medication will work, but if it doesn't control your symptoms, you may need to take a second medication. Keep in mind, however, that there are concerns over long-term suppression of gastric acid using proton pump inhibitors, particularly that it could lead to bone fractures and infection.
Antacids. Over-the-counter antacids containing aluminum oxide, magnesium carbonate, and sodium bicarbonate (for example, Gaviscon, Gelusil, Maalox, Mylanta) rapidly neutralize stomach acid and are taken after meals when you experience heartburn. These medications provide fast relief, but their effect is short lived.
H2-blockers. Over-the-counter or prescription H2-blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), have a longer effect on gastric acid than antacids. They usually need to be taken twice a day. A combination antacid/H2-blocker, Pepcid Complete, also appears to be more effective at relieving symptoms than H2-blockers or antacids alone.
Mucosal protectants. A prescription mucosal protectant called sucralfate (Carafate), which is taken one hour before a meal, coats the esophagus and increases its resistance to reflux from the stomach.
Proton pump inhibitors. These prescription drugs are the most potent suppressors of gastric acid secretion and include
- esomeprazole (Nexium), generic version first approved by the FDA in January 2015
- lansoprazole (Prevacid)
- omeprazole (Prilosec, Zegerid)
- pantoprazole (Protonix)
- rabeprazole (Aciphex; generic versions first approved by the FDA in November 2013)
- dexlansoprazole (Dexilant)
- omeprazole/sodium bicarbonate combination (Zegerid)
They have a long-lasting effect and need to be taken only once a day. Prilosec and Prevacid 24HR are available over the counter.
Promotility agents. The effects of H2-blockers and proton pump inhibitors can be enhanced by taking a promotility agent, such as metoclopramide (Reglan) or bethanechol (Urecholine). This medication increases acid clearance from the esophagus, raises the pressure of the lower esophageal sphincter, and speeds emptying of the stomach.
Updated by Remedy Health Media