Treatment of Gastro-Esophageal Reflux Disease (GERD)

By Dr. Ananya Mandal, MDReviewed by April Cashin-Garbutt, MA (Editor)

Gastro-Esophageal Reflux Disease (GERD) is one of the most common digestive disorders affecting millions of people worldwide at some point in their lives. Treatment of this condition depends on lifestyle changes as well as medication.

Lifestyle changes for treating GERD

Life style changes advised for patients with GERD include 1-5:

• The obese and the overweight are more likely to suffer from GERD and related symptoms. Weight reduction often helps in reducing symptoms of GERD.

• Smokers are at a higher risk of GERD. Quitting tobacco use helps patients with GERD.

• Patients are advised to eat smaller and more frequent meals rather than three large meals a day. The last meal of the day should be taken at least 4 hours before bed. Lying down immediately after a meal may aggravate symptoms of GERD.

• Other food and beverage triggers include alcohol, coffee, chocolate, tomatoes, or fatty or spicy food. These should be avoided.

• Avoidance of wearing tight clothes especially around the abdomen also increases symptoms of GERD.

• Raising the head end of the bed by about 20 cm (8 inches) by placing a wedge or block under it helps to reduce the symptoms of GERD. Extra pillows are not advised as they increase the pressure over the abdomen.

• Patients on medications that raise the risk of GERD are advised to stop the medication or are advised acid neutralizing or reducing drugs in conjunction. These offending drugs include:
  • nitrates

  • anti-cholinergics

  • tricyclic antidepressants

  • NSAIDs (Ibuprofen)

  • potassium salts and bosphosphonates like alendronate

Medications for treating GERD

GERD treatment usually involves drugs that reduce the acidity of the stomach contents by neutralizing the acid or by reducing the production of the acid.

Another group of medications are called prokinetics that increase the motility of the gastrointestinal system and thus allow food to be transmitted through the esophagus and gut faster. This also reduces the risk of reflux.

Drugs used in GERD include:

Antacids

These do not require a prescription and are available over-the-counter. They work by neutralizing the gastric acid and relieve the symptoms of heart burn and acid reflux.

These drugs should not be taken along with other medications of GERD as they may interact and reduce the efficacy of the other drugs. These antacids also reduce the ability of the body to absorb the other drugs.

Alginates

Alginates are alternatives to antacids. These are also available without prescription. They work by producing a protective coating that shields the lining of the stomach and esophagus from the effects of the acidic contents of the stomach.

Proton-pump inhibitors (PPIs)

Patients who fail to respond to over the counter medications and life style changes are prescribed PPIs like Omeprazole, Pantoprazole, Rabeprozole and Lansoprazole. These work by reducing the acid produced by the stomach.

Side effects of these drugs are mild and include headaches, diarrhea, nausea, pain abdomen, constipation etc. Sometimes PPIs may be prescribed for a long period of time.

H2-receptor antagonists

H2-receptor antagonists are another variety of drugs that may be taken along with PPIs or as their alternative. These agents include Ranitidine, Cimetidine and Famotidine and block the effects of the chemical histamine that helps produce stomach acid. Thus these agents reduce the acid production. Side effects are mild and include headaches, diarrhea, fatigue, rashes and sizziness.

Prokinetic agents

These agents are prescribed when GERD does not respond to acid reducing or neutralizing agents. Bethanechol and Metoclopramide are such drugs.

Metoclopramide can lead to side effects like extrapyramidal symptoms that may become severe. These include muscle spasms, slurred speech, abnormal posture and movements in the body. (1-5)

Surgery

In severe cases surgery is recommended for GERD. Surgical therapy usually removes the nerves that help produce gastric acid.

The problems that may occur after surgical procedures include difficulty in swallowing, flatulence or gas, bloating and difficulty in burping.

Practised surgical options include:

• laparoscopic nissen fundoplication (LNF)

• endoscopic injection of bulking agents to strengthen the lower esophageal sphincter (LES)

• endoluminal gastroplication

• endoscopic augmentation with hydrogel implants

• endoscopic radiofrequency ablation etc.

In LNF (Laparoscopic nissen fundoplication) the surgeon makes small incisions over the abdomen and tightens the LES by wrapping the upper section of the stomach around the esophagus and staples it in place. LNF is one of the most common surgical techniques used to treat GERD. The surgery takes 60 to 90 minutes to complete.

Endoscopic injection of bulking agents use an endoscope to find the site where stomach and the esophagus meets. At this site a combination of plastic and liquid is injected. This makes the LES tight and the passage narrow and helps prevent reflux of the gastric contents. (1-5)