From the Guidelines
The recommended treatment for Gastroesophageal Reflux Disease (GERD) typically begins with an initial trial of empirical acid-suppressive therapy with once-daily proton-pump inhibitors (PPIs), which may be escalated to twice-daily therapy if symptoms persist, as supported by the American College of Physicians 1.
Key Considerations
- Lifestyle modifications, such as weight loss, avoiding trigger foods, eating smaller meals, and elevating the head of the bed, may be beneficial for some patients, but the evidence for their effectiveness is not as strong as that for PPIs 1.
- PPIs, such as omeprazole, esomeprazole, or pantoprazole, are the most effective medication options, with dosing typically starting at 30 minutes before breakfast for 4-8 weeks initially.
- H2 blockers, such as famotidine, may be used for milder symptoms or as add-on therapy, while antacids provide quick but temporary relief.
Treatment Approach
- For patients with typical GERD symptoms, such as heartburn or regurgitation, without alarm symptoms, an initial trial of empirical PPI therapy is warranted, with endoscopy not indicated initially 1.
- If symptoms persist despite 4-8 weeks of twice-daily PPI therapy, further investigation with endoscopy is recommended to rule out complications like esophageal stricture or Barrett's esophagus.
- For patients with severe erosive esophagitis or alarm symptoms, such as dysphagia, bleeding, or weight loss, upper endoscopy is recommended to investigate for potentially clinically actionable findings 1.
From the FDA Drug Label
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. 1.5 Treatment of Erosive Esophagitis (EE) Due to Acid-Mediated GERD Pediatric Patients 2 Years of Age to Adults Omeprazole delayed-release capsules are indicated for the short-term treatment (4 to 8 weeks) of EE due to acid-mediated GERD that has been diagnosed by endoscopy in patients 2 years of age and older The recommended treatment for Gastroesophageal Reflux Disease (GERD) is omeprazole delayed-release capsules for up to 4 weeks in patients 2 years of age and older.
- Indications: Treatment of heartburn and other symptoms associated with GERD.
- Duration: Up to 4 weeks.
- Patient age: 2 years of age and older. 2
From the Research
Treatment Options for GERD
The treatment of Gastroesophageal Reflux Disease (GERD) involves a combination of lifestyle changes, medication, and surgery.
- Lifestyle changes: Weight loss and smoking cessation are often useful in managing GERD symptoms 3.
- Medication: Proton pump inhibitors (PPIs) are the most common treatment for GERD, with the aim of using the lowest effective dose after initial full-dose therapy 3.
- Surgery: Laparoscopic fundoplication is an invasive treatment alternative in select patients after thorough and objective assessments, particularly if they are young and healthy 3.
Medication Comparison
Comparing different proton pump inhibitor formulas, studies have shown:
- Dexlansoprazole has a higher response rate than lansoprazole in treating atypical GERD symptoms such as cough and globus 4.
- On-demand treatment with PPIs gives a high success rate with a fairly low dose, while H2-blockers have significantly less success 5.
- PPIs relieve acid reflux-related symptoms more rapidly than standard-dose or high-dose histamine2 receptor antagonists and accelerate the rate of esophageal healing 6.
Combination Therapy
Combination therapy with PPIs and histamine(2) receptor antagonists has been evaluated, but: