GERD Treatment: All You Need to Know

In this blog we have discussed everything you need to know about GERD treatment

What is Gastroesophageal reflux and disease

Acid reflux happens when content from your stomach move back up Into your esophagus. This action is also called acid regurgitation or gastroesophageal reflux. And having this once in a while is common; but if you are experiencing this more than twice a week or very often then you might have GERD

It can sometimes cause serious complications, if it is left left untreated,

Most people can manage this discomfort of GERD with lifestyle changes and other over-the-counter medications while others may need stronger medications or surgery to ease symptoms.

What are the symptoms of GERD?

GERD symptoms:

The main symptom of GERD is acid reflux. Acid reflux can cause an uncomfortable burning feeling in your chest, which can move up into your neck and throat. This feeling is often known as heartburn.

So having acid reflux, can develop a sour or bitter taste at the back of your mouth. It might also cause the regurgitation of food or liquid from your stomach into your mouth.

Some other symptoms of GERD like:

• Nausea
• Chest pain
• Pain when swallowing
• Chronic cough
• Bad breath
• Difficulty swallowing
• Hoarse voice

GERD Treatment Options:

The symptoms of GERD can be managed and reduced by making some lifestyle changes like:

– Maintaining a moderate weight, in overweight individuals

– quitting smoking, if you smoke

– avoiding big, heavy meals in the evening

• waiting a few hours after eating to lie down
• Additionally keeping the head elevated during the sleep and not lying down immediately after meal

Medication for GERD Treatment

There are many over-the-counter (OTC) medications that can treat GERD; however they can cause side effects ,so talk to your doctor about which option is the best for you.

Antacids

Antacids have been used for centuries in the treatment of patients with dyspepsia and acid reflux disease. It is typically used for occasional and mild symptoms of acid reflux and GERD.

Antacids are weak bases that react with gastric hydrochloric acid to form a salt and water. Their main function is to reduce gastric acidity. A single dose of antacid taken 1 hour after a meal can effectively neutralise gastric acid for upto 2 hrs. 

Precautions to follow while taking Antacid:

1. If you are taking antacids which contains magnesium hydroxide or aluminium hydroxide:

• Always take an antacid which contains magnesium hydroxide or aluminium hydroxide together. This will reduce gastric upset side effects like constipation and diarrhoea. 

2. If you have any renal problem then avoid taking this agent for long term. As both magnesium and aluminium are absorbed and excreted by the kidney.

3.Antacids may affect the absorption of other medications like tetracyclines, fluoroquinolone, itraconazole and iron. There should be a gap of at least 2hours between the antacid and other medications.

Also, if you find that you’re taking antacids almost every day, you may need a stronger medication.

H2 receptor blockers for GERD Treatment

H2 blockers like cimetidine, ranitidine, famotidine and nizatidine suppress acid secretion. 

If you are experiencing heartburn or dyspepsia fewer than 3 times per week , then you can take antacids or H2 blockers. 

Antacids gives faster relief as compared to the H2 blocker. But the effect of antacids are short lived usually 1-2 hours while H2 blockers is effective upto 6-10 hours. 

So if you need faster relief then you can take antacids but if you are travelling somewhere and you want to reduce acid secretion for longer time then you should consider H2 blockers. H2 blockers is also best for night time acid secretion. And they are extremely safe medicines.

When to take H2 blocker?

It should be taken 30 minutes before meal to be effective. If it is taken after the meal then you will not get the required benefit from this medication.

However, it’s important to note is that one type of H2 blocker — ranitidine (which also known as Zantac) — was recently recalled by the FDA for containing the ingredient N-Nitrosodimethylamine (NDMA), which is a known carcinogen.

Proton pump inhibitors (PPIs) for GERD Treatment

PPIs like Omeprazole, pantoprazole, esomeprazole, rabeprazole also lower the amount of acid your stomach makes. As they tend to work better than H2 blockers, they are more helpful when it comes to healing the esophageal lining — which can become damaged when someone is dealing with GERD for a while.

When to take PPIs?

If you take PPIs with food then the bioavailability decreases upto 50%. In simple words, medicine will be 50% effective. So the best time to take PPIs is approximately 1 hour before meal. Normal recommended dose is once daily. It relieves GERD related symptoms in 85-90% of the patients. Twice daily dose might be needed in some people.

In case of GERD, symptoms can recur within 6 months after discontinuing the medication. In that case a long term medication therapy would be needed under doctor’s guidance. 

PPIs are extremely safe drug which has no such serious side effects. 

Prokinetic Agents for GERD Treatment:

In a healthy human esophagus, swallowing induces primary peristalsis. These are the contractions that move your food down your esophagus and through the rest of your digestive system. In turn, gastroesophageal reflux provokes a second wave of muscular contractions that clears the esophagus, pushing food down through the lower esophageal sphincter (LES) and into the stomach.

However, in some people, the LES either relaxes or opens spontaneously, allowing stomach contents, including acids, to reenter the esophagus.

Prokinetics help to strengthen the lower oesophageal sphincter and prevent acid reflux. The most widely studied agents include bethanechol, metoclopramide, domperidone and cisapride. It is used as a single agent or in combination therapy

Foam barriers for GERD Treatment

Foam barriers are tablets that are composed of an antacid and a foaming agent. As soon as the tablet reaches to the stomach it disintegrates and turns into foam that floats on top of the liquid contents of the stomach. 

It is a kind of physical barrier which prevents the reflux of liquid. At the same time, the antacid bound to the foam neutralizes acid that comes into contact with the foam. So it has a double effect.

The tablets are best taken after meals (when the stomach is distended) and when lying down, both times when reflux is more likely to occur.

Foam barriers are usually used with other medications

Surgery for GERD

In most cases, lifestyle changes and medications are enough to prevent and relieve symptoms of GERD. But sometimes, surgery is needed.

For instance, your doctor might recommend surgery if lifestyle changes and medications alone haven’t stopped your symptoms. They might also suggest surgery if you’ve developed complications of GERD.

There are multiple types of surgery available to treat GERD, including fundoplication (during which the top of your stomach is sewn around your esophagus), and bariatric surgery (usually recommended when a doctor has concluded that your GERD may be exacerbated by too much excess weight).

Takeaway:

Treating occasional occurrences of heartburn with OTC antacids and some lifestyle changes, like waiting a few hours to lie down after eating, can usually provide relief. But if you are experiencing heartburn more than twice a week and small lifestyle changes don’t seem to be fixing anything, you might be dealing with GERD.

So its better to consult your doctor who will help you come up with a treatment plan that works best for you.

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