GERD

Gastroesophageal Reflux Disease

Medically reviewed by Carina Fung, PharmD, BCPPS

GERD Treatment

There are different approaches to GERD treatment. Most patients respond well to a combination of lifestyle changes, dietary changes, and medication.

Depending on the severity of their symptoms and condition, some patients may need to undergo surgery for their GERD. Others may have a choice between surgery and long-term medication use.

GERD lifestyle changes

Making changes to your lifestyle is often an effective way to treat (and, in some cases, even help prevent) GERD. The following changes might help alleviate the signs and symptoms of GER (acid reflux) and GERD:

  • Losing weight: If you’re overweight, losing weight can reduce the strain on the lower esophageal sphincter (LES), helping to prevent chronic acid reflux.
  • Quitting smoking: Smoking decreases the LES’ ability to function as it should, increasing the risk of acid reflux.
  • Avoiding trigger foods: Keeping a food journal and tracking your GERD symptoms can help you identify what foods and drinks worsen your symptoms. Common triggers for acid reflux include acidic foods (such as tomato sauce), fatty or fried foods, alcohol, garlic, mint, chocolate, onions, and caffeine.
  • Eating slowly: Taking time not to rush your eating can help prevent acid reflux and overeating (which can also cause symptoms to occur).
  • Waiting to go to bed after eating: Wait at least three hours to lie down or go to bed after eating a meal.
  • Changing your sleeping posture: If you experience chronic heartburn while lying in bed, try elevating your mattress or the feet of your bed with a wedge or blocks. You should aim to raise the head of your bed by six to eight inches. Unfortunately, elevating your head with extra pillows alone won’t help.
  • Avoiding wearing tight clothing around your abdomen, as this puts pressure on the abdomen and LES.

GERD medication

Many over-the-counter medications are effective at relieving the symptoms of GERD. However, if your symptoms don’t go away with these alone, speak to your provider. These medications all work differently, and you may need a combination of them to effectively manage your symptoms.

Some over-the-counter medications commonly taken for GERD include17:

  • Antacids: Healthcare providers often recommend taking antacids for quick relief of heartburn and other mild GERD symptoms. This type of medication is best for mild-to-moderate and infrequent symptoms of acid reflux. It’s important to note that antacids can’t heal an inflamed esophagus, and overuse of these medications may exacerbate symptoms.

Some over-the-counter antacids include aluminum-magnesium hydroxide-simethicone (generic Mylanta) and calcium carbonate (generic Tums).

  • Histamine-2-receptor blockers: These medications, also known as H-2-receptor blockers, help decrease acid production. While they don’t work as quickly as antacids, H-2-receptor blockers provide longer relief from symptoms.

Some over-the-counter H-2-receptor blockers include cimetidine, famotidine (generic Pepcid), and nizatidine (generic Axid).

If you frequently experience heartburn after meals, your provider may recommend taking a proton pump inhibitor. These medications include an antacid (to neutralize stomach acid) and an H-2-receptor blocker (to reduce acid production).

  • Proton pump inhibitors: PPIs block all the major pathways for acid secretion. Compared to H2 blockers, PPIs are more effective at suppressing acid production. They can also help allow time for damaged esophageal tissues to heal, even in patients with extensive esophageal damage (as is seen in erosive GERD, or esophagitis). However, research has shown18 that long-term use or high dosage contributes to hip, wrist, and spinal fractures.

    Some over-the-counter proton pump inhibitors include omeprazole (generic Prilosec) and lansoprazole (generic Prevacid).

Prescription medications for GERD

Patients with severe GERD may require prescription medication to help manage their symptoms. Some prescription medications used to treat GERD include:

Patients with severe GERD may require prescription medication to help manage their symptoms. Some prescription medications used to treat GERD include:

  • Prescription-strength H-2-receptor blockers: These medications include prescription-strength famotidine (generic Pepcid) and nizatidine (generic Axid). While they’re usually well-tolerated, the long-term use of these drugs may be associated with a slightly higher risk of bone fractures and vitamin B-12 deficiency.
  • Prescription-strength proton pump inhibitors: Common prescription-strength proton pump inhibitors include dexlansoprazole (generic Dexilant), esomeprazole (generic Nexium), lansoprazole (generic Prevacid), omeprazole (generic Prilosec), pantoprazole (generic Protonix), and rabeprazole (generic Aciphex).

These medications are also usually well-tolerated. However, they may cause some side effects, including headache, diarrhea, nausea, and vitamin B-12 deficiency. Chronic use of these drugs may also increase the risk of bone fractures.

