From the Guidelines
Proton pump inhibitors (PPIs) are the most effective medications for treating gastroesophageal reflux disease (GERD), and twice daily PPI is superior to once daily PPI in gastric acid suppression and likely more effective for extraesophageal reflux (EER) symptoms. According to a recent study 1, acid suppression with PPIs is the mainstay of pharmacologic therapy for GERD, and multiple randomized controlled trials have shown the effectiveness of these medications for healing of erosive esophagitis and controlling typical symptoms of GERD. Some common PPIs include omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), and pantoprazole (Protonix).
Some key points to consider when treating GERD with PPIs include:
- Twice daily PPI may be more effective than once daily PPI for EER symptoms 1
- A 2- to 3-month trial of PPI is considered optimal treatment in patients with EER symptoms 1
- Patients with objectively documented GERD and EER symptoms may fail PPI therapy for various reasons, including true PPI failure with ongoing acid reflux, adequate acid suppression but ongoing non-acid or weakly acidic reflux, or the presence of additional non-GERD factors contributing to their symptoms 1
- Non-PPI treatment options, including alginate-containing antacids, neuromodulators, cognitive behavioral therapy, and hypnotherapy, may have a role in reducing EER symptoms, although more robust data are needed 1
It's also worth noting that other medications, such as antacids and H2 blockers, may be used to treat GERD, but PPIs are generally the most effective option. As stated in another study 1, any PPI may be used because absolute differences in efficacy for symptom control and tissue healing are small.
In terms of treatment approach, a step-up approach is often used, starting with lifestyle modifications and antacids, then progressing to H2 blockers and finally PPIs if symptoms persist. This approach allows for the use of the most effective medication while minimizing potential side effects and costs.
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 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.
Common medications for gastrointestinal reflux disease (GERD) include:
- Lansoprazole: indicated for short-term treatment of symptomatic GERD in adults and pediatric patients
- Omeprazole: indicated for the treatment of heartburn and other symptoms associated with GERD in patients 2 years of age and older 2 2 3
From the Research
Common Medications for Gastrointestinal Reflux Disease (GERD)
The common medications for GERD include:
- Proton pump inhibitors (PPIs) which are the agents of choice for the suppression of gastric acid production and have become the mainstay of therapy for acid-related diseases 4, 5, 6, 7
- Histamine H2-receptor antagonists (H2RAs) which can provide effective symptomatic relief, particularly in patients with milder GERD 5
- Antacids and alginates which can provide effective symptom relief to about one quarter of patients suffering from GERD 5
- New drugs that have been introduced to increase the defensive properties of the mucosa, which have shown promising results in randomized clinical trials 6
Pharmacological Management of GERD
The pharmacological management of GERD is individualized for each patient depending on the severity of symptoms, complications of GERD, and patient/physician preference 8. PPIs remain the first-choice therapy in the treatment of GERD, but a consistent proportion of patients continue to experience symptoms despite their intake 6.
Considerations for PPI Use
The use of PPIs should be guided by best practice guidelines, and individualized decisions should be made with regard to PPI use 7. The significant increase in use of PPIs for ill-defined indications over the years, associated adverse outcomes with long-term use, and consequent increase in health care costs have drawn much attention 7. Efforts at deprescribing the PPI may be attempted following discussion with the patient, and approaches include stopping the drug, reducing the dose, or using "on-demand" therapy after completing the course of treatment for the specific indication 7.