Conditions in Depth

This page contains the basic information about Gastroesophageal Reflux Disease (GERD) .

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Gastroesophageal Reflux Disease (GERD)

Treatment

Treatment for most people with GERD includes lifestyle changes as described above and medication. If symptoms persist, surgery or endoscopy treatments are other options.

There are several medications that can be used to treat GERD. They include:

• Over-the-counter acid buffers — Buffers that neutralize acid include Mylanta, Maalox, Tums, Rolaids, Gaviscon and others. The liquid forms of these medications work faster, but the tablets may seem more convenient to you. Because antacids that contain magnesium can cause diarrhea and antacids that contain aluminum can cause constipation, your doctor may advise you to alternate antacids to avoid these problems. These medicines work for a short time and they do not heal the inflammation of the esophagus.

• Over-the-counter H2 blockers — These drugs work by causing the stomach to make less acid, and they are effective in patients with mild to moderate symptoms. They include famotidine (Pepcid AC), cimetidine (Tagamet HB) and ranitidine (Zantac 75).

• Over-the-counter proton pump inhibitors — An over-the-counter form of omeprazole (Prilosec OTC) is one of several medicines that block the pump mechanism in the stomach's acid-making cells, shutting off the stomach's acid production. Proton pump inhibitors are very effective medications that can be especially helpful in patients who do not respond to H2 blockers and antacids. These drugs are more potent acid-blockers than are H2 blockers, but they take longer to begin their effect. They should not be combined with an H2 blocker, because the H2 blocker can prevent them from working due to a drug interaction.

• Prescription medications — Prescription medications include:

  • H2 blockers — These are prescribed at higher doses than those available in over-the-counter forms.

  • Proton pump inhibitors — A variety of proton pump inhibitors are available by prescription, including omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix), and rabeprazole (Aciphex).

  • Motility drugs — These medications may help to decrease esophageal reflux, but usually are not used as the only treatment for GERD. They help the stomach to empty faster, which decreases the amount of time during which reflux can occur. The most commonly prescribed motility drug is metoclopramide (Reglan).

  • Mucosal protectors — These medications coat, soothe and protect the irritated esophageal lining. One example is sucralfate (Carafate).

Surgery is an option for people with severe, difficult-to-control GERD symptoms or people who have complications such as asthma or pneumonia, or strictures (blockages) of the esophagus from scar tissue. Some people who do not want to take medications for a long time may choose surgery.

Surgery for GERD can be done using camera-guided instruments, a technique called laparoscopic surgery. Laparoscopic surgery requires smaller incisions than conventional surgery. In a procedure called Nissen fundoplication, excess stomach tissue is folded around the esophagus and sewn in place, to hold extra pressure around the weakened esophageal sphincter. This operation appears to relieve symptoms about as much as prescription acid-blocking medicines. The success rates of surgery might be lower for people whose symptoms are not relieved by anti-acid medicines. Following surgery, about one out of five people will have a lasting bothersome side effect, but most people who undergo surgery are very satisfied with the results. Potential side effects include swallowing difficulty, diarrhea and the inability to belch or vomit to relieve bloating or nausea.

Endoscopy treatments Three new treatments have been developed to tighten the lower esophageal sphincter using an endoscope. An endoscope is a flexible tube that can be passed through the mouth and throat to examine the interior of the esophagus. The three treatments are stitching ("plication"), heating (the "Stretta" procedure), and injection of the sphincter with a bulking material (the "Enteryx" procedure). All three endoscopic treatments were developed recently, so their long-term success rates are unknown and little is known about their potential complications. They are not yet widely available, but they are being offered at an increasing number of medical centers.