What is the treatment for gastroesophageal reflux disease (GERD) with symptoms of food regurgitation?

From the Guidelines

Treatment for gastroesophageal reflux disease (GERD) with symptoms of food regurgitation should start with lifestyle modifications, including avoidance of refluxogenic foods, eating smaller meals, and elevating the head of the bed, as well as consideration of proton pump inhibitors (PPIs) for a 4- to 8-week trial. The most recent and highest quality study 1 suggests that lifestyle modification measures, such as avoidance of refluxogenic foods, food avoidance for at least 2–3 hours before recumbency, positional changes during the sleep period, and weight loss, have been proposed for management of GERD. Key lifestyle modifications include:

• Avoiding lying down for 2-3 hours after eating
• Elevating the head of the bed by 6-8 inches to reduce nighttime regurgitation
• Eliminating trigger foods like spicy, fatty, or acidic items
• Weight loss, if overweight, to reduce abdominal pressure Medications that may help include:
• Proton pump inhibitors (like omeprazole 20-40mg daily or pantoprazole 40mg daily)
• H2 blockers (such as famotidine 20mg twice daily)
• Prokinetic agents (like metoclopramide 10mg before meals) According to 1, clinicians should provide patients presenting with troublesome heartburn, regurgitation, and/or non-cardiac chest pain without alarm symptoms a 4- to 8-week trial of single-dose PPI therapy, with escalation to twice-a-day dosing or switching to a more potent acid suppressive agent if symptoms persist. Additionally, 1 suggests that a precision approach to escalation of management is suggested for patients with ongoing symptoms despite these measures, which should be driven by integrity of the anti-reflux barrier, presence of visceral hypersensitivity and hypervigilance, confirmation of PPI refractory-GERD, symptom profile, body mass index, and esophageal (as well as gastric) motor function.

From the FDA Drug Label

Treatment of Symptomatic GERD 20 mg once daily Up to 4 weeks If there is recurrence of EE or GERD symptoms (e.g., heartburn), additional 4 to 8 week courses of omeprazole may be considered.

The treatment for gastroesophageal reflux disease (GERD) with symptoms of food regurgitation is 20 mg of omeprazole once daily for up to 4 weeks. If symptoms recur, additional 4 to 8 week courses of omeprazole may be considered 2.

From the Research

Treatment for Gastroesophageal Reflux Disease (GERD)

The treatment for GERD with symptoms of food regurgitation involves a combination of lifestyle modifications, dietary changes, and pharmacotherapy.

• Lifestyle modifications include:
  • Weight reduction and smoking cessation, which have been shown to be beneficial in reducing GERD symptoms 3
  • Avoiding lying on the left side and raising the head of the bed in a supine position to reduce nocturnal reflux symptoms 4
  • Regular and mild-moderate physical activity, which has been shown to reduce the symptoms of reflux 4
• Dietary changes include:
  • Avoiding trigger foods such as fatty, fried, sour, spicy food/products, orange and grapefruit juice, tomatoes and tomato preserves, chocolate, coffee/tea, carbonated beverages, and alcohol 5, 4, 6
  • Eating smaller, more frequent meals and avoiding eating close to bedtime 5, 6
• Pharmacotherapy, including proton pump inhibitors (PPIs), is considered the first-line treatment for GERD patients, but lifestyle modifications and dietary changes are also important elements in supporting the treatment of the disease 5, 7

Management of GERD Symptoms

The management of GERD symptoms also involves non-pharmacological therapies, such as:

• Head of bed elevation and increased meal to sleep time, which may provide effective symptom control in GERD 6
• Incisionless laparoscopic fundoplications and newer endoluminal techniques, such as the LINX device, which are being used as alternatives to traditional surgical fundoplications 7