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

From the Guidelines

To treat GERD, start with lifestyle modifications and consider a 4- to 8-week trial of single-dose proton pump inhibitor (PPI) therapy, escalating to twice-a-day dosing or switching to a more potent acid suppressive agent if symptoms persist, as recommended by the most recent guidelines 1.

Lifestyle Modifications

Lifestyle changes are essential in managing GERD symptoms, including:

• Elevating the head of the bed 6-8 inches
• Avoiding meals within 3 hours of bedtime
• Eliminating trigger foods such as caffeine, chocolate, alcohol, fatty foods, and spicy foods
• Weight loss if overweight

Medication

For medication, the following options can be considered:

• Over-the-counter antacids like Tums or Rolaids for immediate but temporary relief
• H2 blockers such as famotidine (Pepcid) 20mg twice daily or ranitidine (Zantac) 150mg twice daily for longer relief
• Proton pump inhibitors (PPIs) like omeprazole (Prilosec) 20mg daily or esomeprazole (Nexium) 40mg daily before breakfast for more persistent symptoms

Further Evaluation and Treatment

If symptoms persist despite these measures, further evaluation and treatment may be necessary, including:

• Endoscopic evaluation to check for complications like Barrett's esophagus
• Surgical interventions such as fundoplication if medications fail to control symptoms
• Consideration of antireflux surgery in select patients, as recommended by the AGA clinical practice update 1

Key Considerations

• PPIs work by blocking acid production in the stomach, while H2 blockers reduce acid by blocking histamine receptors
• Severe or long-standing GERD may require more intensive treatment and monitoring
• A precision approach to escalation of management is suggested, driven by factors such as 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 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. 1.7 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

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

• Omeprazole delayed-release capsules for up to 4 weeks in patients 2 years of age and older 2
• 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) 3

From the Research

Treatment Options for Gastroesophageal Reflux Disease (GERD)

• Medical therapy: includes antacids, alginates, prokinetic agents, and antisecretory compounds, primarily H2 receptor antagonists and proton pump inhibitors 4
• Lifestyle modifications:
  • Weight loss: improves esophageal pH and/or GERD symptoms 5, 6, 7
  • Head of bed elevation: improves the overall time that the esophageal pH was less than 4.0 6
  • Left lateral decubitus position: improves the overall time that the esophageal pH was less than 4.0 6
  • Dietary changes: although the role of diet is controversial, a diet rich in fiber and low in fat is advisable in preventing reflux symptoms 8, 7
• Surgical therapy: may be necessary for some patients who do not respond to medical therapy 5

Medical Therapy

• H2 receptor antagonists:
  • Rapid onset of effect 4
  • Decrease likelihood of the development of tolerance 4
  • Suitable for on-demand treatment of reflux symptoms 4
• Proton pump inhibitors:
  • Most effective medical therapy for any severity of GERD, particularly in severe oesophagitis 4
  • Long duration of action, allowing once daily administration in most patients 4
  • Slow onset of action, making them unsuited for on-demand therapy 4

Lifestyle Modifications

• Weight loss:
  • Improves pH profiles and symptoms 6
  • Effective lifestyle intervention for GERD 6
• Dietary habits:
  • Fatty, fried, sour, spicy food/products, orange and grapefruit juice, tomatoes and tomato preserves, chocolate, coffee/tea, carbonated beverages, alcohol may trigger GERD symptoms 8
  • Eating habits such as irregular meal pattern, large volume of meals, eating meals just before bedtime may correlate with the symptoms of GERD 8