GERD Treatment: At-Home Care, Prescriptions, Surgery

Treatments for gastroesophageal reflux disease (GERD) include steps to take at home, dietary changes, over-the-counter (OTC) medications, prescription medications, and surgery. GERD occurs when the lower esophageal sphincter (LES), located at the bottom of the esophagus (food tube), is too loose. Acid backs up from the stomach and into the esophagus, causing heartburn and other symptoms.

GERD Treatment Options 

You have many management options for gastroesophageal reflux disease. Treating GERD will reduce symptoms and help avoid potential complications.

Medication might not always be needed if lifestyle and dietary changes offer enough relief from symptoms. Drugs used for GERD are available both over the counter and by prescription. Surgery is reserved for people who do not find relief through less invasive treatments.

At-Home and Lifestyle Habits to Eliminate Triggers

You can take steps at home to help with GERD symptoms.

One of the most common ways to manage GERD is to change your diet. Foods to avoid because they may cause the lower esophageal sphincter to relax and cause symptoms include:

• Acidic foods, including citrus fruits and tomatoes or dishes that contain tomatoes
• Alcoholic beverages
• Chocolate
• Coffee and other forms of caffeine
• Food that is high in fat
• Greasy or spicy foods
• Peppermint and other types of mint

In addition to avoiding dietary triggers, a healthcare provider may suggest ways to prevent heartburn by changing habits, including:

• Avoiding tight clothing around the chest and abdomen
• Managing weight if you are overweight or experiencing obesity
• Raising one’s head and upper back about 6 to 8 inches while sleeping, either with the use of a wedge or pillows or by raising the head of the bed
• Stopping smoking
• Waiting at least two hours to lie down after eating

It may take time to discover your triggers. Keeping notes on symptoms and what was eaten or what you were doing before they started is a strategy that may help to detect and avoid triggers. One of the benefits of making adjustments to diet or lifestyle in managing GERD is generally safe and are not likely to to adverse effects.

OTC and Prescribed Medications

GERD can be treated with over-the-counter and prescription drugs. In some cases, an OTC medication might also be available as a prescription medication in a different dosage.

There’s a general guideline regarding the use of OTC medications for heartburn or GERD symptoms. If it becomes necessary for you to take these medications more than two times a week, talk to a healthcare provider to determine whether more testing is needed to diagnose the condition and provide additional treatment.

Over-the-counter and prescription medications to treat GERD include the following.

Antacids

Antacids treat GERD by neutralizing acid in the stomach. Name brands found in drug stores include:

• Gaviscon (magnesium trisilicate)
• Maalox (aluminum hydroxide)
• Mylanta (aluminum hydroxide and magnesium hydroxide)
• Rolaids (calcium carbonate and magnesium hydroxide)
• Tums (calcium carbonate)

Bismuth Subsalicylate

Bismuth subsalicylate has the effect of limiting the amount of fluids and electrolytes (charged minerals in the blood) that flow into the intestines. Most people recognize this pink product that’s sold under the brand name Pepto-Bismol.

H2-Receptor Blockers

H2-receptor blockers reduce the amount of acid created by the stomach lining for about 12 hours. Some brand names of H2 blockers include:

• Axid AR (nizatidine),
• Pepcid Complete or Pepcid AC (famotidine)
• Tagamet (cimetidine)
• Zantac (ranitidine)

These medications are also available by prescription.

Proton Pump Inhibitors (PPIs)

Proton pump inhibitors are another type of drug that reduces acid production in the stomach. The effects may last for up to 24 hours. They take longer to take effect—usually, about an hour—so they’re designed to be used in anticipation of symptoms instead of after symptoms start. They are also usually prescribed or taken for several days in a row, sometimes for up to two weeks.

Some of the brand names PPIs are:

• Nexium (esomeprazole)
• Prevacid (lansoprazole)
• Prilosec (omeprazole)

These medications are also available by prescription.

Potassium-Competitive Acid Blocker

Potassium-competitive acid blockers (PCAB) have not been used in the United States for as long as other medications for GERD. The PCAB available in the United States is Voquezna (vonoprazan). It works by blocking the acids secreted by the stomach.

PCABs are not recommended as the first type of drug to try for GERD. A PCAB may suppress acid more effectively than other medications, but the long-term effects are not yet known.

Surgery

People may choose to have surgery to treat GERD for a few reasons. One is if lifestyle changes and medication do not stop the symptoms. Another is if it’s not possible for a patient to take medications as prescribed. Many different types of surgery are used to treat GERD.

Nissen Fundoplication

Nissen fundoplication is the most commonly used type of surgery to treat GERD. The goal is to strengthen the LES. This is done by taking a part of the tissue from the upper stomach and wrapping it around the LES. This may help make the LES stronger so it doesn’t loosen and let acid back up into the throat.

Fundoplication is done either laparoscopically (through small incisions with inserted scopes and tools) or with open surgery (a large incision).

Transoral Incisionless Fundoplication (TIF)

Transoral incisionless fundoplication is more of a procedure than a type of surgery. It might be used when a person cannot have a Nissen fundoplication or chooses not to. There are no incisions because the esophagus is accessed by going through the mouth.

A device called an EsophyX is inserted into the mouth, through the throat, and into the esophagus and stomach. It folds the tissue of the esophagus and stomach and anchors it with fasteners. This creates a new valve, which helps prevent acid from backing up from the stomach and into the throat.

