Treatment Options

Treatment options can vary depending on your symptoms and the severity of your condition. Treatments can be divided between lifestyle changes, medical, and surgical approaches, or a combination of these approaches. The majority of patients can be treated effectively with a combination of lifestyle changes and drug therapy. "Because GERD is generally a chronic condition, some form of treatment must be continued indefinitely in most cases (Johns Hopkins medicine Gastroenterology & Hepatology, 2001)."

Changing your dietary consumption and modifying your lifestyle is a great way to lessen your symptoms. Maintaining a healthy weight is very important to help reduce the frequency of heartburn. The excess pounds put pressure on your abdomen, causing acid to back up into your esophagus. If you are overweight or obese, work with your doctor to slowly lose weight. Avoid tight-fitting clothing, tight-fitting clothing around your waist can put pressure on your abdomen and the lower esophageal sphincter. Avoid food and drinks that trigger heartburn. Fatty or fried foods, caffeinated beverages, acidic foods or liquids, foods like chocolate, onions, garlic, peppermint, carbonated beverages, alcohol, citrus and tomato products are examples of food that should all be avoided. Reducing the amount of food intake to smaller meals will help you avoid overeating and reduce frequent heartburn. Waiting at least three hours after eating to lie down or go to bed is advised. Elevating the head of your bed is usually recommended if you have reflux while you sleep. Quit smoking and avoid secondhand smoke to increase the lower esophageal sphincter’s ability to function properly. (NIH, 2016)

If dietary and lifestyle changes isn’t sufficient to control your symptoms, medical approaches such as drug therapy should be considered. Drug therapy usually begins with over-the-counter heartburn medication. If your symptoms show no sign of improvement contact your doctor for other options. Your doctor may prescribe antacids, H2 blockers, proton pump inhibitors (PPIs), or prokinetic agents. Antacid include over-the-counter medicines such as Maalox, Mylanta, Riopan, and Rolaids. Antacids can neutralize the acid present in the stomach at the time of ingestion. The duration of the antacid tends to be limited making them good for quick relief. Histamine blocker or H2 blockers, is a drug that helps decrease acid production. Some examples of H2 blockers are Tagamet HB, Pepcid AC, Axid AR, and Zantac 75. It provides short-term or on-demand relief for many people. Proton pump inhibitors (PPIs) lower the amount of acid your stomach makes. PPIs are better at treating GERD than H2 blockers. They are often prescribed for long-term GERD treatment. Taking this medication may be associated with a slight increase in risk of bone fracture. Some PPIs medication include, Nexium, Prevacid, Prilosec, Protonix, and AcipHex to name a few. Prokinetic agents help your stomach empty faster. They tend to be as effective as H2 blocker, but less effective than PPIs. Prokinetics include Urecholine and Reglan, these medications may have side effects, including nausea, diarrhea, fatigue, depression, anxiety, and delayed or abnormal physical movement. Tell your doctor if you are taking other medication before taking prokinetic agents. (NIH, 2016) and (Johns Hopkins medicine Gastroenterology & Hepatology, 2001) and (Mayo Clinic, 2014)

Your doctor may recommend surgery if your symptoms don’t improve with lifestyle changes or drug therapy.

Surgery approaches include fundoplication, The Linx device and endoscopic techniques. According to the National Institute of Diabetes and Digestive and Kidney Diseases, fundoplication is the most common surgery for GERD. This operation is done under general anesthesia and you can leave the hospital in one to three days and resume your daily activities in two to three weeks. A surgeon performs the operation using a laparoscope, a thin tube with a tiny video camera. During the operation, the surgeon sews the top of your stomach around your esophagus to add pressure to the lower end of your esophagus and reduce reflux.

The Linx device is a "ring of tiny magnetic titanium beads that is wrapped around the junction of the stomach and esophagus (Mayo Clinic, 2014)." This ring is strong enough to keep the "opening between the two closed to refluxing acid, but weal enough so that food can pass through it (Mayo Clinic, 2016)."

Endoscopic techniques such as endoscopic sewing uses small stitches to tighten your sphincter muscle. Radiofrequency, creates heat lesions, or sores, that help tighten your sphincter muscle. During both operations you receive general anesthesia and a surgeon operates using an endoscope. (NIH, 2016) 

Reference (APA Citation without URL):

Johns Hopkins medicine Gastroenterology & Hepatology. (2001). Gastroesophageal Reflux disease: Introduction. Retrieved November 22, 2016.

Mayo Clinic (2014). Treatments and drugs. Mayoclinic. Retrieved November 22,2016.

National Institute of Diabetes and Digestive and Kidney Diseases. (2016, October 3). Acid Reflux (GER & GERD) in adults. Retrieved November 22, 2016.