GERD Treatments and Medications

Living with gastroesophageal reflux disease (GERD)—and the heartburn that goes with it—can be uncomfortable. But it shouldn't prevent you from leading a normal life. There are lots of treatment options, like antacids and lifestyle changes, that can be so effective you might even forget you have it. Though sometimes stronger, prescription medication may be necessary to fully relieve symptoms. Keep reading to learn all the GERD treatments, medications, and natural home remedies available.

What is GERD?

GERD is a digestive disorder that affects the lower esophageal sphincter (LES), which comprises the ring of muscle between the esophagus and stomach. This condition occurs when stomach acid or bile flows into the food pipe and irritates the lining, causing symptoms like chest pain, belching, and nausea. Common treatments include antacid medications and self-care.

Almost 20% of U.S. adults are affected by GERD every year. Because it's so prevalent, there are ongoing clinical trials and development of new treatments for the condition.

How is GERD diagnosed?

GERD is caused by frequent acid reflux and heartburn. Acid reflux occurs when your LES doesn’t close properly and allows digestive juices from your stomach to rise up to your esophagus.

Anyone, including infants and children, can experience GERD. Those at a higher risk include pregnant women, people who smoke, people who are obese, those with a hiatal hernia, and those with connective tissue disorders. You may also be at risk for GERD if you eat certain foods like citrus, chocolate, or fatty foods, and drink coffee, tea, and alcohol on a regular basis.

If you’re not sure whether you have GERD, schedule an appointment with your primary healthcare provider right away, as he or she can help diagnose the issue and provide further medical advice. Here’s what you can expect at your appointment:

• Your doctor will perform a physical exam and ask you questions about your symptoms.

• Your doctor may have you participate in a barium swallow. He or she will give you a barium solution to drink and then use an X-ray to examine your upper digestive tract.

• Your doctor may perform an upper endoscopy. During this procedure, your provider will thread a flexible tube with a light and camera attached to it down your esophagus and examine your esophagus and stomach for inflammation. He or she might perform a biopsy and collect sample tissue to test for complications like Barrett’s esophagus.

• Your doctor may order an esophageal manometry. Similar to an endoscopy, a flexible tube is threaded through your esophagus to measure the strength of your esophageal muscles and muscle contractions in your esophagus when you swallow.

• Your doctor may perform esophageal pH monitoring, by inserting a monitor into your esophagus to identify when, and how long, stomach acid regurgitates in the area. The monitor will either be a thin, flexible tube, such as a catheter, that’s threaded through your nose into your esophagus, or it will be a clip that’s paced into your esophagus during your endoscopy.

Questions your doctor may ask you

During your appointment, your doctor may ask the following questions to better inform the diagnosis of GERD:

• Have you been experiencing constant heartburn?

• Are you regurgitating any of your stomach contents?

• Do you have pain in the middle or upper part of your stomach?

• Have you been nauseous?

• What types of food are you eating?

• Do you smoke?

• Have you been falling asleep shortly after eating?

Questions you should ask your doctor

If you do have GERD, it’s important to understand its causes and course of action over the short and long-term. Here are some of the more important questions to ask your doctor during your appointment:

• What causes GERD?

• Are there medications I’m taking that could be causing GERD?

• How do I keep the disease under control?

• What are the treatment options for GERD?

• Are there side effects of prescribed medicine that I should be aware of?

• Are there certain foods and drinks I should avoid?

• What lifestyle changes should I make to relieve symptoms?

• Can GERD lead to other health complications if not treated?

Though primary care physicians and pediatricians can usually treat GERD, they may refer you to a gastroenterologist if your condition persists or worsens. Long-term symptomatic GERD can lead to certain stomach cancers, therefore, it is important to be evaluated by a physician if heartburn symptoms persist.

GERD treatment options

After you receive your diagnosis, your doctor should provide you with a variety of options to treat your gastroesophageal reflux disease. In most cases, treatment will consist of prescription medications, antacids to neutralize stomach acid, H2 blockers, proton pump inhibitors (PPIs), prokinetics, or antibiotics.

“PPIs are the strongest class of medications that are available to treat GERD. The H2 blockers are not as potent in inhibiting gastric acid production,” said Jesse P. Houghton, MD, Senior Medical Director of Gastroenterology at Southern Ohio Medical Center.

In fact, recent studies done by the VA Office of Research and Development found that proton pump inhibitors (PPIs), which block gastric acid production, are the most effective medications for GERD.

Esophageal pH/impedance monitoring shows that PPI-resistant GERD symptoms correlate with episodes of reflux in nearly one-half of patients. Those patients might benefit from surgery to treat GERD. Dr. Hougton says the best surgical treatments for GERD patients are Laparoscopic Nissen Fundoplication, TIF (Transesophageal Incisionless Fundoplication), a LINX procedure, or a Stretta device. In some cases, certain endoscopic techniques, like endoscopic sewing or radiofrequency, may be used.

Early diagnosis and treatment can prevent GERD symptoms from occurring and even stop the disease completely. If left untreated, GERD can cause severe inflammation and permanent damage to the esophagus, lead to esophageal cancer or esophagitis, and cause peptic stricture or Barrett’s esophagus.

GERD medications

Your doctor may prescribe one or more medications in the following drug classes to help treat GERD and prevent symptoms from worsening. Talk to your doctor about which medications are safe for you and remember to always use over-the-counter medicine as directed.

Antacids

Antacids counteract the effects of stomach acid by raising gastric pH and provide relief for heartburn, indigestion, and peptic ulcers. Common brands include Maalox, Mylanta, Tums, and Rolaids. Some side effects include gas, belching, constipation, and diarrhea.

Antibiotics

Antibiotics fight bacterial infections by killing bacteria and slowing their growth. Some antibiotics, like erythromycin, can relieve GERD symptoms by helping your stomach empty faster. Common side effects are nausea, vomiting, abdominal pain, and diarrhea.

H2 blockers

These drugs decrease acid production, heal the esophagus, and can provide short- and long-term relief for those with GERD symptoms. H2 blockers compete with histamine for H2 receptors on the stomach’s parietal cells and decrease the production of hydrochloric acid during this process. Popular brands include Pepcid AC, Tagamet HB, Zantac, and Axid AR. People who take H2 blockers may experience constipation, diarrhea, difficulty sleeping, dry skin, and headaches.

Proton pump inhibitors (PPIs)

PPIs bind to proton pumps in the stomach and block acid production. They work by blocking the gastric proton pump, which is part of the final step of acid production. Some of the more popular brands include Prilosec, Prevacid, Protonix, Dexilant, Nexium, and Zegerid. Side effects include headache, diarrhea, nausea, and vomiting. Long term use of PPIs can lead to osteoporosis and bone fractures.

Prokinetics

Prokinetics, or prokinetic agents, are drugs that control acid reflux and are used in the more serious cases of GERD. They help strengthen the LES, causing the stomach to empty faster and allowing less time for acid reflux to occur. Here are some popular prokinetic brand names: Reglan, Motilium, and Zelnorm. Side effects include anxiety, depression, drowsiness, and fatigue.

What is the best medication for GERD?

The best medication for GERD depends on the patient’s medical condition, medical history, and medications they may already be taking that could interact with GERD medication as well as the patient’s response to treatment.

This table compares the most commonly prescribed GERD medications.

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Best medications for GERD