Acid reflux, or heartburn, occurs when stomach acid backs up into the esophagus. It can cause a burning sensation behind the breastbone or throat and usually feels worse after eating.
Weaker medicines like antacids treat mild heartburn, but stronger drugs such as H2 blockers and PPIs reduce acid production and allow the esophagus to heal.
Antacids
Antacids neutralize the acid in your stomach and can relieve heartburn symptoms. They are available over the counter in liquid or chewable form and can be purchased without a prescription. They provide quick but temporary relief of heartburn, sour stomach, and acid indigestion. However, they do not treat the underlying cause and long-term use can lead to serious health issues like diarrhea.
Antacid medications vary in how fast they take effect, how long they last, and how well they interact with other medicines. For this reason, people taking antacids should speak to their doctor before combining them with any other type of medicine.
People who have frequent heartburn should also speak to their doctor because regular antacid medication could mask symptoms of more serious reflux diseases like esophageal strictures or Barrett’s esophagus. Long-term antacid use can even cause a condition called neurotoxicity in which the nervous system is damaged.
H2 blockers
H2 blockers reduce the amount of acid your stomach makes by binding with histamine type 2 receptors on gastric cells. These cells are responsible for secreting hydrochloric acid, which is needed to break down and digest food and kill germs. When histamine binds to these receptors, it triggers the cell to secrete acid. H2 blockers act like a dimmer switch for these cells, blocking the histamine from binding and thus dimming acid secretion.
These medications, such as famotidine (Pepcid) and ranitidine (Zantac), are typically taken before each meal and can work within 30 to 90 minutes, providing acid-suppression that lasts for several hours. They are also available in prescription and over-the-counter oral formulas.
While these medications are effective for heartburn, long-term use can lead to tolerance and decrease the effectiveness of the medication. It is recommended to find other treatment options for chronic acid reflux symptoms, including diet and lifestyle changes, probiotics, apple cider vinegar, and aloe vera juice or capsules.
PPIs
After antacids and H2 blockers, PPIs reduce stomach acid production the most effectively. These drugs also heal erosive esophagitis (acid reflux that damages the lining of your throat or stomach) much more quickly than antacids do.
Like H2 blockers, PPIs come in tablets and liquid form. Some are designed to be taken with food; others, such as dexlansoprazole, are enteric-coated “slow release” pills that are released into the intestine at two different points, several hours apart, to provide greater coverage.
Although there are some concerns about long-term PPI use, most doctors consider them safe and effective medications that target the source of a lot of gastrointestinal distress. Taking them can be one part of a GERD treatment plan that includes making lifestyle changes, such as not smoking, eating smaller meals and not reclining or leaning back while you eat, not lying down right after a meal, and elevating your head and chest when sleeping.
Surgery
Surgery is an option for people who have serious GERD symptoms that don’t improve with lifestyle changes and medicines. However, you should only consider it if your doctor recommends it and you understand the risks.
Surgery can help you avoid complications of GERD, such as stomach ulcers and inflammation (esophagitis). Surgery can also repair a hiatal hernia and help you stop a recurring acid reflux episode.
NYU Langone was one of the first hospitals to offer a new minimally invasive GERD surgery called the LINX system, which is proven effective in relieving acid reflux symptoms. It uses a small, ring-like device made of magnetic titanium beads to strengthen the lower esophageal sphincter. This keeps food from flowing back into the stomach and prevents acid from returning to your throat.
Many patients who have had surgery say they are very satisfied with their results. But it’s important to know that even after surgery, most people continue taking GERD medications regularly.
