What can be given for the pain of gastroesophageal reflux disease (GERD)?

From the Guidelines

For the pain of gastroesophageal reflux disease (GERD), proton pump inhibitors (PPIs) like omeprazole (Prilosec) or esomeprazole (Nexium) are the most effective treatment, providing the strongest and longest-lasting relief by blocking acid production. According to the most recent and highest quality study 1, a 4- to 8-week trial of single-dose PPI is considered safe and appropriate for patients with typical reflux symptoms and no alarm symptoms.

Treatment Options

• Over-the-counter antacids like Tums, Rolaids, or Maalox can provide immediate relief by neutralizing stomach acid quickly, but their effect is brief.
• H2 blockers such as famotidine (Pepcid) or ranitidine (Zantac) can reduce acid production for several hours and should be taken 30 minutes before meals.
• PPIs like omeprazole (Prilosec) or esomeprazole (Nexium) provide the strongest and longest-lasting relief, but take 1-4 days to reach full effect, and should be started with 20mg once daily before breakfast.
• Lifestyle changes are also important, including avoiding trigger foods (spicy, fatty, acidic), eating smaller meals, not lying down for 3 hours after eating, elevating the head while sleeping, and maintaining a healthy weight.

Management Approach

The management of GERD should be personalized, involving a stepwise diagnostic approach to identify the mechanisms driving symptoms, and a shared decision-making model with the patient 1. For patients with persistent symptoms, increasing the dose or switching to another PPI can be beneficial, and adding other medications such as histamine-2 receptor antagonists (H2RA) or alginates can also improve symptom control 1.

Long-term Management

For patients who require long-term PPI therapy, objective reflux testing should be offered to establish a diagnosis of GERD and a long-term management plan 1. The goal of treatment is to titrate PPI therapy to the lowest effective dose, and to optimize lifestyle and pharmacotherapy to achieve adequate symptom control.

From the FDA Drug Label

1. Treatment of GERD. Symptomatic relief commonly occurs within 24 hours after starting therapy with ranitidine 150 mg twice daily. Concomitant antacids should be given as needed for pain relief to patients with active duodenal ulcer; active, benign gastric ulcer; hypersecretory states; GERD; and erosive esophagitis. Treatment of Symptomatic GERD 20 mg once daily Up to 4 weeks Treatment of EE due to Acid-Mediated GERD 20 mg once daily 4 to 8 weeks

Pain management for GERD can be achieved with:

• Ranitidine 150 mg twice daily for symptomatic relief of GERD, with antacids given as needed for pain relief 2
• Omeprazole 20 mg once daily for up to 4 weeks for treatment of symptomatic GERD, and up to 8 weeks for treatment of EE due to acid-mediated GERD 3

From the Research

Treatment Options for Gastroesophageal Reflux Disease (GERD)

The following treatment options are available for managing the pain of GERD:

• Antacids: can provide effective therapy for mild symptoms 4, 5, 6
• Histamine H2-receptor antagonists (H2RAs): can provide symptomatic relief, particularly in patients with milder GERD, but may become less effective over time 4, 5, 6, 7
• Proton pump inhibitors (PPIs): are the most effective medical therapy for GERD, particularly in severe cases, and can provide faster and more complete symptomatic relief and healing of erosive GERD compared to H2RAs 4, 5, 6, 8, 7
• Lifestyle changes: can provide effective therapy when combined with antacids and/or alginates 5
• Prokinetic agents: such as cisapride, can be used to optimize the therapeutic benefit in each patient 6

Considerations for Treatment

When choosing a treatment option, the following factors should be considered:

• Severity of symptoms: PPIs are more effective for severe cases, while H2RAs and antacids may be sufficient for milder cases 4, 5, 6
• Frequency of symptoms: intermittent or on-demand therapy with H2RAs or PPIs may be effective for patients with episodic symptoms 7
• Presence of erosive oesophagitis: PPIs are more effective for healing erosive oesophagitis compared to H2RAs 5, 7
• Patient characteristics: such as age, renal function, and presence of other diseases, may affect the choice of treatment and dosing regimen 6