Understanding Gastroesophageal Reflux Disease (GERD) -- Diagnosis and Treatment
Conventional Medicine for GERD
Three types of drugs are generally used to treat GERD. They are:
- Antacids such as Maalox, Rolaids, and Tums
- Histamine H2-blockers such as nizatidine (Axid), famotidine (Pepcid), cimetidine (Tagamet), and ranitidine (Zantac)
- Proton pump inhibitors such as rabeprazole (Aciphex), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), and dexlansoprazole (Dexilant),
Taking antacids when needed may be appropriate for the initial treatment of minor symptoms. H2-blockers help cut the stomach's production of acid and work best for people with mild GERD. They are available in prescription strength and over-the-counter (half) strength. For moderate or severe GERD, doctors may start with these drugs or another type of drug known as a proton pump inhibitor, which is stronger than H2-blockers. These drugs turn off the acid pumps that stimulate the production of acid from the stomach. They are all available in prescription strength, and Prilosec OTC, Prevacid 24hr, Nexium 24HR, and Zegerid OTC are available over the counter. For complicated or chronic GERD, proton pump inhibitors are often taken indefinitely. A doctor needs to be consulted if these medications are used more than occasionally, because more serious problems may be overlooked.
Proton pump inhibitors are effective in reducing symptoms and promoting healing of any inflammation. But when you stop taking the drugs, symptoms may rebound or return quickly. So if you use these drugs, you should work out a plan with your doctor for long-term GERD management.
Occasionally, motility drugs such as Reglan (metoclopramide) can be used to strengthen the lower esophageal sphincter and speed the emptying of the stomach to reduce symptoms of GERD. Unfortunately, these drugs have multiple side effects that limit their usefulness. Long-term (more than three months) use of Reglan is not recommended due to possible development of irreversible neurologic side effects. In fact, there is a warning from the FDA against long-term use of Reglan.
If drug therapy is ineffective, your doctor may suggest surgery or an endoscopic procedure to help prevent GERD.
If you have GERD, be sure your doctor knows about other medicines -- prescription and nonprescription -- that you take. Drugs such as aspirin, nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen, and birth control pills, can worsen symptoms of GERD. Also, some medications may have side effects if combined with some GERD medications.