8 Treatments for Acid Reflux/GERD

Gastroesophageal reflux disease (GERD) is one of the most common digestive disorders that affects millions of people worldwide at some point in their lives. Treatment of this condition depends on lifestyle changes and medication.

Lifestyle changes for the treatment of GERD

Lifestyle changes recommended for patients with GERD include 1-5:

  • Obese and overweight are more likely to suffer from GERD and related symptoms. Weight reduction, often helps to reduce the symptoms of GERD.
  • Smokers have a higher risk of GERD. Quitting smoking helps patients with GERD.
  • Patients are advised to eat smaller, more frequent meals rather than three large meals a day. The last meal of the day should be taken at least 4 hours before bedtime. Lying down immediately after a meal may aggravate symptoms of GERD.
  • Other food and beverage triggers include alcohol, coffee, chocolate, tomato or fatty or spicy foods. These should be avoided.
  • Avoid wearing tight clothing, especially around the abdomen, this also increases the symptoms of GERD.
  • Lift the side of the head of the bed about 20 cm (8 inches) by placing a wedge or block under it, this helps reduce the symptoms of GERD. Extra pillows are not recommended as they increase pressure on the abdomen.
  • Patients on medications that increase the risk of GERD are advised to stop the medication or are advised to neutralize acids or reducing drugs together. These offending drugs include:
    • nitrates
    • anti-colinérgicos
    • tricyclic antidepressants
    • NSAIDs (Ibuprofen)
    • bosphosphonates and potassium salts, such as alendronate

Drugs for the treatment of GERD

Treatment of GERD generally involves drugs that reduce stomach acid content, do the task of acid neutralizing or reducing the production of acid.

Another group of drugs called prokinetics are used to increase motility of the gastrointestinal system and, thus, allow food to be passed through the esophagus and intestine faster. This also reduces the risk of reflux.

Drugs used in GERD include:

Antacids

These do not require a prescription and are available over the counter. They work by neutralizing stomach acid and relieve the symptoms of heartburn and acid reflux.

These drugs should not be taken along with other medications for GERD, as they can interact and reduce the effectiveness of other drugs. These antacids also reduce the body’s ability to absorb other drugs.

Alginatos

Alginates are alternatives to antacids. These are also available without a prescription. They work by producing a protective film that protects the stomach lining and esophagus from the effects of stomach acid content.

Inhibitors of proton pump (PPIs)

Patients who do not respond to over the counter medications and lifestyle changes are prescribed PPIs like Omeprazole, Pantoprazole, Lansoprazole and Rabeprozole. These work by reducing the acid produced by the stomach.

Side effects of these drugs are mild and include headache, diarrhea, nausea, abdominal pain, constipation etc. Sometimes the PPI may be prescribed for a long period of time.

H2 antagonists two receivers

H2 receptor antagonists are another variety of drugs that may be taken together with IPP or as a replacement. Such agents include ranitidine, cimetidine, and famotidine and block the effects of histamine chemicals that help produce the stomach acid. Thus, these agents reduce the production of acid. Side effects are mild and include headache, diarrhea, fatigue, rashes and dizziness.

Pro kinetic agents

These agents are prescribed when GERD does not respond to acid reduction or neutralization agents. Bethanechol and metoclopramide are such drugs.

Metoclopramide can lead to side effects such as extrapyramidal symptoms which may become severe. These include muscle spasms, slurred speech, a bodily posture and body movements. (1-5)

Surgery

In severe cases surgery is recommended for GERD. Surgical treatment usually removes the nerves that help produce gastric acid.

The problems that can occur after surgical procedures include difficulty swallowing, flatulence or gas, bloating and difficulty belching.

Practiced surgical options include:

  • Fundoplicação laparoscopic Nissen (LNF)
  • Endoscopic injection agents to strengthen the lower esophageal sphincter (LES) volume
  • endoluminal gastroplication
  • Endoscopic increase with hydrogel implants
  • ablation do radiofrequency endoscópico etc.

In LNF (Fundoplication Laparoscopic nissen) the surgeon makes small incisions along the abdomen and tightens the LES involving the upper part of the stomach around the esophagus and staple it in place. LNF is one of the most common surgical techniques used to treat GERD. The surgery takes 60 to 90 minutes to complete.

Endoscopic injection of bulking agents use an endoscope to find the location where the esophagus and the stomach meet. On this site, a combination of plastic and liquid is injected. This causes the LES to tighten up and narrows the passage to help prevent reflux of gastric contents. (1-5)

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