GERD medications & treatments
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Gastroesophageal reflux disease (GERD) occurs when your stomach contents move back up into your esophagus. GERD is a common condition that affects 20% of Americans, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). This number could be higher because of patients’ access to over-the-counter medications they can use to treat this condition. GERD affects men at a slightly higher rate than women. While it can affect people at any age, you have a higher chance of developing GERD after age 40.
What is GERD?
Acid reflux occurs when the lower esophageal sphincter (LES) at the end of your esophagus doesn’t close properly. This allows stomach acid to flow back through your esophagus and into your throat and mouth, causing irritation. If you repeatedly have symptoms of acid reflux, you may have a condition called gastroesophageal reflux disease (GERD).
GERD can affect anyone at any age. If have any of the following risk factors, you are more likely to develop GERD:
- Hiatal hernia (the top of your stomach bulges into your diaphragm)
- Gastroparesis (delayed emptying of the stomach)
- Connective tissue disorders (scleroderma, rheumatoid arthritis)
- Medications (doxycycline, NSAIDs, alendronate)
If you already have GERD, the following can worsen symptoms include:
- Eating large meals
- Eating at bedtime
- Foods such as fatty or fried foods
- Alcohol and coffee
How is GERD diagnosed?
Most cases of GERD can be diagnosed by your healthcare provider from a review of your symptoms and your medical history. If your symptoms don’t improve after lifestyle changes and medications or if they suspect a complication, your doctor may run additional tests.
The most common symptoms of GERD include:
- Burning sensation in your chest (heartburn)
- Backwash (regurgitation) of food into your throat and mouth
- Chest pain
- Dysphagia (difficulty swallowing)
- Chronic cough
- Sore throat
- The feeling of a lump in your throat
- Laryngitis (vocal cord inflammation)
- Bad breath
- New or worsening asthma
In addition to reviewing your symptoms and medical history, your doctor or gastroenterologist may also run the following tests:
- Upper GI series. This is typically one of the first tests your doctor will perform. After drinking a barium solution, your doctor will x-ray and examine your upper digestive tract, including the esophagus, stomach, and duodenum (upper part of the small intestine).
- Upper gastrointestinal (GI) endoscopy. An upper endoscopy uses a thin, flexible tube with a camera (endoscope) to look at the lining of the esophagus, stomach, and duodenum. Your doctor can also collect a tissue sample (biopsy) for further examination if needed.
- Esophageal manometry. This test uses a small, flexible tube to measure the strength of your esophagus muscles. Esophageal manometry cannot diagnose GERD, but it is used to rule out other conditions that have some of the same symptoms as GERD. It is typically performed if you have trouble swallowing.
- Esophageal pH monitoring. This test measures the pH (acid level) in your esophagus for about 5 days.
- Esophageal Impedance testing. This test measures the movement of acid and other substances through your esophagus. It can be used to confirm a diagnosis of GERD and the severity of your condition.
What are some GERD treatment options?
After confirming your diagnosis of GERD, your healthcare provider will likely recommend some lifestyle changes and medications to treat your condition. If your symptoms do not improve with these measures, your doctor may recommend surgery.
Many GERD medications are available over the counter. If you are still having symptoms with these OTC medications your doctor may prescribe another medication. Some common drugs used to treat GERD include:
- Antacids. OTC medications that contain calcium carbonate include Tums, Maalox, Mylanta, and Rolaids. They neutralize gastric acid to provide fast but temporary relief of mild GERD symptoms.
- H2 blockers. Histamine H2 receptor antagonists decrease the amount of acid your stomach produces. They take longer to work than antacids, but can reduce acid production for up to 12 hours to provide longer symptom relief. H2 blockers can be used to help heal the esophagus. There are over-the-counter and prescription H2 blockers available. Examples include Tagamet HB (cimetidine) and Pepcid AC (famotidine).
- Proton pump inhibitors (PPIs). PPIs block acid production in your stomach. These medications are better at reducing GERD symptoms and healing the esophagus than H2 blockers. PPIs are available OTC or by prescription. Some examples include Nexium (esomeprazole), Prilosec (omeprazole), and Protonix (pantoprazole).
- Prokinetics. These medications increase muscle contractions in your small intestine to help empty your stomach faster. Medications such as Reglan (metoclopramide) are typically used in severe cases of GERD that have failed other therapies.
GERD can typically be managed with medication. But if you are still having symptoms, your doctor may recommend:
- Fundoplication. In this procedure, a surgeon will sew the top of your stomach around the lower esophageal sphincter. This will tighten the muscle and prevent reflux. Fundoplication is typically a minimally invasive (laparoscopic) procedure. It is the most common surgery used to treat GERD.
