From the Guidelines
To manage GERD, patients should make lifestyle changes, including avoiding trigger foods, eating smaller meals, and elevating the head of their bed, and consider medication options, such as proton pump inhibitors, under the guidance of a healthcare provider. The most recent and highest quality study, 1, emphasizes the importance of a personalized approach to managing GERD, including lifestyle modifications and medication therapy.
Lifestyle Modifications
Some key lifestyle changes that can help manage GERD include:
- Avoiding trigger foods like spicy, fatty, or acidic items, chocolate, caffeine, and alcohol
- Eating smaller meals and not lying down for 2-3 hours after eating
- Elevating the head of the bed by 6-8 inches using blocks or a wedge pillow
- Maintaining a healthy weight, quitting smoking, and wearing loose-fitting clothes
Medication Options
For medications, patients can start with over-the-counter antacids like Tums or Rolaids for occasional symptoms. For regular symptoms, trying H2 blockers like famotidine (Pepcid) 20mg twice daily or ranitidine (Zantac) 150mg twice daily may be effective. For more severe symptoms, proton pump inhibitors like omeprazole (Prilosec) 20mg daily or esomeprazole (Nexium) 40mg daily before breakfast are effective, as recommended by 1.
Shared Decision-Making
It is essential for patients to work with their healthcare provider to develop a personalized care plan, including investigation of symptoms, selection of therapy, and long-term management, as emphasized by 1 and 1. This shared decision-making approach ensures that patients receive the most effective treatment for their specific needs and can help improve outcomes and quality of life.
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)]. The patient instructions for GERD treatment with lansoprazole are:
- For adults and pediatric patients 12 to 17 years of age, take the medication for up to eight weeks.
- For pediatric patients one to 11 years of age, take the medication for up to 12 weeks.
- The medication is used for the treatment of heartburn and other symptoms associated with GERD 2.
From the Research
Patient Instructions for GERD
To manage GERD symptoms, patients can follow these instructions:
- Elevate the head of the bed by 6-8 inches to reduce nocturnal reflux symptoms 3, 4
- Lose weight if obese, as weight loss has been shown to improve pH profiles and symptoms 3, 5
- Avoid lying on the right side and instead lie on the left side to reduce reflux symptoms 4
- Avoid trigger foods and beverages that can worsen GERD symptoms, such as:
- Increase fiber intake and lower dietary fat 5
- Engage in regular and mild-moderate physical activity, as excessive physical activity can trigger GERD symptoms 4
- Consider alternative approaches such as breathing exercises, which have been shown to improve gastroesophageal reflux symptoms 5
- Take medication as prescribed and follow dietary recommendations to improve adherence and manage symptoms 6
Medication and Treatment
Patients with GERD can be treated with:
- Antacids and alginates, which can provide quick relief but may affect absorption of other medications 7
- H2 receptor antagonists, which can be used for on-demand treatment of reflux symptoms but may have variable efficacy and potential interactions with other medications 7
- Proton pump inhibitors, which are the most effective medical therapy for GERD and can provide long-term relief 7
- Prokinetic agents, such as cisapride, which can help improve gastric emptying and reduce reflux symptoms 7
Lifestyle Modifications
Lifestyle modifications can play an important role in managing GERD symptoms, and patients should: