From the Guidelines
In an urgent care setting, the most appropriate medication for Gastroesophageal Reflux Disease (GERD) is a proton pump inhibitor (PPI) such as omeprazole 20mg once daily or pantoprazole 40mg once daily for 4-8 weeks, as recommended by the most recent and highest quality study 1.
Key Considerations
- PPIs are considered safe and effective for the treatment of GERD, with a low risk of side effects 1.
- The typical approach is to start with a PPI for 4-8 weeks, then reassess symptoms 1.
- Patients should take PPIs 30-60 minutes before the first meal of the day for optimal effectiveness.
- Lifestyle modifications should accompany medication, including:
- Avoiding trigger foods (spicy, fatty, acidic)
- Eating smaller meals
- Not lying down for 2-3 hours after eating
- Elevating the head of the bed
- Weight loss if appropriate
Alternative Options
- H2 blockers such as famotidine 20mg twice daily can be prescribed as an alternative to PPIs 1.
- Antacids like calcium carbonate or aluminum/magnesium hydroxide can be recommended as needed for immediate symptom relief 1.
Referral to a Gastroenterologist
- If symptoms persist beyond 4-8 weeks of treatment or if there are alarm symptoms like difficulty swallowing, weight loss, or bleeding, referral to a gastroenterologist for further evaluation is recommended 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)].
1.8 Treatment of Erosive Esophagitis (EE) 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 healing and symptom relief of all grades of EE
For adults who do not heal with lansoprazole delayed-release capsules for eight weeks (5 to 10%), it may be helpful to give an additional eight weeks of treatment.
The appropriate medication for Gastroesophageal Reflux Disease (GERD) in an urgent care setting is lansoprazole.
- The recommended treatment duration is up to eight weeks for adults and pediatric patients 12 to 17 years of age, and up to 12 weeks for pediatric patients one to 11 years of age.
- Lansoprazole 15 mg once daily is the recommended dose for the treatment of symptomatic GERD.
- If symptoms persist after eight weeks of treatment, an additional eight weeks of treatment may be considered 2.
From the Research
Medication Options for GERD in Urgent Care Settings
The following medications are commonly used to treat GERD:
- H2 receptor antagonists, such as cimetidine, ranitidine, famotidine, and nizatidine, which are effective in treating mild and intermittent GERD symptoms 3
- Proton pump inhibitors, such as omeprazole, lansoprazole, and pantoprazole, which are more effective in treating severe forms of GERD, including erosive esophagitis 3, 4
Efficacy of Medications
Studies have shown that:
- Omeprazole is more effective than ranitidine in resolving heartburn symptoms in patients with GERD 5, 6
- Proton pump inhibitors are more effective than H2 receptor antagonists in healing esophagitis and relieving reflux symptoms 4, 6
- Adding a bedtime H2-blocker to a proton pump inhibitor regimen can enhance nocturnal gastric pH control and decrease nocturnal acid breakthrough 7
Treatment Considerations
When treating GERD in an urgent care setting, consider the following: