Gastroesophageal Reflux Disease (GERD) - Treatment Overview

Treatment Overview

Treatment for gastroesophageal reflux disease (GERD) is aimed at reducing the abnormal backflow, or reflux, of stomach acid and juices into the esophagus; preventing injury to the lining of the esophagus or helping it to heal if injury has already occurred; preventing GERD from recurring; and preventing other conditions that might arise as complications of GERD.

Initial treatment

Treatment for people who have symptoms of gastroesophageal reflux disease (GERD) begins with making lifestyle changes and taking antacids, or nonprescription medicines that reduce or block acid. These include H2 blockers (for example, Pepcid) or a proton pump inhibitor (for example, Prilosec OTC). Frequent or severe GERD symptoms usually require stronger prescription medications along with lifestyle changes for successful treatment. When prescription medications are used to treat GERD symptoms:

• You may need to try different medications or combinations of medications before finding the one that best relieves your symptoms.
• The dose or frequency may need to be gradually increased until the most effective dose for you is found.
• Long-term—perhaps for the rest of your life—medication therapy is usually necessary to treat severe, persistent symptoms or complications of GERD.

Prescription medications for GERD include proton pump inhibitors (such as Nexium and Prilosec) and H2 blockers (such as Pepcid and Tagamet). Many of these medications are available in both prescription and nonprescription strength. For example, Prilosec OTC, the nonprescription version of omeprazole, is available for the treatment of GERD.

If symptoms are severe or have been present for a long time, your doctor may order an upper gastrointestinal endoscopy (esophagogastroduodenoscopy, or EGD). This test can help your doctor detect Barrett's esophagus, a change in the cells of the esophagus brought on by long-term exposure of the esophagus to stomach juices, or stricture, a narrowing of the esophagus. Barrett's esophagus increases the risk of cancer of the esophagus.

An important part of treating GERD is avoiding the things that stimulate your symptoms. These include foods such as spicy or fatty foods, chocolate, drinks that contain caffeine or alcohol, behaviors such as smoking, and taking nonsteroidal anti-inflammatory drugs (NSAIDs) or other medications that increase symptoms.

Fundoplication surgery, which strengthens the valve between the stomach and the esophagus, may be used to treat GERD if lifestyle changes don't help or if treatment with medications does not relieve your symptoms.

Ongoing treatment

If medications and lifestyle changes control symptoms of gastroesophageal reflux disease (GERD), you will likely continue the same treatment. It is important that you continue to take medications as instructed by your health professional, since stopping therapy will often bring symptoms back.

Usually, basic treatments like lifestyle changes and taking antacids, or nonprescription medicines that reduce or block acid, are tried first before changing the treatment to prescription versions of these medicines. The nonprescription medicines include H2 blockers (for example, Pepcid) or a proton pump inhibitor (for example, Prilosec OTC). Each treatment should be tried for about 2 months before a new one is tried. The approach your doctor chooses will depend on the cause of your GERD, the symptoms you are having, and how severe they are. You and your doctor will also need to balance the effectiveness and safety of various treatments against the costs.

If you have also been diagnosed with Barrett's esophagus, a change in the cells of the esophagus brought on by long-term exposure of the esophagus to stomach juices, this condition may need to be monitored. Your health professional may refer you to a specialist for an upper gastrointestinal endoscopy (esophagogastroduodenoscopy). Treatment after this exam will depend on the results. Talk to your health professional about whether you should have follow-up exams to monitor your condition.

Treatment if the condition gets worse

If your symptoms of gastroesophageal reflux disease (GERD) do not improve with treatment, or if complications develop, you may begin to take your medication more often, or you may be switched to a stronger medication. Your health professional may reevaluate your diet and lifestyle as well.

Depending on your symptoms your health professional may refer you to a specialist for an upper gastrointestinal endoscopy (esophagogastroduodenoscopy) to test for Barrett's esophagus, a change in the cells of the esophagus brought on by long-term exposure of the esophagus to stomach juices. He or she may also conduct tests such as an abdominal ultrasound, which can provide pictures of structures and organs in the abdomen, to rule out other causes of your symptoms, including problems with your gallbladder.

Surgery may be an option when:^{5, 6}

• Treatment with medications does not completely relieve your symptoms, and the remaining symptoms are proved to be caused by reflux of stomach juices.
• You do not want or, because of side effects, you are unable to take medications over an extended period of time to control GERD symptoms and you are willing to accept the risks of surgery.
• You have complications such as asthma, hoarseness, or cough along with reflux that do not improve when treated with medications.

Your health professional may conduct other esophageal tests, such as esophageal manometry. This test can detect spasms of the esophagus and problems with the ability of the esophagus to move food down to the stomach (motility problems). Manometry is the most useful test for these purposes.

What To Think About

Up to 80% of pregnant women have symptoms of GERD during pregnancy.¹ Heartburn is common during pregnancy because hormones cause the digestive system to slow down. The muscles that push food down the esophagus also move more slowly during pregnancy. In addition, as the uterus grows, it pushes on the stomach and sometimes forces stomach acid up into the esophagus. Some medications used to treat symptoms of GERD may not be used during pregnancy.

Many people who develop GERD have the condition for the rest of their lives. Depending on the severity of your symptoms, medications may need to be taken on a daily basis or only occasionally when GERD symptoms occur. Long-term—often lifelong—medication treatment is usually required for GERD symptoms that are more severe because symptoms tend to return (recur) when medication treatment is stopped. Even when symptoms can be controlled with lifestyle changes or nonprescription medications, these treatments need to be maintained over the long term to prevent GERD symptoms from recurring.

Surgery may be effective in controlling GERD symptoms, but the risks of failure, complications, and side effects associated with surgery need to be considered carefully.

Should I use medications or surgery to treat gastroesophageal reflux disease (GERD)?