Medication can reduce heartburn and acid reflux symptoms, heal the lining of your esophagus, and may even help prevent GERD from becoming more serious.
There are various medications for GERD, such as antacids, H2 blockers and prokinetic agents. Doctors also suggest making dietary and lifestyle changes to treat the condition such as losing weight or elevating your head.
Proton-pump inhibitors
Proton-pump inhibitors are the premier prescription medication for acid reflux, as they work by restricting stomach acid production. Furthermore, proton-pump inhibitors reduce the risk of peptic ulcers and other serious complications caused by chronic acid reflux such as erosive esophagitis or Barrett’s esophagus.
Proton-pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), and pantoprazole (Aciphex) are the most widely prescribed. Once absorbed into the bloodstream, these drugs send signals to cells producing acid within the stomach lining, instructing them to reduce production.
However, these drugs may cause several side effects when taken long-term, one of which is rebound acid secretion.
Another concern is that some individuals taking proton pump inhibitors for an extended period may develop an increased risk of pneumonia and antibiotic-associated diarrhea. While there is no definitive cause, it’s essential to monitor these risks.
There have been some concerns regarding the potential effects of these medications on the liver and kidneys. If you plan to take them for an extended period, consult your doctor first for advice.
If you’re thinking of taking a proton-pump inhibitor, talk to your healthcare provider about your symptoms and which medicine would be best for you. Be sure to mention any other medications that you may be taking as well.
At present, six prescription-strength PPIs and four over-the-counter versions exist in the United States; both of them effective at treating acid related disorders and are among the most prescribed classes of medication worldwide.
Antacids
Antacids work by neutralizing stomach acid to alleviate symptoms of heartburn and indigestion. They are available over the counter or with a valid prescription, come as liquid or tablet form and may include other ingredients like alginates which float on top of stomach acid to stop it from entering into your esophagus.
They work quickly and can help reduce heartburn symptoms. Furthermore, they may help heal an inflamed esophagus caused by stomach acid damage.
Some antacids contain sodium bicarbonate, which creates a carbon dioxide bubble in the stomach and can reduce heartburn symptoms. Others combine different antacid ingredients like calcium carbonate or aluminum hydroxide for additional relief.
Other antacids contain simethicone, which reduces gas bubbles in the stomach. Although these may not be as effective at relieving symptoms as their simethicone-containing counterparts, these products are safer to take than those without this ingredient.
Antacids should only be taken when necessary and at the dose recommended on the label. Excessive use may lead to side effects, so consult your doctor or pharmacist about using antacids frequently or for extended periods.
Most people can safely take an antacid, but those with kidney or liver issues, or high blood pressure should consult their doctor before taking one. Some antacids contain large amounts of salt (sodium), which could potentially affect circulation and blood pressure.
Antacids can affect how your body absorbs other medicines, so be sure to take them at least 2 to 4 hours after taking other drugs. They may also interact with certain antibiotics, psychiatric medications and other drugs.
H2 blockers
H2 blockers are the go-to prescription medication for acid reflux and gastroesophageal reflux disease (GERD). They’re also effective at treating peptic ulcers. H2 blockers offer faster relief than antacids do, making them the ideal treatment option for people suffering from GERD.
These medicines reduce stomach acid by blocking receptors on cells in the lining of the stomach that release acids. Furthermore, these drugs block histamine – a chemical which stimulates gastric acid production when exposed to stomach acids.
Studies have demonstrated that H2 blockers can significantly reduce heartburn symptoms over a 24-hour period, giving your esophagus time to heal and repair itself.
Four H2 blockers have been approved by the FDA for short-term use: nizatidine (Axid), famotidine (Fluxid), cimetidine (Tagamet) and ranitidine (Zantac). These medications can be taken orally, via IV infusion or nasal tube.
The appropriate dosage of each drug depends on your age, symptoms, and health condition. Never exceed what your doctor prescribes without consulting with a healthcare professional first.
Overdoses of this medication may cause side effects such as nausea and vomiting. You may also notice a drop in your blood pressure.
Another potential side effect of taking an H2 blocker may be low potassium levels. This could result in muscle pain and weakness. Speak to your doctor about how much potassium should be taken when on an H2 blocker.
Some individuals with kidney or liver issues may require a lower dose of the drugs than other patients. Be sure to inform your doctor if you are pregnant or breastfeeding so they can prescribe an appropriate dosage. Additionally, when taking an H2 blocker it is wise to take a multivitamin and mineral supplement as well.
Prokinetic agents
Prokinetic agents work by tightening your lower esophageal sphincter (LES), causing stomach contents to empty more quickly, helping prevent reflux symptoms from occurring. They’re usually taken in combination with other heartburn medications like proton pump inhibitors or H2 receptor blockers for maximum benefit.
Your LES and other muscles in your gastrointestinal tract work together to perform peristalsis. This contraction occurs at a speed that suits your body’s needs, leading to reflux or other issues like GERD and gastroparesis. When something interferes with gastrointestinal motility, it could result in reflux or other issues like gastroparesis.
Prokinetic medications come in tablet and liquid forms, with Domperidone being the most popular. Unfortunately, it has serious side effects including 7% CNS side effects that could be toxic or heart effects (longer Q-T interval and QT prolongation).
Metoclopramide (Reglan) is a drug that relaxes the muscles in your gastrointestinal tract. While it’s often prescribed as a first-line treatment for GERD, its side effects can be serious and therefore it should not be used long term.
Erythromycin (Ciprofloxacin) is a macrolide antibiotic with prokinetic effects. It’s available both oral and IV form for treating gastroparesis – an issue where the stomach doesn’t empty completely – as well as other stomach conditions.
However, it’s not the best prescription medication for GERD due to its ineffectiveness compared to PPIs or H2 blockers. Furthermore, there may be dangerous side effects like tachyphylaxis.
For acid reflux, the ideal prescription medication is a combination of medications that address the root cause. This usually includes a gut healing regimen to eliminate toxins, inflammation and dysbiosis which may contribute to decreased gut motility.
Transoral incisionless fundoplication
If you are struggling to manage your reflux symptoms with antacids or proton pump inhibitors, a minimally invasive procedure called transoral incisionless fundoplication (TIF) might be the answer. This operation fixes the esophagus valve so acid does not come back up into your stomach.
TIF (Thin Endoscopic Fundoplication) is an endoscopic procedure that utilizes a special device and upper gastrointestinal endoscope to repair the damaged valve between your stomach and esophagus. It’s less invasive than traditional surgery like Nissen fundoplication, leading to shorter treatment times and faster recoveries.
A gastroenterologist trained in TIF will use a TIF device and an endoscope to create an artificial barrier between your stomach and esophagus, helping relieve chronic GERD symptoms and improving quality of life.
Patients who have undergone the TIF procedure report relief of heartburn and other symptoms, with many being able to discontinue taking daily antacids. Compared with patients who underwent laparoscopic Nissen fundoplication, those in the TIF group experienced fewer side effects and lower long-term costs.
TIF, in particular, has been found to cause less gastrointestinal bleeding than traditional antireflux surgery and thus, it’s the least invasive of all antireflux treatments.
The most commonly performed TIF procedure is a 360deg fundoplication, though it can also be performed as partial fundoplication. Furthermore, some TIF procedures include magnetic sphincter augmentation to improve its strength and location.
TIF is a safe, effective, minimally invasive procedure that repairs the malfunctioning valve between your stomach and sphincter. Multiple studies have demonstrated its superiority over proton pump inhibitors for symptom reduction and patient satisfaction.
