Treatment for Gastroesophageal Reflux Disease
Treatment for GERD varies depending on its severity. Conservative treatment often involves lifestyle changes to alleviate symptoms. Patients are encouraged to quit smoking, avoid excessive stooping or bending, maintain a healthy weight and wear loose-fitting clothing.
Changes in eating habits(e.g., eating smaller meals, waiting 3 or 4 hours after eating to lie down) also may help reduce symptoms. Avoid foods and beverages that trigger heartburn, such as
- fatty and fried foods
- carbonated beverages
Tomatoes and citrus foods also should be avoided, since acid from these foods can irritate the esophagus further.
Because GERD symptoms often increase when a person lies down, some physicians recommend raising the head of the bed about six inches so that gravity can help prevent reflux from rising into the esophagus.
Medications to Treat GERD
Antacids can help reduce heartburn symptoms by neutralizing the acid in the stomach, but they are not effective for treating esophageal irritation. Common side effects of antacids include diarrhea and constipation.
Other medications are available in over-the-counter and prescription formulas to treat GERD. In many cases, over-the-counter medications are about half the strength of prescription medications.
H-2 receptor blockers (e.g., Pepcid AC, Tagamet) can reduce the amount of acid reflux. These medications work more slowly than antacids, but provide longer relief. Side effects include dry mouth, dizziness, and drowsiness.
Proton pump inhibitors (e.g., Prilosec, Nexium, Prevacid, Aciplex, Zegerid; generic versions) inhibit acid production and give the esophagus a chance to heal. These medications are used daily for a short period of time (e.g., 14 days). Side effects include headache, stomach pain, and diarrhea. Proton pump inhibitors should only be used as directed by a physician. Long-term effects of these medications are not yet known.
In 2009, the U.S. Food and Drug Administration (FDA) approved the proton pump inhibitor (PPI) dexlansoprazole (Kapidex Delayed Release Capsules) treat GERD and reflux esophagitis, and to reduce chronic heartburn caused by acid reflux, as well as an over-the-counter strength of omeprazole (Zegerid OTC) to treat frequent heartburn. Kapidex, which is available in two doses and is taken once daily, provides two releases of medication. It can be taken for up to 4 weeks to reduce symptoms of GERD and can be used for as many as 6 months to treat esophagitis. Common side effects are similar to those caused by other proton pump inhibitors and include abdominal pain, nausea, and diarrhea.
In 2011, the FDA approved esomeprazole sodium (Nexium I.V.) injection to treat GERD patients who have a history of erosive esophagitis. This medication can be used up to 10 days and is administered either by once daily by intravenous injection or intravenous infusion. Side effects include headache, dry mouth, dizziness, and nausea.
Prokinetic agents (e.g., metoclopramide), which are available by prescription, may be used with H-2 receptor blockers to treat GERD. Instead of reducing or preventing acid production, these drugs help food move through the stomach more efficiently and can help strengthen the lower esophageal sphincter. These medications may cause nausea, diarrhea, confusion, sleeplessness, and depression.