Treating gastroesophageal reflux disease (GERD) is important. Untreated GERD can lead to the following serious complications:
- Esophageal ulcers (mucosal defects that won’t heal)
- Esophageal strictures (scar tissue)
- Barrett’s esophagus (a disorder of the cells lining the esophageal mucosa, which may lead to cancer)
- Esophageal cancer
Treatments for GERD include lifestyle measures, medication, and surgery.
The treatment of GERD starts with lifestyle measures. This may eliminate symptoms in some people with mild reflux. Doctors usually recommend avoiding large meals that can increase pressure in the stomach and cause reflux. Some foods can cause reflux as well.
- Fatty foods (including fried foods) should be avoided.
- Acidic foods (tomato-based products and citrus fruits) and spicy foods may irritate an inflamed esophagus.
- Peppermint, spearmint, chocolate, cinnamon, coffee, and tea may lower the pressure in the lower esophageal sphincter. This can cause reflux.
- Carbonated beverages may worsen reflux by increasing pressure in the stomach.
- Salt intake should be limited.
- If you smoke, you should stop.
The American College of Gastroenterology’s current guidelines highlight three key lifestyle modifications as a first step to treating GERD:
- Lose weight if you are overweight or have recently gained weight.
- Raise the head of your bed 6 to 8 inches at night with blocks or a foam wedge if you suffer from nighttime reflux. Don't use pillows. They can cause an unnatural bend in the body and increase pressure to the stomach.
- Avoid high-fat meals within two to three hours of bedtime.
It is also helpful to sleep on your left side, avoid tight-fitting clothes, and, when reaching down, bend at the knees as opposed to the waist. If there are specific foods that you’ve found trigger your reflux, avoid those foods. Dietary triggers vary from individual to individual.
Recent research has found that diaphragmatic breathing may help those who suffer from gastroesophageal reflux disease (GERD) to reduce burping. This is also called belly breathing. You might recognize belly breathing from yoga classes. It is safe, free of cost, and easy to do, but it takes some practice. Here’s how to start:
- While lying down, place one hand on your chest and the other on your abdomen, above your belly button.
- Breathe in slowly through your nose. Imagine you have a balloon in your stomach (under your hand) that you’re inflating as you breathe in, to a count of four. The chest and shoulders should be still as your abdomen rises.
- Breathe out through your mouth. Imagine that the balloon is deflating, to a count of four. The abdomen falls as you exhale. Chest and shoulders remain still.
- When you’re comfortable, increase the exhale portion to a count of eight. Practice 30 breaths (about five minutes) three times a day or when you experience symptoms. Once you’re confident in the technique, you can advance to practicing while sitting or standing. This is more difficult to do while maintaining proper technique.
In addition to belly breathing, these small changes can make a big difference in reducing belching:
- Eat and drink slowly.
- Chew food well.
- Avoid chewing gum and hard candies since they can increase air intake.
- Cut back or eliminate carbonated beverages.
- Avoid using a straw.
Sometimes lifestyle modifications don’t help. Your doctor will recommend medication to neutralize or decrease acid production in the stomach. The guidelines recommend antacids, histamine H2-receptor antagonists (also known as H2 blockers), and proton pump inhibitors. Sometimes a single medication will work. But if it doesn’t control your symptoms, you may need to take a second medication.
Over-the-counter antacids containing aluminum oxide, magnesium carbonate, and sodium bicarbonate (for example, Gaviscon, Gelusil, Maalox, Mylanta) quickly neutralize stomach acid. They are taken after meals when you experience heartburn. These medications provide fast relief, but their effect is short. If you need an antacid, choose one that does not contain aspirin or any other non-steroidal anti-inflammatory drug (NSAID). Liquid antacids are more effective than tablet forms.
Over-the-counter or prescription H2 blockers have a longer effect on gastric acid than antacids.
Available H2 blockers, generic (brand):
- Cimetidine (Tagamet HB)
- Famotidine (Pepcid AC)
They usually need to be taken twice a day. A combination antacid/H2 blocker, Pepcid Complete, may also be more effective at relieving symptoms than H2 blockers or antacids alone.
Proton pump inhibitors
Proton pump inhibitors (PPIs) are the strongest suppressors of gastric acid secretion. Some are available over the counter. They have a long-lasting effect and need to be taken only once a day. Take them 30 to 60 minutes before eating.
