Treatment options for GERD

Treatment for gastroesophageal reflux disease can be tricky. With different levels of severity of GERD comes the decision of which option is best for the patient. The primary treatment options include medications, surgery, and lifestyle changes. Another factor to take into account is that sometimes certain treatments don’t work for some patients, but do for others. You don’t want to jump straight to trying surgery for a patient who could benefit from simple lifestyle changes, but trial and error can take a long time.

There are a few types of medications commonly used to treat GERD. Sometimes a simple over-the-counter antacid, such as Pepto-Bismol or Tums, taken after meals can help people suffering from GERD. Antacid can sometimes cause diarrhea or constipation, but those are more common when the antacids are taken too frequently. H2 Blockers reduce the amount of acid produced by the stomach. H2 Blockers can be over-the-counter (ex: Zantac 25), but higher dosage H2 Blockers are prescription medications. H2 Blockers can sometimes cause headaches, constipation, diarrhea, nausea, and vomiting. If side effects are experienced often, talk to the doctor. Proton pump inhibitors (PPIs) are mostly all prescription medications and they limit acid secretion longer than H2 Blockers. PPIs can cause diarrhea, nausea, vomiting, abdominal pain, upset stomach, headaches, and in rare cases can cause an increased risk for pneumonia and bone fracture. As with H2 Blockers, talk to the doctor about side effects if you experience them often. One type of medication does not necessarily work better than another. It all depends on the person taking it and what the doctor feels is best. 

There are different types of surgery that can be performed for treating GERD. If a person has GERD due to a hiatal hernia, hernia repair surgery can help. There are a few different surgeries that can be done to reinforce the lower esophageal sphincter. One type involves installing a small ring around the outside of the sphincter. It keeps the sphincter closed until food comes down the esophagus and then as the sphincter opens the ring stretches. Another type of surgery called fundoplication involves taking the top of the stomach (called the fundus) and wrapping it around the lower esophageal sphincter. This reinforces the sphincter like the ring, and can also be performed after a hiatal hernia repair. Side effects are rare with these surgeries, although it is common for patients to have difficulty swallowing for the first couple months afterwards and occasionally patients feel slightly bloated.

Lifestyle changes principally involve the person’s diet. Watching what you eat and how much is very important with GERD, but I will go into more detail about diet considerations later. Since obesity has been linked to GERD, losing weight is a must if you are overweight and suffering from GERD. Other lifestyle changes include watching your posture, quitting smoking, raising the head of your bed, and being careful of when you exercise. Keeping good posture after meals and not lying down makes it harder for food to travel backwards. Allow time for food to digest before lying down. The International Foundation for Functional Gastrointestinal Disorders says “Don't lie down within 3 hours of eating. That's when acid production is at its peak, so plan early dinners and avoid bedtime snacks.” Raising the head of the bed is helpful for people who experience GERD at nighttime. It makes it harder for stomach acid to flow back into your esophagus while you are lying down. Scheduling when you exercise can make a difference. Exertion after eating can put stress on your esophagus, so exercising immediately after meals is probably not a good idea. Wait a couple hours to allow the food to digest. 

The main premise for treating GERD is to watch what you are putting down and doing to your esophagus and to talk to your doctor about what is best.

jacksonville.com,. (2015). New device at Mayo Clinic 'a game changer' for acid reflux. Retrieved 18 October 2015, from http://jacksonville.com/news/health-and-fitness/2012-04-18/story/new-device-mayo-clinic-game-changer-acid-reflux

REFERENCES:

Aboutgerd.org,. (2015). Treatment of GERD - aboutGERD.org. Retrieved 18 October 2015, from http://www.aboutgerd.org/site/treatment/

Healthline,. (2015). Over-the-Counter Treatments for GERD. Retrieved 18 October 2015, from http://www.healthline.com/health/gerd/over-the-counter#Overview1

Medscape,. (2015). Effect of Bed Head Elevation and Nocturnal GERD. Retrieved 18 October 2015, from http://www.medscape.com/viewarticle/765033_4

U.S. National Library of Medicine. (2015).Anti-reflux surgery: MedlinePlus Medical Encyclopedia. Nlm.nih.gov. Retrieved 18 October 2015, from https://www.nlm.nih.gov/medlineplus/ency/article/002925.htm