- LINX device. The LINX device is a small flexible band of magnetic titanium beads that is implanted around the lower esophageal sphincter to prevent the contents of the stomach from backing up into the esophagus. It does not prevent food from passing through into the stomach.
- Bariatric surgery. If you have GERD and are obese, your doctor may recommend weight-loss surgery. The most common type of bariatric surgery is gastric bypass. Studies have shown that the resulting weight loss from bariatric surgery leads to reduced GERD symptoms.
What is the best medication for GERD?
The best medication for the treatment of GERD will depend on the individual’s specific medical condition, medical history, medications that the individual is already taking that may potentially interact with GERD medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most commonly used over-the-counter or prescription medications approved by the Food and Drug Administration (FDA).
Best medications for GERD
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|Tagamet HB (cimetidine)||H2 blocker||Oral||400mg every 6 hours or 800mg every 12 hours.||Headache, dizziness, drowsiness, diarrhea|
|Pepcid AC (famotidine)||H2 blocker||Oral||20mg to 40mg every 12 hours for up to 12 weeks.||Headache, diarrhea, dizziness, constipation|
|Axid (nizatidine)||H2 blocker||Oral||150mg every 12 hours or 300mg at bedtime.||Headache, constipation, diarrhea, nausea, dizziness, stomach pain|
|Prilosec (omeprazole)||PPI||Oral||20mg once daily.||Headache, stomach pain, diarrhea, nausea, vomiting, decreased magnesium levels|
|Nexium (esomeprazole)||PPI||Oral||20mg to 40mg once daily.||Headache, gas, indigestion, nausea, stomach pain, diarrhea|
|Prevacid (lansoprazole)||PPI||Oral||15mg to 30mg once daily.||Headache, constipation, diarrhea, nausea, stomach pain|
|Protonix (pantoprazole)||PPI||Oral||40mg once daily.||Headache, stomach pain, swelling, chest pain, diarrhea, constipation|
|Dexilant (dexlansoprazole)||PPI||Oral||30mg once daily.||Diarrhea, stomach pain, nausea, vomiting, gas|
|Aciphex (rabeprazole)||PPI||Oral||20mg once daily.||Headache, constipation, diarrhea, gas, stomach pain|
|Zegerid (omeprazole/sodium bicarbonate)||PPI/antacid||Oral||20mg/1.1g once daily.||Fever, low potassium and magnesium levels, increased blood sugar, low blood pressure|
|Reglan (metoclopramide)||Prokinetic agent||Oral||10mg to 15mg every 6 hours, 30 minutes before meals, and at bedtime. Max of 80mg/day.||Extrapyramidal symptoms, fatigue, restlessness, drowsiness, headache|
Your healthcare provider will determine the right dosage based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of GERD medications?
As with all medicines, those used for GERD will have some side effects, depending on the class you are taking. The most common side effects of these medications include:
- Stomach pain
What are some home remedies for GERD?
In addition to medications, there are several lifestyle changes and home remedies that can help reduce symptoms and prevent flare-ups.
- Maintain a healthy weight
- Quit smoking
- Elevate the head of your bed by 6 to 8 inches
- Don’t lie down for 2 to 3 hours after eating
- Avoid heavy evening meals
- Limit or avoid foods that can trigger reflux such as alcohol, caffeine, or peppermint
Frequently asked questions about GERD
What are some signs and symptoms of GERD?
The most common symptoms of GERD are heartburn, regurgitation of stomach contents into your throat and mouth, difficulty swallowing, the sensation of a lump in your throat, hoarseness, sore throat, or chronic cough.
What are some complications of GERD?
If left untreated, chronic inflammation in your esophagus can cause:
- Esophagitis (inflammation of esophageal tissue that can cause ulcers)
- Esophageal stricture (narrowing of your esophagus)
- Barrett’s esophagus, which is associated with an increased risk of esophageal cancer
- Aspiration of your stomach contents into your lungs
What foods should I avoid with GERD?
If you have GERD, some foods can trigger symptoms, including:
- Fried foods
- Fatty foods
- Citrus fruit
- Fruit juices
- Energy drinks
- Spicy foods
How Common Is GERD?
GERD is a common condition that affects 20% of Americans.
Related resources for GERD
- The pathophysiology of gastroesophageal reflux disease. StatPearls, National Library of Medicine
- GERD overview. MayoClinic
- Acid reflux in adults. National Institute of Diabetes and Digestive and Kidney Diseases
- GERD symptoms and causes. Cleveland Clinic
- Reflux esophagitis. MedScape