Gerd Treatment

While no cure exists for GERD (gastroesophageal reflux disease), treatment can alleviate symptoms and reduce the risk of complications. GERD treatment can be as simple as lifestyle changes or as invasive as surgery. Antacids may be prescribed to treat symptoms, but GERD medications such as Prevacid® and Prilosec® offer more consistent symptom relief.

GERD Treatment and Lifestyle Changes

Some lifestyle choices can aggravate GERD, and changing habits to alleviate GERD symptoms is an important facet of GERD treatment. Reducing consumption of the following foods and beverages is recommended:

  • alcohol
  • caffeine
  • chocolate
  • citrus fruits and juices
  • fatty foods
  • fried foods
  • peppermint
  • tomato-based foods.

Quitting smoking is often advised as part of a GERD treatment regimen. Maintaining a healthy weight also is encouraged.

Eating small food portions helps avoid overeating and the subsequent pressure on the lower esophageal sphincter. After eating, people with GERD should avoid lying down or sleeping for two or three hours, to allow time for digestion.

Nocturnal GERD Treatment

If acid reflux wakes you up at night, a simple GERD treatment often provides some relief. Elevate the head of the bed so that it is six inches higher than the foot. This keeps the esophagus higher than the stomach while sleeping, reducing the risk of nocturnal acid reflux.

Antacids and GERD Medications

Over the counter antacids are not effective GERD medications, but are often the first treatment most people use to control heartburn. While antacids provide temporary relief of symptoms, they do not treat the underlying cause of the condition, nor are antacids capable of reducing stomach acid to allow the esophagus time to heal from acid damage.

Using antacids regularly for more than two weeks indicates the possibility of GERD. Long-term use of antacids can produce adverse reactions, most commonly diarrhea and constipation.

GERD Medications

GERD medications are often part of a GERD treatment regimen. Effective GERD medications, such as Prevacid and Prilosec, have three purposes:

  • alleviate GERD symptoms
  • prevent the recurrence of GERD symptoms
  • allow time for the esophagus to heal.

Protein pump inhibitors, or PPIs, are among the most commonly prescribed GERD medications. Prevacid and Prilosec are PPIs and limit stomach acid production. Protein pump inhibitors are favored treatment options as the medications provide fast symptom relief and permit esophageal healing in up to 95 percent of patients. Side effects from protein pump inhibitors are uncommon, and the PPI family of GERD medications is often used for lifelong treatment.

Other Gerd Medications

Prilosec, Prevacid and other PPIs are not the only available GERD medications. Both over the counter and prescription-strength histamine 2 receptor blockers (H2-Blockers) can be taken before meals to prevent heartburn. H2-Blockers reduce stomach acid levels.

An H2-Blocker, such as Pepcid®, Tagamet® or Zantac®, must be of prescription strength to allow for esophageal healing. Even at prescription strength, H2-Blockers are not as effective as protein pump inhibitors: Only fifty percent of cases see esophageal healing, and GERD symptom relapse is common with H2-Blocker medications.

Prokinetics are a family of GERD medications that make the stomach empty faster, relieving pressure on the lower esophageal sphincter. Prokinetics, such as Reglan®, also strengthen the esophageal sphincter muscles, but side effects, which range from headache to difficulty breathing, prevent prokinetics from being commonly used in GERD treatment.

Promobility medications, which increase sphincter pressure, have also been used as GERD treatment. However, promobility medications can cause severely adverse reactions, and some have been pulled from the market because of this.

GERD Surgery

GERD medications and lifestyle changes are often sufficient to control acid reflux. GERD surgery is a treatment option pursued only if health complications are present, or if GERD medications prove ineffective or they aren’t appropriate for the patient.

GERD surgery need not be invasive: Many procedures can be performed using laparoscopes or endoscopes, thin tubes inserted into the body that guide tiny cameras and surgical tools to the surgery site. The most common GERD surgery, fundoplication, can be performed as either incisional surgery or laparoscopic surgery.

Fundoplication strengthens the lower esophageal sphincter by wrapping the upper portion of the stomach around the sphincter. The surgery is used to prevent acid reflux and to repair hiatal hernias.

Another GERD surgery technique is the Bard Endocinch System, which stitches pleats into the lower esophageal sphincter to tighten and strengthen the sphincter.

Endoscopic GERD surgery includes the delivery of radiofrequency energy to the lower esophageal sphincter. The energy creates scar tissue on the sphincter, causing the sphincter to tighten.

A new GERD treatment, Entergx, uses an endoscope to deliver a solution to the esophagus/stomach junction. Once at the junction, the Entergx solution becomes a spongy substance that reinforces the lower esophagus sphincter.

GERD surgery treatments, while effective, don’t actually cure GERD. Often, other GERD treatments such as lifestyle changes and GERD medications must be continued after surgery.

Complications of GERD Surgery

GERD surgery, like any other surgery, can cause unwanted side effects. Five to ten percent of GERD surgery cases result in difficulty swallowing, difficulty belching or an impaired ability to vomit. Most GERD surgery side effects resolve over time, but in some cases they can be permanent.

GERD surgery treatments are not always permanent. Ten to thirty percent of acid reflux correctional surgery must be repeated after twenty years. For this reason, and due to the possibility of surgery side effects, other GERD treatments and medications tend to be tried before surgery is considered.

Resources

Beers, M.H.