What Pharmaceutical Treatment
Options Are Available?
Initial GERD treatment typically involves a combination of lifestyle changes, over-the-counter medications (OTC), and prescription drug regimens. GERD is a progressive disease, however, and prescription medications do nothing to slow or prevent this progression. Some patients who respond well to prescription medication may find they require increasing dosage of the medication over time or that they need to switch to a new medication to maintain symptom control.
As the disease progresses, to correct the root cause, the anatomic defect at the gastroesophageal junction, you and your doctor may want to consider surgical intervention, either a conventional laparoscopic procedure or the new incisionless procedure called TIF (Transoral Incisionless Fundoplication).
OTC
Over-the-counter (OTC) medications such as antacids and lower dosage H2 receptor antagonists (H2RA) and proton pump inhibitors (PPIs) are an easily accessible, pain-reducing option for people who suffer from occasional mild-to-moderate GERD. Many OTC treatments work to neutralize the acid, reduce gas, and coat the lining of the esophagus and stomach, thereby providing short term relief from symptoms.
Prescription (PPIs and H2RAs)
Prescription doses of PPIs and H2RAs (H2 blockers) are effective pain reducing treatment options for moderate and recurrent heartburn because they reduce the amount of acid produced in the stomach. These medications, however, do not prevent neutralized acid from refluxing up into the esophagus, lungs, mouth, and/or nasal cavities. They also do not prevent reflux of other caustic agents, including bile, pepsin and digestive enzymes. In other words, medication treats the symptoms of GERD without addressing the root cause, reflux and regurgitation.
Effective GERD medications have revolutionized the treatment of GERD, yet 20-40% of GERD patients on pharmaceutical therapy are dissatisfied with their treatment. Some are not able to eat large meals, eat late at night, drink alcohol, coffee, carbonated beverages, or eat fatty foods, chocolate, strawberries, or spicy foods without having symptoms return. Some patients may also have breakthrough symptoms at night, and regurgitate while sleeping. Some even find a pool of yellow fluid (bile) on the pillow when experiencing reflux at night. So called "silent aspiration" is often cited as the reason for GERD-related asthma. Raising the head of the bed is one option to help in reducing nighttime reflux. Some patients are concerned about the the costs, potential drug interactions, and possible side effects of a lifetime of taking pills.
Risks of Long-Term Use of Prescription Medications
A 2006 study published in the Journal of the American Medical Association showed a significant increase in the risk of osteoporosis in patients over 50 years of age who were taking PPIs for more than a year. Patients who took PPIs twice a day were at nearly a three-fold risk of developing a hip fracture if they took medication more than one year.1
1. JAMA. 2006;296:2947-2953. Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture. Yu-Xiao Yang, MD, MSCE; James D. Lewis, MD, MSCE; Solomon Epstein, MD; David C. Metz, MD
Pharmaceutical treatments range from simple and relatively inexpensive over-the-counter acid suppression drugs to much stronger and more costly acid suppression drugs like PPIs and H2As.
