Treatment Options for GERD
- Patients normally will initially be evaluated for habits or provocative events that can be causing the reflux;
- Patient may need to be guided regarding eating habits, portion control, and to avoid aggravating food products. Tomato base foods, chocolate, caffeinated drinks, alcohol, peppermint among others can decrease the lower esophageal sphincter pressure.
- Overweight or obese patients may benefit from reducing the intra-abdominal pressure. Weight loss guidance needs to be provided and encouraged.
- Avoid going to sleep soon after eating.
- Elevation of the head of the bed. Patients commonly find that using 2 to 3 pillows or beds that allows angulation can provide gravity assistance to keep secretion or food in the stomach.
Smoking cessation since it not only can cause gastritis and ulcers, but also can reduce the lower esophageal sphincter pressure.
Currently we have a great variety of medications readily available as “over the counter”. Some medications tend to simply neutralize the acidic pH, others with reduce the acid production.
- ANTACIDS: Commonly obtained over the counter, can neutralize the low pH of the stomach acid, such as Maalox, Tums, Alka-Seltzer, Rolaids, Mylanta, Pepto-Bismol. The effect is limited since it is normally eliminated from the stomach in 1 to 2 hours.
- H2 BLOCKER (HISTAMINE ANTAGONIST): Once a prescribed medication, now they are widely used as an over the counter medication. It blocks the receptors in the stomach where histamine stimulates acid producing cells in making acid. Examples of H2 Blockers include but are not limited to:
- PROTON PUMP INHIBITOR (PPI): They act in the final stage of acid production on the parietal cells (acid producing cells), by irreversibly blocking the hydrogen/potassium adenosine triphosphate enzyme system also known as the gastric proton pump. There are several available medications such as:
- Omeprazole: Gasec, Losec, Prilosec, Zegerid, ocid, Lomac, Omepral, Zolppi, Omez, Omepep, UlcerGard, GastroGard, Altosec
- Lansoprazole: Prevacid, Zoton, Monolitum, Inhibitol, Levant, Lupizole
- Dexlansoprazole: Kapidex, Dexilant
- Esomeprazole: Nexium, Esotrex;
- Pantoprazole: Protonix, Somac, Forppi, Pantoloc, Pantozol, Pantomed, Zurcal, Zentro, Pan, Controloc, Tecta;
- Rabeprasole: AcipHex, Pariet, Erraz, Zechin, Rabecid, Nzole-D, Rabeloc, Razo, Superia. Dorafeml
- GASTRO INTESTINAL MOTILITY STIMULATOR: It works by stimulating the stomach and proximal intestine to contract causing emptying of the stomach. It is also used in patients with delayed emptying of the stomach (gastroparesis) commonly seen in diabetic patients. Medications in this category include Metoclopramide (Reglan), and Bethanecol (Urecholine). The use is limited to a shorter time of a few months since It can be associated with significant side effects ranging from minor to serious side effects.
- Prescribed medications have an important role in the treatment and control of GERD. However, most medications have labels with specific instructions and time limit for its use. There has been reported an associated of anti-acids with a great variety of side- effects ranging from minor symptoms to serious debilitating problems. The side effects depend on the drug used and for how long it is taken. The list includes but is not limited to:
- Gynecomastial Impotence;
- Abdominal pain;
- Muscle pain with potential serious rhabdomyolysis;
- Decrease absorption of Iron, Magnesium, Calcium, Magnesium, Vitamin B12
- Bone fractures (FDA included this warning on PPI labels in 2010)
- Clostridium difficile infections leading to gastritis and ulcers;
- Development of polyps;
- Increase risk of pneumonia;
- Dementia in patients older than 75;
- Chronic Kidney Disease;
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