From the Guidelines
Proton pump inhibitors (PPIs) are the most effective medications for treating Gastroesophageal Reflux Disease (GERD), and should be used as a first-line treatment for patients with typical reflux symptoms and no alarm symptoms, as recommended by the American Gastroenterological Association (AGA) in 2022 1.
Medication Options for GERD
Medications to treat GERD include:
- Antacids like Tums or Rolaids for quick, temporary relief
- H2 blockers such as famotidine (Pepcid) or ranitidine (Zantac) for longer relief, typically at doses of 10-20mg twice daily
- Proton pump inhibitors (PPIs) like omeprazole (Prilosec) or esomeprazole (Nexium) at 20-40mg daily, taken 30-60 minutes before breakfast, which are the most effective for more persistent symptoms
Treatment Approach
The AGA recommends a personalized approach to the evaluation and management of GERD symptoms, including a 4- to 8-week trial of single-dose PPI therapy for patients with typical reflux symptoms and no alarm symptoms 1. If symptoms persist, dosing can be increased to twice a day or switched to a more effective acid suppressive agent once a day. Lifestyle modifications, such as avoiding trigger foods, eating smaller meals, not lying down after eating, and elevating the head of the bed, should accompany medication.
Key Considerations
- PPIs work by blocking acid production in the stomach and should be used for 2-8 weeks initially, with possible maintenance therapy for chronic cases
- For breakthrough symptoms, combine a PPI with an antacid as needed
- If symptoms persist despite medication for 4-8 weeks, consult a healthcare provider as you may need dosage adjustments or further evaluation, as up to 50% of patients do not derive adequate relief with empirical PPI therapy 1
From the FDA Drug Label
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. Omeprazole delayed-release capsules are used in adults: • for up to 4 weeks to treat heartburn and other symptoms that happen with gastroesophageal reflux disease (GERD). Omeprazole delayed-release capsules are used in adults: • for up to 8 weeks to heal acid-related damage to the lining of the esophagus (called erosive esophagitis or EE). For children 2 to 16 years of age, omeprazole delayed-release capsules are used: • for up to 4 weeks to treat heartburn and other symptoms that happen with gastroesophageal reflux disease (GERD). • for up to 8 weeks to treat gastroesophageal reflux disease (GERD) with acid-related damage to the lining of the esophagus [called erosive esophagitis (or EE) due to acid-mediated GERD]
Medications used to treat Gastroesophageal Reflux Disease (GERD) include:
From the Research
Medications for Gastroesophageal Reflux Disease (GERD)
The following medications are used to treat GERD:
- Proton pump inhibitors (PPIs) such as lansoprazole, omeprazole, pantoprazole, and rabeprazole 3, 4, 5
- H2-receptor antagonists (H2RAs) such as cimetidine and ranitidine, although they are less effective than PPIs 3, 4
- Potassium-competitive acid blockers such as vonoprazan, which has been shown to be effective in healing GERD, particularly in patients with severe esophagitis 6
- Prokinetics such as metoclopramide and cisapride, although they are limited by low efficacy, pharmacological tolerance, and toxicity 3
Specific Medications and Their Effects
- Omeprazole 20 mg has been shown to significantly reduce signs and symptoms of laryngopharyngeal reflux and comorbid chronic rhinosinusitis after 8 weeks of treatment 7
- Lansoprazole and esomeprazole have been shown to produce similar degrees and onset of symptom relief, with both providing greater symptom relief compared to omeprazole 5
- Vonoprazan has been shown to have a higher healing effect than rabeprazole, but not higher than other PPIs, and is more effective in patients with severe erosive esophagitis 6