If you have had GERD symptoms or have been using antacids or over-the-counter acid reducers for more than two weeks to attempt to relieve those symptoms, you should contact your physician. You may need to be referred to a gastroenterologist, a specialist who treats diseases of the stomach and intestines. Available treatments for GERD include:
Changes in lifestyle may help lessen the symptoms of GERD, including:
- Avoiding foods and beverages that worsen symptoms
- Weight loss
- Quitting smoking
- Wearing loose-fitting clothes
- Eating small, frequent meals instead of a few large meals
- Avoiding lying down sooner than three hours after a meal
- Elevating the head of your bed six to eight inches by means of wooden blocks secured under the bedposts
Elevating the head of the bed is one of the most effective lifestyle changes one can adopt in coping with GERD. Note that using extra pillows will not help; the bed itself should be elevated on blocks.
There are a number of medications that can help alleviate the pain and discomfort of GERD, many of them over-the-counter medications, such as:
- Antacids: Drugs such as Alka-Seltzer®, Maalox®, Mylanta®, Rolaids® and Tums® may relieve mild symptoms of GERD.
- Foaming agents: These drugs, such as Gaviscon®, work by covering the stomach contents with foam to prevent reflux.
- H2 blockers: These medications offer short-term relief by decreasing acid production in the body. They include drugs such as Tagamet HB® (cimetidine), Pepcid AC® (famotidine), Axid AR® (nizatidine) and Zantac 75® (ranitidine) and are also available in prescription strength.
- Proton pump inhibitors: Drugs such as Prilosec® (omeprazole), Prevacid® (lansoprazole), Protonix® (pantoprazole) and Nexium® (esomeprazole) offer stronger treatment than H2 blockers.
- Prokinetics: Drugs such as Urecholine® (bethanechol) and Reglan® (metoclopramide) strengthen the lower esophageal sphincter and make the stomach empty its contents faster. Prokinetics have a number of side effects, however, that may limit their treatment value.
Sometimes a combination of drugs may be taken to help treat symptoms of GERD. For example, taking an antacid and an H2 blocker may help an individual by first neutralizing the acid in the stomach (the antacid) and then limiting additional acid production (the H2 blocker). Your physician will suggest the proper combination of medications, if this approach is used.
In some cases, surgery may be considered as an alternative to long-term use of drugs or physical discomfort. Surgeries for GERD may include:
- Nissen fundoplication: In this procedure, the upper part of the stomach is wrapped around the lower esophageal sphincter to repair a hiatal hernia, prevent acid reflux and strengthen the sphincter itself. This surgery may be performed using a laparoscope, which is inserted into the body through tiny incisions in the abdomen. Patients who receive this surgery typically leave the hospital in one to three days and may return to work in two to three weeks.
- Endoscopic techniques: These techniques use an endoscope to repair the faulty sphincter, including Bard® EndoCinch system, NDO Plicator and Stretta system.
- LINX® procedure: A laparoscopic procedure for the treatment of GERD, which involves placing a string of metal beads around the lower esophagus.
When the patient swallows, the beads separate to allow food to pass into the stomach. The magnet then draws the beads back together to keep acid from going up into the esophagus.
Complications of GERD
- Esophagitis: Inflammation of the esophagus.
- Swallowing disorders: Scar and tissue damage can narrow the esophagus, causing strictures that may swallowing difficult.
- Barrett’s esophagus: In some cases, chronic GERD may cause Barrett’s esophagus, in which abnormal cells develop in the esophageal lining, increasing the risk of esophageal cancer.