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

From the Guidelines

Treatment for acid reflux should begin with a 4- to 8-week trial of single-dose proton pump inhibitors (PPIs) for patients with typical reflux symptoms and no alarm symptoms, as recommended by the most recent and highest quality study 1. This approach is supported by the American Gastroenterological Association (AGA) clinical practice update on the personalized approach to the evaluation and management of GERD, which suggests that a stepwise diagnostic approach and a precision management approach can help identify the mechanisms driving symptoms and improve patient outcomes 1. The treatment plan should also include lifestyle modifications, such as:

• Avoiding trigger foods like spicy, fatty, or acidic items, caffeine, chocolate, and alcohol
• Eating smaller meals
• Not lying down for 2-3 hours after eating
• Elevating the head of the bed by 6-8 inches
• Maintaining a healthy weight
• Quitting smoking For medication, antacids like Tums or Rolaids can provide immediate but temporary relief, while H2 blockers such as famotidine (Pepcid) or ranitidine can provide relief for several hours and are taken 30 minutes before meals 1. However, PPIs like omeprazole (Prilosec) or esomeprazole (Nexium) offer stronger acid reduction and are typically taken once daily before breakfast for 2-8 weeks, making them a more effective option for patients with persistent symptoms 1. It's also important to note that if symptoms persist after 2 weeks of self-treatment, patients should consult a doctor as they may need prescription-strength medication or further evaluation, and that PPIs work by blocking acid production at the source, while H2 blockers reduce acid by blocking histamine receptors in stomach cells, making them effective options for different severity levels of acid reflux 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)]. 1.4 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.

Treatment for acid reflux includes:

• Lansoprazole: for short-term treatment of symptomatic gastroesophageal reflux disease (GERD) 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) 2
• Omeprazole: for the treatment of heartburn and other symptoms associated with GERD for up to 4 weeks in patients 2 years of age and older 3

From the Research

Treatment Options for Acid Reflux

• Proton pump inhibitors (PPIs) such as omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole are widely used for the treatment of gastro-oesophageal reflux disease and other acid-related disorders 4.
• PPIs suppress gastric acid secretion by blocking the gastric acid pump, H(+)/K(+)-adenosine triphosphatase (ATPase), but have variations in the degree of acid suppression and speed of onset of acid inhibition 4.
• Combination therapy with PPIs and histamine(2) receptor antagonists has been evaluated, but the clinical significance of this approach is not clear, and further investigation is needed to determine optimal therapy in patients refractory to standard doses of PPIs 5.

Pharmacology and Efficacy of Specific PPIs

• Lansoprazole and omeprazole have been shown to be effective in the treatment of duodenal ulcers, gastric ulcers, peptic ulcer disease involving Helicobacter pylori infection, recurrent ulcers, ulcers induced by nonsteroidal anti-inflammatory drugs, reflux esophagitis, Barrett esophagus, and Zollinger-Ellison syndrome 6, 7.
• Lansoprazole has a bioavailability of 85%, while omeprazole has a bioavailability of 54%, and both have a plasma half-life of less than 2 hours, but a duration of action of more than 24 hours 6.
• Lansoprazole and omeprazole have similar adverse-effect profiles and are well tolerated in both long- and short-term therapy 6, 7.

Lifestyle Changes in Acid Reflux Treatment

• Lifestyle modification has an important role in the treatment of gastroesophageal reflux disease (GERD), and individual differences in the development of GERD symptoms with various foods have been observed 8.
• Elevating the head of the bed and lying on the left side can reduce the development of nocturnal reflux symptoms, and smoking and obesity (especially abdominal) can trigger GERD symptoms 8.
• Regular and mild-moderate physical activity has been shown to reduce the symptoms of reflux, while excessive physical activity is a significant risk factor for the development of GERD 8.