- Lifestyle modifications
- Antacid therapy
- H2 Receptor antagonists
- Proton pump inhibitors
- Surgical treatments
Lifestyle modifications: Patients are told to avoid acidic foods (citrus and tomato-based products), alcoholic beverages, caffeinated beverages, chocolate, onions, garlic, and peppermint. It's important to avoid large meals and to avoid lying down for 3 to 4 hours after eating. Avoid tight clothing around the waist. Decrease intake of dietary fat. Elevate the head of the bed 4 to 8 inches. Lose weight and stop smoking.
A doctor should be notified if the patient takes any of the following medications: calcium channel blockers, ß-agonists, a-adrenergic agonists, theophylline, nitrates, and sedatives. These medications may aggravate GERD symptoms.
Antacid therapy: Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Rolaids, Riopan, and Tums are the first drugs recommended to relieve heartburn and other mild GERD symptoms. These are over-the-counter medications. They use combinations of three basic salts--magnesium, calcium, and aluminum--with hydroxide or bicarbonate ions to neutralize stomach acids. There are side effects of these medicines. Magnesium containing preparations can cause diarrhea; aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects. Calcium containing antacids can also be a supplemental source of calcium but they can also cause constipation.
H2 Receptor antagonists (H2RAs): The most popular brands of this type of acid reflux medication are approved for over-the-counter (OTC) use. The four OTC H2RAs-ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid) suppress acid production. These GERD medicines provide short-term relief. The OTC preparations should not be used for more than a few weeks at a time. The prescription strength preparations may be taken longer, simply because they are taken under the supervision of a doctor. H2RAs work for about 50% of those patients with GERD symptoms.
Proton pump inhibitors: Proton pump inhibitors are available by prescription only and are usually given to patients after H2RAs have failed. These drugs include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium). Proton pump inhibitors are more effective than H2 RAs and relieve symptoms in almost everyone who has GERD.
Surgical treatments: If the above lifestyle modifications and medications don't work, additional testing and possibly surgery is needed. Since most patients respond to proton pump inhibitor therapy, surgery for GERD is on the decline. Because a significant number of patients who undergo surgical procedures have complications and require continuation of pharmacotherapy to control symptoms, patients should consult a physician about the surgical options available for GERD and consider them only after other interventions have failed.