Acid Reflux: What to Do When Antacids Stop Working
You may take an antacid for relief from occasional heartburn. And for people with GERD (gastroesophageal reflux disease), a more severe and frequent form of acid reflux, antacids and lifestyle changes can be an effective first-line treatment. But if these treatments don’t work or stop working, you have many other options. Talk with your doctor about which ones may be best for you.
Medicines That Treat GERD
Antacids aren’t the only option when it comes to medicines for GERD. There are a whole host of medicines—both over-the-counter and prescription—that can help with symptoms. Your doctor may suggest one or more of the following:
Histamine type 2 (H2) blockers. These medicines help decrease the amount of acid in your stomach, which helps reduce symptoms of GERD. In most cases, you take them only when you have symptoms. H2 blockers can also help heal the esophagus. You can buy some of these medicines over the counter, but you will need a prescription for stronger doses. H2 blockers include famotidine (Pepcid AC, Mylanta AR), cimetidine (Tagamet), nizatidine (Axid), and ranitidine (Zantac 75).
Proton pump inhibitors (PPIs). These medicines also reduce stomach acid and help heal the esophagus. They generally work better than H2 blockers for most people with GERD. Your doctor may recommend you take a PPI every day, even if you don’t have symptoms. PPIs include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), esomeprazole (Nexium), pantoprazole (Protonix), and rabeprazole (Aciphex). Some are available over the counter and some require a prescription.
Antibiotics. Some antibiotics can help your stomach digest foods properly so it empties out more quickly. This process can help relieve the symptoms of GERD.
Prokinetics. These medicines can also help the stomach empty more quickly. But doctors may not use them as often as other medicines because they are more likely to cause side effects like diarrhea, tiredness, depression, anxiety and trouble with movement. They can also interact with other medicines.
Surgery and Other Procedures for GERD
If medicines don’t seem to be working for you, your doctor may suggest surgery or endoscopic procedures. Your doctor can tell you whether one of these options is right for you:
Fundoplication (Acid Reflux Surgery). In this surgery, the surgeon wraps the top part of the stomach around the lower part of the esophagus. This creates a stronger barrier between the esophagus and stomach and helps prevent food and stomach acid from coming back up into the esophagus. The surgery is most often minimally invasive, done with a thin tube called a laparoscope. Your doctor makes a small cut in your stomach and uses small tools and a camera inserted into the laparoscope to perform the surgery.
Endoscopic treatments. The goal of these treatments is to tighten the muscle in between the stomach and esophagus. During these treatments, your doctor lowers a thin tube called an endoscope into your mouth and down into your esophagus. Your doctor tightens the muscle by either using small stitches or heating small areas of the esophagus with radiofrequency energy. Endoscopic treatments may not be as widely available as surgery.