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

From the Guidelines

Patients with GERD symptoms should initially receive a 4- to 8-week trial of single-dose proton pump inhibitors (PPIs), with escalation to twice-a-day dosing or switching to a more potent acid suppressive agent if symptoms persist, as recommended by the most recent clinical practice update 1. The treatment of Gastroesophageal Reflux Disease (GERD) involves a stepwise approach, starting with lifestyle modifications and patient education on GERD pathophysiology.

• Lifestyle modifications include weight loss, avoiding trigger foods, eating smaller meals, not lying down for 2-3 hours after eating, elevating the head of the bed, and quitting smoking.
• Medication options include PPIs, such as omeprazole or esomeprazole, which provide stronger acid suppression and are typically taken 30 minutes before breakfast.
• The goal of treatment is to reduce acid exposure to the esophagus, allowing irritated tissue to heal and preventing complications like Barrett's esophagus or esophageal cancer.
• For patients with persistent symptoms despite medical therapy, surgical options like laparoscopic fundoplication or less invasive procedures like the LINX device may be considered.
• A precision approach to escalation of management is suggested for patients with ongoing symptoms, driven by factors such as integrity of the anti-reflux barrier, presence of visceral hypersensitivity and hypervigilance, and confirmation of PPI refractory-GERD 1.
• PPI therapy should be titrated to the lowest effective dose, and long-term use should be carefully considered due to potential risks of bone fractures, vitamin deficiencies, and kidney problems.
• Objective reflux testing with upper GI endoscopy or prolonged wireless pH monitoring off PPI therapy may be necessary to establish a diagnosis of GERD and guide long-term management 1.

From the FDA Drug Label

1.7 Treatment of Symptomatic Gastroesophageal Reflux Disease (GERD) Lansoprazole delayed-release capsules are indicated for short-term treatment in adults and pediatric patients 12 to 17 years of age (up to eight weeks) and pediatric patients one to 11 years of age (up to 12 weeks) for the treatment of heartburn and other symptoms associated with GERD [see Clinical Studies ( 14.7)]. 1.4 Treatment of Symptomatic Gastroesophageal Reflux Disease (GERD) Omeprazole delayed-release capsules are indicated for the treatment of heartburn and other symptoms associated with GERD for up to 4 weeks in patients 2 years of age and older.

The treatment options for Gastroesophageal Reflux Disease (GERD) include:

• Lansoprazole delayed-release capsules for short-term treatment in adults and pediatric patients 12 to 17 years of age (up to eight weeks) and pediatric patients one to 11 years of age (up to 12 weeks) 2
• Omeprazole delayed-release capsules for the treatment of heartburn and other symptoms associated with GERD for up to 4 weeks in patients 2 years of age and older 3 Key points:
• Treatment duration may vary depending on the patient's age and response to treatment
• These medications are indicated for short-term treatment of GERD symptoms 2 3

From the Research

Treatment Options for Gastroesophageal Reflux Disease (GERD)

The treatment options for GERD can be categorized into lifestyle modifications, medical treatments, and alternative approaches.

• Lifestyle modifications:
  • Weight loss: Studies have shown that weight loss can improve pH profiles and symptoms of GERD 4, 5.
  • Head of bed elevation: Elevating the head of the bed can reduce nocturnal reflux symptoms 4, 5.
  • Left lateral decubitus position: Lying on the left side can also reduce reflux symptoms 4.
  • Avoiding trigger foods: Although the evidence is limited, some studies suggest that avoiding certain foods such as salty foods, chocolates, fatty foods, and fizzy drinks may help alleviate GERD symptoms 6, 5.
  • Regular and mild-moderate physical activity: Exercise has been shown to reduce reflux symptoms, while excessive physical activity may trigger GERD symptoms 5.
• Medical treatments:
  • Proton pump inhibitors (PPIs): PPIs are the cornerstone of medical treatment for GERD and have been shown to be effective in relieving heartburn symptoms 6, 7.
  • H2-receptor antagonists (H2RAs): H2RAs are also used to treat GERD, although they are less effective than PPIs 7.
  • Prokinetics: Prokinetics may be used to treat GERD, although the evidence is limited 7.
• Alternative approaches:
  • Breathing exercises: A study found that a training program that induces a change from thoracic to abdominal breathing can improve GERD symptoms 8.