Treatment Options for Acid Reflux and GERD
Acid reflux ranges in intensity from occasional heartburn to GERD (gastroesophageal reflux disease), a more severe form of acid reflux. GERD is a fairly common condition. It affects 10 to 20% of people in Western cultures.
In GERD, the valve (esophageal sphincter) between the stomach and the esophagus does not work well, and stomach acid refluxes, or backs up into the esophagus causing heartburn and regurgitation. With regurgitation, you get a bad, sour taste in your mouth from the stomach acid. Other symptoms include nausea, vomiting, chronic cough, chest pain, and wheezing. Treating acid reflux can help prevent chronic problems in your esophagus, such as scarring, narrowing, and precancerous changes to the esophageal lining.
Lifestyle changes can prevent and relieve some acid reflux and GERD symptoms. This is especially true if your symptoms aren’t severe. But anyone with acid reflux should consider making the following changes:
Lose excess weight. There is a clear relationship between being overweight or obese and suffering from acid reflux.
Avoid late evening meals—within 2 to 3 hours of reclining or going to bed—and don’t overeat.
Prop up your upper body while sleeping if you suffer from symptoms at night. If you don’t have an adjustable bed you can elevate the head of the bedframe with 6” blocks.
Change your diet if certain foods or drinks trigger your symptoms.
Wear loose clothing and avoid tight belts. Clothes that press on your stomach can make acid reflux worse.
If you still have symptoms after trying lifestyle changes, your doctor will likely recommend medications. There are several types of medications to treat acid reflux and GERD:
Antacids are over-the-counter medicines that neutralize stomach acid. They work quickly to provide relief. But their effects don’t last long and using them too much can cause other digestive problems.
Histamine type 2 (H2) blockers reduce the amount of acid your stomach makes. Examples include famotidine (Pepcid) and ranitidine (Zantac). H2 blockers take longer than antacids to start working—about an hour, but they provide lasting relief. You can buy H2 blockers over the counter. Higher strengths are available with a prescription.
PPIs (proton pump inhibitors) are even stronger stomach acid reducers. Examples include omeprazole (Prilosec) and lansoprazole (Prevacid). They often work for acid reflux that doesn’t respond to antacids or H2 blockers. But they take longer to provide relief. Like H2 blockers, PPIs are available over the counter and by prescription.
Metoclopramide (Reglan), are medicines that improve stomach emptying. People who don’t respond completely to PPIs may benefit by adding this medicine. This drug has significant side effects, so it’s usually a last resort.
Baclofen (Lioresal) is another option for people who don’t get adequate relief from a PPI. Baclofen works to prevent your esophageal sphincter from relaxing. This cuts down the number of reflux episodes. Side effects also limit the use of this drug.
Most people—more than 95%—find relief from acid reflux and GERD with lifestyle changes and medications. If you are in the small group of people who don’t, your doctor may recommend surgery. Surgery may also be the best treatment if you have complications from GERD, such as bleeding or scarring of the esophagus. And some people opt for surgery rather than take lifelong medications.
There are a variety of acid reflux surgery procedures. No matter which one your surgeon recommends, they are all a version of a surgery called a fundoplication. This surgery creates a new esophageal sphincter by wrapping part of the stomach around the esophagus. This reduces the amount of acid regurgitation from the stomach into the esophagus.
The good news is that surgery is very successful. About 95% of people who have acid reflux surgery don’t need to use medications afterward. And symptom improvement is long term. Studies have found people still have relief more than five years after surgery.
Endoscopy therapy, also known as sphincter augmentation, is a nonsurgical method of tightening the esophageal sphincter with heat energy or special stitches. A surgeon inserts a lighted tube with a camera—an endoscope—through the mouth and lowers it into the esophagus to treat the area. Endoscopic therapy may be an option for some people, but it’s not as effective as fundoplication surgery for reducing acid reflux and providing long-term symptom relief.
Whether lifestyle measures, medications, or surgery, work with your doctor to choose the right treatment based on your specific circumstances and health goals.