Available PPIs, generic (brand):
- Esomeprazole (Nexium)
- Lansoprazole (Prevacid)
- Omeprazole (Prilosec)
- Pantoprazole (Protonix)
- Rabeprazole (AcipHex)
- Dexlansoprazole (Dexilant)
- Omeprazole/sodium bicarbonate combination (Zegerid)
Besides providing the most effective heartburn relief, PPIs are good at healing inflammation of the esophagus caused by GERD. Keep in mind there are concerns over long-term suppression of gastric acid using proton pump inhibitors. The main concern is that it could lead to bone fractures and infection.
The FDA now requires PPI labels to include a warning about a possible increased risk of hip, wrist, and spine fractures. Some studies have also linked PPIs to decreased kidney function and increased risk of heart attack. An association has clearly been found between PPI use and an increased risk of Clostridium difficile infection. This can cause diarrhea and illness severe enough to require hospitalization. PPIs may also interfere with the absorption of calcium, magnesium, iron, and vitamin B12.
PPIs should be taken for about two weeks for uncomplicated GERD. Such a course of treatment can be repeated for control of occasional symptoms. It is important to discuss the need for long-term use of PPIs (more than two weeks) with your doctor. Endoscopy and pH monitoring should usually be performed before committing to long-term use. If ongoing PPI use is found to be appropriate or necessary to control GERD or the complications of GERD (like Barrett's Esophagus), the benefits should outweigh the potential risks.
Lifestyle measures and medications are so effective at controlling reflux symptoms that few people need to undergo surgery.
However, there is increasing evidence to support a surgical approach when medical therapy fails. Up to 40% of people who have GERD symptoms continue to have persistent symptoms despite PPI therapy and lifestyle modifications.
Invasive therapies such as surgery are inappropriate in most situations. But if it’s determined that acid reflux is the cause of ongoing symptoms, invasive therapies should be pursued. In some instances, people who have a large hiatal hernia with reflux and regurgitation also can benefit from surgical intervention.
When surgery is required, the most common procedure is Nissen fundoplication. This procedure involves lifting a portion of the stomach and tightening it around the gastroesophageal junction. This increases pressure in the lower esophageal sphincter and prevents reflux.
The procedure is typically performed using a laparoscope. This is an instrument that can be inserted through small incisions in the abdomen. Five small incisions are made in the abdomen. The surgeon inserts a tiny camera and specialized instruments to perform the procedure.
Nissen fundoplication is performed in a hospital. You will receive general anesthesia and need to stay in the hospital for one to three days. After the procedure, you can return to work in two to three weeks.
Serious complications are rare but the following can occur:
- A bad reaction to the anesthesia
- Blood loss
- Injury to the esophagus, stomach, or spleen
More common complications are difficulty swallowing, stomach bloating, belching, and vomiting. These problems usually improve within one to three months.
Surgery reduces reflux symptoms in most people. But it doesn’t always eliminate them. One study found that about 80% of people who underwent Nissen fundoplication still require medication on a regular basis to control their symptoms three years after surgery.
Several methods for treating GERD endoscopically have also been developed. These procedures are done during an upper endoscopy. They are done on an outpatient basis and do not require incisions, general anesthesia, or a hospital stay. As experience with these techniques increases, they may replace the need to undergo a Nissen fundoplication.
The World Health Organization defines medication adherence as "the degree to which the person's behavior corresponds with the agreed recommendations from a health care provider." Poor adherence to prescribed regimens can result in serious health impacts including hospitalization and death.
About half of all medications for chronic diseases are not taken correctly. People change or skip doses, stop too soon, don’t take them at all, or never fill their prescriptions.
What to do when you get a new medication:
- Take notes on what your doctor tells you about the medication.
- Double check with the pharmacist on how to take the medication.
- Ask questions to make sure you fully understand the medication. Be clear about when and how to take it.
- Creating a chart for your daily medication regimen can help you stay on track. So might a pill box with multiple sections. This is helpful if you take more than one medication. This is also helpful if you take medications more than once a day.
- If you’re being treated for a chronic condition, check regularly with your doctor about whether you are taking the medication(s) correctly.
- If you are concerned about or are experiencing side effects, talk to your doctor.
- Do not take yourself off of medications without the knowledge and guidance of your doctor.
- If you’re having trouble sticking to your medication, for any reason, talk with your doctor. They may be able to suggest other treatments or refer you to services that can help.