How is GERD treated?
Treatment for GERD may involve one or more of the following, depending on the severity of symptoms: lifestyle changes, medications, or surgery.
Lifestyle Changes
Some people can reduce GERD symptoms by
Medications
People can purchase many GERD medications without a prescription; however, people with persistent symptoms should still see a health care provider.
Antacids, which include over-the-counter medications such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan, are a first-line approach health care providers usually recommend to relieve heartburn and other mild GERD symptoms. Antacids, however, can have side effects, including diarrhea and constipation.
H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), decrease acid production. These medications are available in both over-the-counter and prescription strengths. H2 blockers provide short-term or on-demand relief and are effective for many people with GERD symptoms. They can also help heal the esophagus, although not as well as proton pump inhibitors (PPIs).
PPIs include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are available by prescription. Omeprazole and lansoprazole also come in over-the-counter strength. PPIs are more effective than H2 blockers and can relieve symptoms and heal the esophageal lining in most people with GERD. Health care providers most commonly prescribe PPIs for long-term management of GERD. However, studies show people who take PPIs long term or in high doses are more likely to have hip, wrist, and spinal fractures. People should take these medications on an empty stomach in order for stomach acid to activate them.
Prokinetics, which include bethanechol (Urecholine) and metoclopramide (Reglan), help make the stomach empty faster. However, both bethanechol and metoclopramide have side effects that often limit their use, including nausea, diarrhea, tiredness, depression, anxiety, and problems with physical movement. Prokinetics can interact with other medications, so people taking prokinetic agents should tell their health care provider about all medications they are taking.
Antibiotics, including one called erythromycin, have been shown to improve gastric emptying. Erythromycin has fewer side effects than bethanechol and metoclopramide; however, like all antibiotics, it can cause diarrhea.
All of these medications work in different ways, so combinations of medications may help control symptoms. People who get heartburn after eating may take antacids and H2 blockers. The antacids neutralize stomach acid, and the H2 blockers stop acid production. By the time the antacids stop working, the H2 blockers have stopped acid production.
Surgery
When a person cannot manage severe GERD symptoms through medication or lifestyle changes, Dr. Jones may recommend surgery. Dr. Jones may also recommend surgery for GERD that results from a physical abnormality or for GERD symptoms that lead to severe respiratory problems. Fundoplication is the standard surgical treatment for GERD and leads to long-term reflux control in most cases. Dr. Jones may also use endoscopic techniques to treat GERD. People are more likely to develop complications from surgery than from medications. Anti-reflux surgery is most successful in people younger than 50.
Fundoplication is an operation to sew the top of the stomach around the esophagus to add pressure to the lower end of the esophagus and reduce reflux. A surgeon performs fundoplication using a laparoscope, a thin tube with a tiny video camera attached used to look inside the body.
Endoscopic techniques, such as endoscopic sewing and radiofrequency, help control GERD in a small number of people. Endoscopic sewing uses small stitches to tighten the sphincter muscle. Radiofrequency creates heat lesions that help tighten the sphincter muscle. Surgery for both techniques requires an endoscope. Although the devices for these procedures are approved, results may not be as good as laparoscopic surgery, and these procedures are not commonly used.
