Gastroesophageal Reflux Disease (GERD)
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, to prevent injury to the lining of the esophagus or to help it to heal if injury has already occurred, to prevent GERD from recurring, and to prevent 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 nonprescription medicines that reduce or block acid. These include antacids (such as Tums), H2 blockers (such as Pepcid), or proton pump inhibitors (such as Prilosec OTC). If you have been using nonprescription medicines to treat your symptoms for longer than 2 weeks, talk to your doctor. If you have GERD, the medicine could be causing damage to your esophagus. Your doctor can help you find the right treatment. If you have frequent or severe GERD symptoms, your doctor may recommend that you use prescription medicines along with lifestyle changes. When prescription medicines are used to treat GERD symptoms:
- You may need to try different medicines or combinations of medicines 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.
Medicines for GERD include proton pump inhibitors (such as Nexium and Prilosec) and H2 blockers (such as Pepcid and Tagamet). Many of these medicines are available in both prescription and nonprescription forms.
If symptoms are severe or have been present for a long time, your doctor may order an upper gastrointestinal endoscopy (EGD) to see if your esophagus is inflamed or ulcerated (esophagitis). This test can also 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. The test can also help your doctor see if you have any strictures, which are narrow places in the esophagus.
An important part of treating GERD is avoiding the things that trigger your symptoms. These may include foods such as spicy or fatty foods, chocolate, drinks that contain caffeine or alcohol, behaviors such as smoking, and taking certain medicines. If you think that your symptoms are worse after eating a certain food, you can stop eating that food to see if it helps your symptoms. If you think a medicine you are taking is making your symptoms worse, talk to your doctor.
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 medicines does not relieve your symptoms.
Ongoing treatment
If medicines 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 medicines as instructed by your doctor, because stopping therapy will often bring symptoms back.
You can try basic treatments like lifestyle changes and nonprescription medicines that reduce or block acid before you try prescription medicines. The nonprescription medicines include antacids (such as Tums), H2 blockers (such as Pepcid), and proton pump inhibitors (such as Prilosec OTC). If you have been using nonprescription medicines to treat your symptoms for longer than 2 weeks, talk to your doctor. If you have GERD, the medicine could be causing damage to your esophagus. Your doctor can help you find the right treatment. The approach your doctor chooses will depend the symptoms you are having, how severe they are, and how much damage (if any) has been done. You and your doctor will also need to balance the effectiveness and safety of various treatments against the costs.
Treatment if the condition gets worse
If your symptoms of gastroesophageal reflux disease (GERD) do not improve with treatment, or if complications develop, your doctor may suggest that you take your medicine more often. Or you may be switched to a higher dose or a stronger medicine. Your doctor may reevaluate your diet and lifestyle also.
Depending on your symptoms, your doctor may refer you to a specialist for an upper gastrointestinal endoscopy (esophagogastroduodenoscopy, or EGD). This can test for esophagitis (inflammation and ulceration in your esophagus) and 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 do 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.
If your biopsy during upper gastrointestinal endoscopy (EGD) leads to a diagnosis of Barrett's esophagus, this condition will need to be watched. Your doctor may recommend that you keep taking medicine and have regular EGDs to watch the problem. Talk to your doctor about how often you should have follow-up EGDs to monitor your condition.
Surgery may be an option when:
- Treatment with medicines 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 medicines over an extended period of time to control GERD symptoms, and you are willing to accept the risks of surgery.
- Along with reflux you have complications such as asthma, hoarseness, or cough that do not improve when treated with medicines.
Your doctor 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. Lifestyle changes and antacids are usually tried first to treat pregnant women who have GERD. Antacids are safe to use for heartburn symptoms during pregnancy. If lifestyle changes and antacids don't help control your symptoms, talk to your doctor about using other medicines. Most of the time, symptoms get better after the baby is born.
Many people who develop GERD have the condition for the rest of their lives. Depending on how bad your symptoms are, you may need to take medicines 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 medicines, 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)?
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| Author: | Monica Rhodes | Last Updated: March 31, 2008 |
| Medical Review: | Kathleen Romito, MD - Family Medicine Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology | |
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