Treatment Options for GERD

How is GERD treated?

There are steps you can take to manage gastroesophageal reflux disease (GERD) effectively. Your doctor may recommend lifestyle changes and medication to get your symptoms under control. If those steps don’t give you enough relief, surgery may be an option.

Lifestyle changes

You can make lifestyle changes for GERD prevention. Try these daily acid reflux management tips:

• Avoid trigger foods: Foods to avoid for GERD may include spicy, fatty, acidic or citrus foods, as well as chocolate, mint, tomatoes (or tomato sauce) and caffeine . You may want to keep a journal of your food and symptoms for a few weeks to look for any patterns. You can generally eat lean proteins, whole grains, non-citrus fruits, vegetables and non-mint herbal teas without triggering symptoms.
• Eat smaller meals throughout the day instead of large, heavy meals: Smaller meals can help keep your stomach from being overly full, which can cause acid reflux.
• Eat slowly and chew your food well: When you eat slowly, you don’t swallow as much air. Swallowing air can make reflux worse.
• Avoid drinking lots of liquids with your meals: This can increase stomach pressure.
• Lose weight if you are overweight or obese: Weight management can help, since losing weight will lower the pressure on your stomach.
• Elevate your head during sleep: Raise the head of your bed 6 to 8 inches or sleep on a wedge pillow that raises your upp er body. When your upper body is raised, it’s harder for stomach acid to flow into the esophagus. It’s important to use a wedge pillow, rather than a regular pillow when trying to elevate your head. A regular pillow will raise your head in such a way that increases abdominal pressure (increasing reflux). You may also want to try different sleeping positions to see if it helps.
• Finish your last meal two to three hours before bedtime and don’t lie down during this time: That way, gravity can help keep stomach contents down. It will also allow time for your stomach to digest the food and empty your stomach before you lie down.
• Choose loose clothing instead of tight-fitting clothes and belts.
• Quit smoking: Smoking weakens the lower esophageal sphincter (LES) valve between your esophagus and stomach. Also, when you smoke you make less saliva, and saliva helps reduce stomach acid.
• Drink less or no alcohol: Alcohol relaxes the LES, so it makes acid reflux more likely.
• Reduce stress: Stress can make GERD symptoms worse. Try techniques like deep breathing, meditation or yoga.
• Get regular physical activity to help your digestive system work well.
• Take note of your symptoms: This will help you spot triggers and take steps to avoid them.

Over-the-counter (OTC) GERD medications

If you have mild to moderate symptoms of acid reflux or GERD, OTC medications might help along with lifestyle changes. They can neutralize or reduce stomach acid.

• Antacids for reflux or GERD work to neutralize stomach acid, and they may help reduce your symptoms quickly. Common antacids are Tums, Rolaids, Maalox, Mylanta and Gaviscon.
• H2 blockers for GERD block histamine, a chemical that makes your stomach produce acid. They can help control your symptoms longer than antacids. Common H2 blockers are famotidine (Pepcid) and cimetidine (Tagamet).

If you’re not getting relief from OTC medications or you’re taking them frequently, talk to your health care provider. You might need prescription medication or other treatment options.

Prescription medications for GERD

If you have moderate or severe symptoms of GERD and OTC medicines aren’t controlling them, prescription medications might be a better choice. You should still continue with lifestyle changes.

Your doctor may recommend:

• Proton pump inhibitors (PPIs), which make your stomach produce less acid. They are often the first prescription that doctors suggest for GERD. Common PPIs include omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix) and rabeprazole (Aciphex ). These should be taken 30 minutes before meals (breakfast or dinner).
• H2 blockers. Prescription-strength versions include famotidine (Pepcid) in higher doses than OTC versions.
• Prokinetic medications help strengthen the LES and help your stomach empty faster. You’ll usually take them along with other GERD medications. Metoclopramide (Reglan) is an example . Erythromycin is another option to help empty your stomach faster, but it does not have any effect on the LES.
• Baclofen, which may keep the LES from relaxing too much.
• Alginate/antacid combinations, which combine antacids with alginic acid. Alginic acid forms a protective barrier in the stomach that may help prevent reflux.

Whichever medication(s) you take to treat GERD, be sure to follow the dosage instructions. Ask your provider if you should take it once or twice daily and with or without food. Don’t change the amount you take or how often you take it without talking to your provider.

For best control of your symptoms, try to take GERD medication at the same time every day. Take all the medication your provider prescribed, even if you start feeling better. If you stop taking the medicine too soon, your symptoms will come back.

Talk to your provider about any side effects or concerns you have about your medication. Make sure you go to your follow-up appointments, so your provider knows how well your treatment is working.

Surgery

If lifestyle changes and medication aren’t relieving your GERD symptoms, you do not want to use lifelong GERD medications or    if you have complications from GERD, your provider might recommend surgery. Surgery usually gives you long-term relief, and most people no longer need medication afterward.

Prior to being considered for surgery, a number of tests are needed to ensure you qualify and don’t have any contraindications (conditions or symptoms that could make the procedure risky).

Surgical options for severe GERD are usually done with minimally invasive techniques —surgeons reach the esophagus and stomach through your mouth or through small incisions in your abdomen.

Here are some ways surgery can treat GERD:

• Fundoplication: Surgeons wrap the top of the stomach around the esophagus to reinforce the lower esophageal sphincter (LES). It’s a minimally invasive procedure is done through small incisions in the abdomen with a camera to guide the surgeon. A version with a partial wrap can help reduce side effects like trouble swallowing.
• Transoral incisionless fundoplication (TIF): This type of fundoplication is done through the mouth, so you don’t have any incisions on your abdomen. Surgeons  , as well as gastroenterologists, use a device to fold the stomach tissue around the LES. TIF has a shorter recovery time and less risk of complications than fundoplication.
• LINX reflux management system: Surgeons place a small, flexible magnetic ring around the LES. Beads in the ring open so food and liquids can get into the stomach but close to prevent reflux. It’s minimally invasive, and with it, you can swallow and burp normally.
• Stretta procedure: Surgeons insert a device through your mouth to the LES. The device sends radiofrequency energy to the LES, which strengthens it.
• Medigus Ultrasonic Surgical Endostapler (MUSE): Surgeons use small tools to place surgical staples and create folds in the area where your esophagus and stomach meet. These folds help tighten the LES. This procedure is done through your mouth.

You will want to talk to a gastroenterologist (digestive system doctor) or a surgeon who specializes in GERD about your options. The best surgical choice for you will depend on how severe your symptoms are and how healthy you are overall.

Preventing complications of untreated GERD

When GERD is treated properly, you’re not likely to have complications. So getting care for GERD symptoms and following your treatment plan is important.

Untreated, GERD could lead to:

• Esophagitis, including eosinophilic esophagitis where your esophagus is inflamed and painful. It may bleed and you could have trouble swallowing.
• Strictures, which are tight or narrow areas in your esophagus. They can make it hard for you to swallow food.
• Barrett’s esophagus, which is a change in the lining of the esophagus that may increase your risk of esophageal cancer.
• Breathing problems: If stomach acid in the throat gets into your airways, it can cause coughing and wheezing and make asthma worse.
• Dental problems: Stomach acid can wear away the enamel on your teeth, so your teeth are more sensitive and can get more cavities.
• Sleep problems: GERD symptoms can keep you awake at night, making you more tired the next day.

You can reduce your chances of having these complications by making lifestyle changes, taking the medication your provider recommends and having surgery if other treatments aren’t working.