Stretta Procedure

This treatment uses an endoscope (a flexible tube with a light and a camera on the end) to guide the placement of a tube with a balloon electrode on the end into the esophagus and stomach. The balloon electrode has sharp prongs that heat up. These prongs are used to make small cuts in the esophagus.

When these cuts heal, scar tissue is created. Scar tissue is tougher and less flexible than tissue that hasn’t been through the healing process. The new scar tissue supports and reinforces the esophageal muscles to prevent acid from backing up into the throat.

In addition, the nerves in that area are affected. Those nerves may be dulled, which means they may not react to acid backing up from the stomach and into the throat.

Bard EndoCinch System Procedure

This procedure, also known as endoluminal gastroplication, involves inserting an endoscope into the mouth and down into the esophagus. A tool on the end of the endoscope creates two stitches in the LES. The stitches essentially make a pleat in the LES. This pleat makes the LES stronger so that acid is less likely to come up from the stomach and into the esophagus.

This procedure is minimally invasive because it is done via endoscopy. However, it is not used as frequently as some other options for GERD, which might be because it is a newer technique and/or may not be covered by insurance.

LINX Surgery

The LINX reflux management system is an implanted device that wraps around the LES. The LINX is a ring of magnetic titanium beads which help keep the LES closed. It’s less invasive than open surgery but insurance policies may not cover it.

Treatment Effectiveness: A GERD Cure?

GERD can be treated effectively. When it is managed well, symptoms may go away altogether. However, they could come back if something changes with the treatment plan or if the plan cannot be followed.

It may be possible to manage GERD well enough through lifestyle and diet changes, medication, and/or surgery that it doesn’t return. It’s important to know that keeping up with the plan that’s working is an ongoing process to manage and stop GERD symptoms for good.

During a GERD Episode, What Helps?

Some options to treat GERD are used to prevent it in the first place. Others are used long term, such as surgery, and won’t help in the moment when GERD starts causing symptoms.

Managing GERD symptoms when they start includes:

• Loosening clothing around the abdomen and chest
• Trying an OTC medication such as an antacid, PPI, or H2 blocker (two medications might be needed; talk to a healthcare provider about which drugs can be taken together)
• Staying upright, not lying down, or elevating the head by 6 to 8 inches

If GERD symptoms occur more than a few times a week, it’s important to see a healthcare provider for diagnosis and treatment.

Managing Medication Side Effects 

Medications for GERD can have side effects. It is always important to discuss medication use, even OTC medications, with a healthcare provider. Some medications may also interact with one another, so it’s important to tell healthcare providers about all supplements and treatments you take.

Antacids

Antacids that contain aluminum and/or magnesium hydroxide may decrease the ability to absorb iron or folic acid. These supplements should be taken two to three hours apart from antacids. Other antacid side effects include:

• Antacids contain calcium carbonate and may cause symptoms of constipation and gas.
• Antacids contain sodium bicarbonate or sodium citrate that may cause gas or bloating.
• Magnesium antacids could cause diarrhea, gas, flushing (sudden warmth of the skin), low blood pressure, and a high magnesium level.
• Aluminum-containing antacids could lead to low magnesium, constipation, anemia, and low phosphate levels.

PPIs

PPIs may cause a decrease in the ability to absorb vitamin B12 from food. For those taking PPIs for a longer period of time, it may be necessary to watch vitamin B12 levels and take a supplement or receive a B12 shot from a healthcare provider.

PPIs may also decrease the ability to absorb some kinds of calcium and iron. Calcium or supplements might be recommended for some people. The decrease in the absorption of important vitamins and minerals could lead to other health effects. It has been suggested that a lack of calcium absorption from PPIs could lead to a risk of bone fractures.

It has also been shown that people who take PPIs may be more likely to get pneumonia and develop an infection with C. diff. Why these associations occur isn’t fully understood, but it’s important to know if taking these medications long term.

Side effects in people who take PPIs for the short term are considered to be minor and include:

• Abdominal pain
• Constipation
• Diarrhea
• Dizziness
• Flatulence
• Headache
• Nausea
• Rash

H2 Antagonists

H2 antagonists may decrease the ability to absorb vitamin B12 and iron. Vitamin B12 levels might need to be monitored through blood tests. Taking iron supplements two hours before or after taking an H2 antagonist might be helpful.

The side effects of H2 blockers are usually considered to be minor and are uncommon. They can include constipation, diarrhea, drowsiness, fatigue, headache, and muscle aches. There is also the possibility of drug interactions and acute liver injury (which is rare).

Specialists Who Oversee Chronic GERD

Several types of healthcare providers may manage GERD. However, the specialist most commonly involved is a gastroenterologist. A gastroenterologist is a medical doctor who has specialized training in the care of digestive conditions.

Other types of healthcare providers may also be involved or may prescribe treatments and management options for chronic GERD, including a primary care provider or a registered dietitian.

Summary

Occasional heartburn is usually not a cause for concern, but ongoing symptoms that impair quality of life are a reason to talk to a healthcare provider. Making changes to diet and how and when meals are eaten are low-risk ways to avoid developing GERD symptoms.

Many OTC medications can be effective in helping symptoms, but some people may need prescription-strength drugs. Surgical options may be considered if these do not control the symptoms.