GERD Treatment
At present time there is no real cure for GERD. In most cases GERD is a chronic condition. However, it can be effectively managed with medications and lifestyle changes in most cases. In severe cases, surgery is an option.
People with heartburn should first try lifestyle and dietary changes.
- Avoid or reduce consumption of foods and beverages that contain caffeine, chocolate, peppermint, spearmint, and alcohol. All carbonated drinks increase the risk for GERD. Alcohol often provokes heartburn, by compromising the lower esophageal sphincter (LES), irritating the esophagus, and by stimulating stomach acid production.
- Avoid fatty or spicy foods.
- Don’t eat large meals. Eating a lot of food at one time increases the amount of acid needed to digest it. Eat smaller, more frequent meals throughout the day.
- Avoid bedtime snacks. In general, avoid eating for at least two hours prior to bedtime. If you don't eat, your body isn't making acid to digest the food.
- When going to bed, try lying on the left side rather than on the right. The stomach is located higher than the esophagus when a person sleeps on the right side, which can put pressure on the LES, increasing the risk for fluid back-up.
- Gravity helps prevent reflux. Maintaining an upright posture until the meal is digested may prevent the heartburn.
- If heartburn occurs regularly at night, consider raising the head of the bed. Sleep in a tilted position can help keep acid in the stomach at night. Raise the bed at an angle using four -to six- inch blocks at the head of the bed and use a wedge-support to elevate the top half of the body.
- Stop smoking. Smoking weakens the lower esophageal sphincter and increases reflux.
- Lose weight if needed. Being overweight can promote reflux. Excess abdominal fat puts pressure on the stomach and the loss of even a moderate amount of weight makes many people feel better.
- Wear loose-fitting clothes.
- Avoid lying down for 3 hours after a meal.
- Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts—just using extra pillows will not help.
Medication treats the symptoms of chronic heartburn, but it does not repair any of the defects or abnormalities that cause the symptoms.
Antacids
Antacids were the standard treatment in the 1970s. Antacids remain the drugs
of choice for quick relief of heartburn and other mild GERD symptoms. These
agents work by neutralizing acid and coating the stomach. Although antacids
are effective in relieving symptoms, they are not used as sole agents for
achieving esophageal healing because of the high dosage requirements and
consequent lack of patient compliance.
Antacids should be taken 1 hour after meals or when gastroesophageal reflux disease symptoms occur. Liquid antacids usually work faster than tablets or chewables. If symptoms occur soon after meals, they should be taken before the meal.
Antacids are useful because they relieve symptoms rapidly. But relief is only temporary. Antacids containing calcium carbonate are the most potent in neutralizing stomach acid. Popular brands are Tums, Titralac, Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Rolaids, Riopan.
Antacids have side effects. Common side effects include changes in the color of bowel movements, constipation, diarrhea, and stomach cramps. Rare side effects include loss of appetite, vomiting, and weakness. Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.
Histamine H2-receptor blockers
Before proton pump inhibitors were introduced, H2-receptor blockers
were the agents of choice for treating reflux symptoms and healing esophagitis.
They remain the mainstay of pharmacologic treatment. H2-receptor blockers
act by inhibiting histamine stimulation of the gastric parietal cell, thereby
suppressing gastric acid secretion.
Histamine H2-receptor blockers are the first line agents for patients with mild-to-moderate symptoms and grades I-II esophagitis. Histamine H2-receptor blockers are effective for healing only mild esophagitis in 70-80% of patients with GERD and for providing maintenance therapy to prevent relapse.
Four over-the-counter H2-receptor blockers are currently available in the United States: Nizatadine (Axid AR), Famotidine (Pepcid AC), Cimetidine (Tagamet HB), Ranitidine (Zantac 75). These agents are indicated for the prevention and relief of heartburn, acid indigestion and sour stomach. They are available in half of the dosage strength of the prescription products. Although over-the-counter H2-receptor blockers do not act as rapidly as antacids, they provide longer relief of symptoms. Because of their slower onset of action, H2-receptor blockers are primarily used to prevent GERD symptoms.
H2-receptor blockers are fairly well tolerated and rarely require discontinuation secondary to adverse effects. The most common adverse effects are headache, diarrhea, nausea, constipation, sore throat, and runny nose. Rare side effects include agitation, anemia, blood disorders, joint pain, kidney disorders, rapid heartbeat, and sleepiness.
Proton pump inhibitors
Proton pump inhibitors are the most powerful medications available. They
should be used only when GERD has been objectively documented. These drugs
strongly inhibit gastric acid secretion. They work by blocking the site
of acid production in the parietal cell of the stomach. By blocking the
final common pathway of gastric acid secretion, the proton pump inhibitors
provide a greater degree and duration of gastric acid suppression compared
with H2-receptor blockers. Clinical trials have clearly shown that the proton
pump inhibitors provide better symptom control, esophageal healing and maintenance
of remission than either H2-receptor blockers or prokinetic agents.
There are five proton pump inhibitors available in the United States: meprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium). These drugs are available by prescription. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms in almost everyone who has GERD. All five medications heal esophagitis in 90-94% of patients. There are no significant differences in overall healing and symptom improvement rates between the five medications.
Proton pump inhibitors are fairly well tolerated. The most common side effects are nausea, diarrhea, constipation, headache and skin rash. Prolonged use of the drugs has been associated with gastric atrophy; however, atrophy is more likely to be a problem in patients infected with Helicobacter pylori.
Prokinetic Agents
Prokinetic agents improve the motility of the esophagus and stomach. These
agents increase both gastric emptying and lower esophageal sphincter pressure.
This group includes bethanechol (Urecholine) and metoclopramide (Reglan).
Long-term use of prokinetic agents may have serious, even potentially fatal, complications and should be discouraged.
Antireflux surgery (Nissen fundoplication) is the standard surgical treatment for GERD. Nissen fundoplication was developed and named after a German Surgeon, Rudolf Nissen, born 1896. Nissen fundoplication surgery is an operation for gastroesophageal reflux disease that wraps the upper part of the stomach (fundus) around the esophagus in order to prevent reflux.
Surgery is never the first option for treating gastroesophageal reflux disease. It is an option when medicine and lifestyle changes do not work. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort. This surgery is successful for more than 85% of people. However it does not cure the underlying problem.
Indications for surgery include the following:
- Patients with symptoms that are not completely controlled by proton pump inhibitor therapy can be considered for surgery. Surgery can also be considered in patients with well-controlled disease who desire definitive, one-time treatment.
- The presence of Barrett esophagus is an indication for surgery. Whether acid suppression improves the outcome or prevents the progression of Barrett esophagus remains unknown, but most authorities recommend complete acid suppression in patients with histologically proven Barrett esophagus.
- The presence of extraesophageal manifestations of GERD may indicate the need for surgery. These include respiratory manifestations (eg, cough, wheezing, aspiration); ear, nose, and throat manifestations (eg, hoarseness, sore throat, otitis media); dental manifestations (eg, enamel erosion).
Surgical treatment for GERD is typically not recommended for:
- Older adults, especially if other health problems exist
- People who have weak peristalsis in the esophagus
- People who have unusual symptoms that may be made worse by surgery
More information about GERD:
- What is Gastroesophageal reflux disease, Causes, Risk Factors
- Digestinol is used to treat and relieve the symptoms associated with GERD