What is the treatment plan for Gastroesophageal Reflux Disease (GERD)?

From the Guidelines

The treatment plan for GERD should start with a 4- to 8-week trial of single-dose proton pump inhibitor (PPI) therapy, as recommended by the AGA clinical practice update on the personalized approach to the evaluation and management of GERD 1. This approach is based on the latest evidence from 2022, which suggests that PPIs are safe and effective for patients with typical reflux symptoms and no alarm symptoms.

• The initial treatment plan should include lifestyle modifications, such as weight loss, avoiding trigger foods, eating smaller meals, not lying down after eating, and elevating the head of the bed.
• For medication therapy, antacids like Tums or Rolaids can be used for immediate relief, followed by H2 blockers like famotidine or ranitidine if symptoms persist.
• PPIs, including omeprazole, esomeprazole, or pantoprazole, should be used for more severe or persistent GERD, typically taken 30 minutes before breakfast for 4-8 weeks.
• The goal of treatment is to control symptoms, heal the esophagus, and prevent complications, with the lowest effective PPI dose or on-demand therapy used for maintenance 1.
• If symptoms do not improve after 8 weeks of PPI therapy, further evaluation with endoscopy may be necessary, and surgical options like Nissen fundoplication may be considered in refractory cases.
• Regular follow-up is important to assess treatment effectiveness and adjust the plan as needed, with a focus on personalized management and shared decision-making between the patient and clinician 1.

From the FDA Drug Label

Omeprazole delayed-release capsules are used in adults: • for up to 4 weeks to treat heartburn and other symptoms that happen with gastroesophageal reflux disease (GERD). GERD happens when acid in your stomach backs up into the tube (esophagus) that connects your mouth to your stomach This may cause a burning feeling in your chest or throat, sour taste, or burping.

The treatment plan for GERD with omeprazole delayed-release capsules is to take the medication for up to 4 weeks to treat heartburn and other symptoms.

• The medication should be taken exactly as prescribed by the doctor.
• It is usually taken 1 time each day, before a meal.
• Antacids may be taken with omeprazole delayed-release capsules.
• The capsules should be swallowed whole and not chewed or crushed.
• If a dose is missed, it should be taken as soon as remembered, but not taken with the next dose. 2

From the Research

Treatment Options for GERD

• Lifestyle modifications are often recommended for patients with GERD, including weight loss, smoking cessation, and dietary changes such as increasing fiber intake and lowering dietary fat 3, 4
• Medications such as proton pump inhibitors (PPIs) and histamine-2 receptor antagonists are effective in suppressing gastric acid and providing symptomatic relief 5, 6, 7
• Antacids can be used to treat symptoms of GERD, but their effect is short-lived 5
• Prokinetic medications, such as metoclopramide, have not been proven to be effective in controlling symptoms of GERD 5
• Baclofen, which inhibits transient lower esophageal sphincter relaxations, can be used as an additional option for patients with persistent symptoms related to GERD, but its use is limited by side effects 5

Medical Therapy for GERD

• Long-term medical therapy for GERD should be tailored to each patient to provide symptomatic control and maintain esophageal mucosal healing 5
• PPIs are the most common treatment for GERD, and the aim is to use the lowest effective dose after initial full-dose therapy 6
• Observational studies have suggested several adverse effects after long-term PPI use, but these findings need to be confirmed before influencing clinical decision making 6

Alternative Approaches for GERD

• Breathing exercises, such as changing from thoracic to abdominal breathing, have been shown to improve gastroesophageal reflux symptoms in some patients 3
• Surgical fundoplication is an invasive treatment alternative for select patients with GERD, particularly those who are young and healthy 6
• Endoscopic and less invasive surgical techniques are emerging as potential treatment options for GERD, but their long-term safety and efficacy remain to be scientifically established 6