What are the treatment options for Gastroesophageal Reflux Disease (GERD) at night?

From the Guidelines

To manage GERD symptoms at night, elevate the head of your bed by 6-8 inches using bed risers or a wedge pillow, and avoid eating within 3 hours of bedtime, as recommended by the american gastroenterological association medical position statement on the management of gastroesophageal reflux disease 1. This approach is supported by the american gastroenterological association medical position statement on the management of gastroesophageal reflux disease, which broadly advocates lifestyle changes for all patients with GERD, including avoidance of foods that may precipitate reflux and adoption of behaviors that may reduce esophageal acid exposure 1. Some key lifestyle modifications that can help manage GERD symptoms at night include:

• Elevating the head of the bed to reduce reflux episodes
• Avoiding trigger foods in the evening, such as alcohol, caffeine, chocolate, fatty or spicy foods, and carbonated beverages
• Wearing loose-fitting clothing to bed and sleeping on your left side to reduce reflux episodes
• Avoiding eating within 3 hours of bedtime to reduce acid production during sleep In addition to lifestyle modifications, medications such as omeprazole (20-40mg) or pantoprazole (40mg) can be taken 30-60 minutes before dinner for maximum effectiveness during sleep, as recommended by the american gastroenterological association medical position statement on the management of gastroesophageal reflux disease 1. It's also important to note that antacids such as Tums or Gaviscon can provide quick relief for breakthrough symptoms, and that proton pump inhibitors like omeprazole work best when taken before meals, allowing them to reach peak effectiveness during the night when lying down makes reflux more likely 1. Overall, a comprehensive approach to managing GERD symptoms at night should include a combination of lifestyle modifications and medications, as recommended by the american gastroenterological association medical position statement on the management of gastroesophageal reflux disease 1.

From the FDA Drug Label

Table 17: Frequency of Heartburn Variable | Placebo (n=43) | Lansoprazole 15 mg (n=80) | Lansoprazole 30 mg (n=86) Median % of Days without Heartburn | Week 1 | 10% | 71% | 46% | Week 4 | 11% | 81% * | 76% | Week 8 | 13% | 84% * | 82% % of Nights without Heartburn | Week 1 | 17% | 86% * | 57% | Week 4 | 25% | 89% * | 73% | Week 8 | 36% | 92% * | 80%

Treatment of GERD at night can be achieved with lansoprazole 15 mg once daily, which has been shown to significantly reduce the frequency and severity of night heartburn associated with GERD. 2

From the Research

GERD Treatment at Night

• The treatment of gastroesophageal reflux disease (GERD) at night can be managed through various methods, including lifestyle modifications and pharmacological interventions 3, 4.
• Lifestyle modifications such as head of bed elevation, prolonging dinner-to-bed time, and promoting left lateral decubitus position have been shown to be effective in reducing nocturnal reflux symptoms 3, 4.
• Pharmacological interventions, including proton pump inhibitors (PPIs) and histamine(2) receptor antagonists, can also be used to manage GERD symptoms at night 5, 3, 6.
• PPIs have been shown to be effective in reducing nocturnal acid breakthrough, but the clinical significance of this finding is not clear 6.
• The use of combination therapy with PPIs and histamine(2) receptor antagonists has not been shown to provide any further benefit above that derived from PPIs alone 6.
• Newer treatments, such as vonoprazan, a potassium-competitive acid blocker, have been approved for the treatment of erosive esophagitis and non-erosive GERD, and may offer improved efficacy and tolerability compared to traditional PPIs 7.

Pharmacological Interventions

• PPIs, such as omeprazole and lansoprazole, are commonly used to treat GERD symptoms at night 5, 3, 6.
• Histamine(2) receptor antagonists, such as ranitidine, can also be used to manage GERD symptoms at night, but may not be as effective as PPIs 5, 6.
• Vonoprazan, a newer potassium-competitive acid blocker, has been shown to be effective in healing and maintaining healing of erosive esophagitis, and relieving heartburn in adult patients with erosive esophagitis and non-erosive GERD 7.

Lifestyle Modifications

• Head of bed elevation can help reduce nocturnal reflux symptoms by preventing stomach acid from flowing up into the esophagus 3, 4.
• Prolonging dinner-to-bed time can also help reduce nocturnal reflux symptoms by allowing the stomach to empty before lying down 3, 4.
• Promoting left lateral decubitus position can help reduce nocturnal reflux symptoms by preventing stomach acid from flowing up into the esophagus 3, 4.