What treatment options are available for gastroesophageal reflux disease (GERD)?

From the Guidelines

For heartburn, I recommend starting with a 4- to 8-week trial of single-dose proton pump inhibitors (PPIs) as the first line of treatment, as it is considered safe and appropriate for patients with typical reflux symptoms and no alarm symptoms 1. This approach is based on the latest clinical practice update on the personalized approach to the evaluation and management of gastroesophageal reflux disease (GERD) 1.

• The initial treatment should focus on lifestyle modifications, including avoiding trigger foods, eating smaller meals, not lying down after eating, and elevating the head of your bed.
• Over-the-counter antacids like Tums or Rolaids can provide quick relief by neutralizing stomach acid.
• H2 blockers such as famotidine (Pepcid) or ranitidine can be taken 30-60 minutes before meals for longer relief, typically at doses of 10-20mg.
• If symptoms persist, PPIs like omeprazole (Prilosec) or esomeprazole (Nexium) at 20mg daily can be used, but should generally not be used for more than 14 days without medical consultation 1. It is essential to note that if symptoms persist beyond two weeks, are severe, or are accompanied by difficulty swallowing, chest pain, or weight loss, consultation with a healthcare provider is necessary to determine the best course of treatment 1.
• The healthcare provider may recommend further testing, such as upper GI endoscopy or esophageal physiologic testing, to assess the severity of GERD and determine the most effective treatment plan 1.
• In some cases, anti-reflux surgery may be considered, but this should be weighed against the potential risks and benefits, and discussed thoroughly with a healthcare provider 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.
2. Treatment of GERD. Symptomatic relief commonly occurs within 24 hours after starting therapy with ranitidine 150 mg twice daily.
3. Treatment of endoscopically diagnosed erosive esophagitis Symptomatic relief of heartburn commonly occurs within 24 hours of therapy initiation with ranitidine 150 mg 4 times daily.

For heartburn, the following options can be considered:

• Ranitidine 150 mg twice daily, which can provide symptomatic relief within 24 hours.
• Omeprazole delayed-release capsules, which 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. 2 3

From the Research

Treatment Options for Heartburn

• Antacids can provide temporary relief by neutralizing acid in the esophagus, but they do not significantly affect gastric pH or prevent subsequent heartburn episodes 4
• Histamine-2 receptor antagonists (H2 RAs) can provide rapid relief, but they develop tolerance with repeat dosing and may not prevent acid exposure in the esophagus 4
• Proton pump inhibitors (PPIs) are superior to antacids and H2 RAs for controlling gastric acid and treating frequent heartburn, with a recommended dose of 20 mg for empiric treatment 4

Proton Pump Inhibitors (PPIs) for Heartburn

• PPIs are the medical treatment of choice for gastroesophageal reflux disease (GERD) and can provide sustained inhibition of gastric acid production 5
• Rabeprazole, a type of PPI, has been shown to relieve heartburn and other symptoms associated with symptomatic GERD within the first 1-2 days of treatment 6
• PPIs, such as omeprazole, lansoprazole, rabeprazole, and pantoprazole, have similar efficacy in terms of heartburn control, healing rates, and relapse rates 7

Lifestyle Changes and Other Treatment Options

• Lifestyle changes, such as weight loss and smoking cessation, can be useful in managing heartburn and GERD symptoms 8
• Surgery, such as laparoscopic fundoplication, is an invasive treatment alternative for select patients with GERD, particularly those who are young and healthy 8
• New endoscopic and less invasive surgical procedures are emerging, but their long-term safety and efficacy remain to be scientifically established 8