  • Antibiotics: Antibiotics, including erythromycin (generic E.E.S. 400, E.E.S. Granules, Ery-Tab), help the stomach empty faster. Erythromycin has also been known to cause diarrhea.
  • Muscle relaxants: These medications help alleviate the symptoms of GERD by decreasing how frequently the LES relaxes. One such medication that can help strengthen the LES is baclofen (generic Lioresal, Gablofen). However, data is limited, and central nervous system (CNS) side effects may occur.

Your provider may prescribe the following medications for GERD:

May be prescribed

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GERD surgery

The goal of surgery for GERD is to strengthen the antireflux barrier.

The most common surgery for GERD is the Nissen fundoplication19. During this procedure, a surgeon makes a small incision to insert a thin tube with a camera (laparoscope) that allows them to operate into the esophagus. The upper portion of your stomach is then sewed to the lower end of the esophagus. This enhances the antireflux barrier and usually leads to permanent reflux control.

Laparoscopy20 offers a less invasive procedure with a short recovery time and satisfactory results. General anesthesia is administered, and you can leave the hospital in less than three days. Most patients are able to perform their daily activities within three weeks of the surgery.

Another surgical option for GERD is known as the transoral incisionless fundoplication (TIF)21. In this procedure, a special TIF device is used to create a passage for an endoscope to enter the esophagus. A surgeon is then able to repair the loose valve, helping to prevent future reflux.

Even compared to laparoscopic surgery (another procedure used in patients with GERD), TIF treatment is faster, less painful, and offers a quicker recovery time. Clinical trials are still ongoing to determine how effective endoscopic therapy is for treating GERD.

GERD diet

While there’s no prescribed “GERD diet,” there are certain foods that may help ease or prevent your symptoms. Making dietary changes22 to help manage GERD usually begins with identifying which foods you should avoid. Some common trigger foods that you may want to strike off your menu include high-fat foods, caffeine, alcohol, carbonated drinks, chocolate, citrus and tomato products, onions, and mint.

The most important thing when making dietary changes is to determine what works best for you, then make modifications accordingly. Keeping a food log and tracking your symptoms (taking special care to note what you’ve consumed when your symptoms do worsen) can help you identify what may be triggering or worsening your GERD.

While different people can have very different responses to the same foods, these are generally “safe” for people with GERD to eat:

  • Non-citrus fruits and vegetables: Avoid citrus fruits like oranges and lemons and instead eat non-citrus ones like bananas, apples, pears, and melons. There is a wide variety of vegetables that can help you prevent GERD. Avoid vegetable sauces and toppings that are high in fat and irritants such as tomatoes, onions, and garlic.

  • Lean proteins: Eggs and lean meats are a good source of protein. If eggs seem to cause symptoms, avoid the higher-fat yolks and only eat the whites. Grilled, broiled, poached, or baked lean meats are a healthy alternative. Avoid high-fat meals and fried foods as these lower the LES pressure and cause a delay in stomach emptying.

  • Complex carbohydrates: Sources of healthy complex carbohydrates include oatmeal, rice, couscous, whole grain bread, potatoes, and other root vegetables.

  • Healthy fats: There are different types of fats. Reduce or refrain from saturated and trans fat. Meat and dairy usually contain saturated fats while, trans fat is most common in shortening, margarine, and processed foods. Supplement these with unsaturated fats such as monounsaturated and polyunsaturated fats from plants and fish.

    Monounsaturated fats include olive, canola, avocado, sunflower, sesame, and peanuts. Polyunsaturated fat sources include safflower, walnut, corn, flaxseed, soybean, salmon, and trout.

As with any health condition, the goal is to create a balanced diet that helps keep your symptoms to a minimum while providing you with a healthy variety of foods. If you’re not sure how your body will react to a certain food, try consuming it in small amounts and make a note of any changes in your symptoms before fully incorporating it into your diet.

Generally speaking, it’s best to talk to your healthcare provider or a specialist (such as a registered dietician) before making any drastic changes to your diet.


Disclaimer: The information on this site is generalized and is not medical advice. It is intended to supplement, not substitute for, the expertise and judgment of your healthcare professional. Always seek the advice of your healthcare professional with any questions you may have regarding a medical condition. Never disregard seeking advice or delay in seeking treatment because of something you have read on our site. RxSaver makes no warranty as to the accuracy, reliability or completeness of this information.

If you are in crisis or you think you may have a medical emergency, call your doctor or 911 immediately.

References