Treatments and drugsBy Mayo Clinic staff
Treatment for heartburn and other signs and symptoms of GERD usually begins with over-the-counter medications that control acid. If you don't experience relief within a few weeks, your doctor may recommend other treatments, including medications and surgery.
Initial treatments to control heartburn
Over-the-counter treatments that may help control heartburn include:
- Antacids that neutralize stomach acid. Antacids, such as Maalox, Mylanta, Gelusil, Rolaids and Tums, may provide quick relief. But antacids alone won't heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or constipation.
- Medications to reduce acid production. Called H-2-receptor blockers, these medications include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) or ranitidine (Zantac 25, Zantac 75, Zantac 150). H-2-receptor blockers don't act as quickly as antacids, but they provide longer relief. Stronger versions of these medications are available in prescription form.
- Medications that block acid production and heal the esophagus. Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC).
Contact your doctor if you need to take these medications two or more times a week or your symptoms are not relieved.
If heartburn persists despite initial approaches, your doctor may recommend prescription-strength medications, such as:
- Prescription-strength H-2-receptor blockers. These include prescription-strength cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac).
Prescription-strength proton pump inhibitors. Prescription-strength proton pump inhibitors include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant).
Rarely, these medications may lead to bone loss and increase the risk of a bone fracture. Your doctor may suggest that you take a calcium supplement to reduce these risks.
These medications may decrease the effectiveness of the blood-thinning medication, clopidogrel (Plavix). If you are prescribed a proton pump inhibitor and are taking Plavix, tell your doctor.
- Medications to strengthen the lower esophageal sphincter. Called prokinetic agents, these medications help your stomach empty more rapidly and help tighten the valve between the stomach and the esophagus. Side effects, such as fatigue, depression, anxiety and other neurological problems, limit the usefulness of these medications.
GERD medications are sometimes combined to increase effectiveness.
Surgery and other procedures used if medications don't help
Most GERD can be controlled through medications. In situations where medications aren't helpful or you wish to avoid long-term medication use, your doctor may recommend more invasive procedures, such as:
- Surgery to reinforce the lower esophageal sphincter (Nissen fundoplication). This surgery involves tightening the lower esophageal sphincter to prevent reflux by wrapping the very top of the stomach around the outside of the lower esophagus. Surgery can be open or laparoscopic. In open surgery, the surgeon makes a long incision in your abdomen. In laparoscopic surgery, the surgeon makes three or four small incisions in the abdomen and inserts instruments, including a flexible tube with a tiny camera, through the incisions.
- Surgery to create a barrier preventing the backup of stomach acid. A device (Esophyx) is inserted through the mouth into the stomach. The device is used to fold the tissue at the base of the stomach into a replacement for the sphincter valve, to keep stomach acid from washing into your esophagus. Your doctor may recommend this procedure if medications aren't effective or if you're not a candidate for Nissen fundoplication. It's not clear who is best suited for this treatment, and research is ongoing.
- A procedure to form scar tissue in the esophagus (Stretta procedure). This approach uses electrode energy to heat esophageal tissue. The heat creates scar tissue and damages the nerves that respond to refluxed acid. The scar tissue that forms as your esophagus heals helps to strengthen the muscles. Your doctor may recommend this procedure if medications aren't effective or if you're not a candidate for Nissen fundoplication. It's not clear who is best suited for this treatment, and research is ongoing.
- Surgery to strengthen the lower esophageal sphincter (Linx). The Linx device is a ring of tiny magnetic titanium beads that is wrapped around the junction of the stomach and esophagus. The magnetic attraction between the beads is strong enough to keep the opening between the two closed to refluxing acid, but weak enough so that food can pass through it. The new device has been approved by the Food and Drug Administration. It can be implanted using minimally invasive surgery methods.
- Ferri FF. Gastroesophageal reflux disease. In: Ferri FF. Ferri's Clinical Advisor 2011: Instant Diagnosis and Treatment.Philadelphia, Pa.: Mosby Elsevier; 2011. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-0-323-05610-6..C2009-0-38600-6--TOP&isbn=978-0-323-05610-6&about=true&uniqId=230100505-53. Accessed April 13, 2011.
- Kahrilas PJ. Clinical manifestations and diagnosis of gastroesophageal reflux in adults. http://www.uptodate.com/home/index.html. Accessed April 13, 2011.
- Kahrilas PJ. Medical management of gastroesophageal reflux disease in adults. http://www.uptodate.com/home/index.html. Accessed April 13, 2011.
- Michelfelder AJ, et al. Integrative medicine and gastrointestinal disease. Primary Care: Clinics in Office Practice. 2010;37:255.
- Kiefer D. Gastroesophageal reflux disease. In: Rakel D. Integrative Medicine. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/208746819-2/0/1494/0.html. Accessed April 13, 2011.
- Achem SR. Noncardiac chest pain — Treatment approaches. Gastroenterology Clinics of North America. 2008;37:859.
- Oranu AC, et al. Noncardiac chest pain: Gastroesophageal reflux disease. Medical Clinics of North America. 2010;94:233.
- Kahrilas PJ, et al. American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383.
- Fennerty MB, et al. Short- and long-term management of heartburn and other acid-related disorders: Development of an algorithm for primary care providers. The Journal of Family Practice. 2009;58:S1.
- Weight management. U. S. Department of Agriculture. http://www.nutrition.gov/nal_display/index.php?info_center=11&tax_level=3&tax_subject=390&topic_id=1741&level3_id=6295&level4_id=0&level5_id=0&placement_default=0. Accessed April 13, 2011.
- Picco MF (expert opinion). Mayo Clinic, Rochester, Minn. April 24, 2011.
- Transoral Incisionless Fundoplication. http://www.endogastricsolutions.com/esophyx_overview.htm. Accessed March 26, 2012.
- Bonavina L, et al. Laparoscopic sphincter augmentation device eliminates reflux symptoms and normalizes esophageal acid exposure: one- and 2-year results of a feasibility trial. Annals of Surgery. 2010; 252: 857.