GERD Medications: Over-the-Counter and Prescription Treatments
Medication therapy may be the most appropriate next step for the treatment of GERD. For many patients, treatment with medicines will reduce heartburn and reflux symptoms. Patients with more severe symptoms may only experience partial symptom control through medicines. Currently, there is no cure for GERD. Therefore, those with this condition will have to manage it through lifestyle changes and medications over the long term, or potentially surgery if these treatments become inadequate.
Types of Medications Used for Treating GERD
Acid suppression is the main function of GERD medication therapy. Three types of medicines are commonly used to treat GERD, including: antacids, h2-receptors (H2RAs), and proton pump inhibitors (PPIs). Some drugs are available as over-the-counter (OTC) medications and others are available by prescription only. PPIs are the most commonly used drug to treat GERD symptoms and to heal esophagitis, which is often damaged by acid reflux caused by GERD.
This type of medication directly neutralizes gastric acid and provides rapid but temporary relief. Antacids are usually consumed in frequent doses as needed, and most are available over the counter. It’s important to be wary of taking too many antacids in a short amount of time, even in the treatment of GERD, as the main ingredient in antacids is calcium carbonate, which is designed to lower acid levels in the gut. A buildup of calcium carbonate can cause several symptoms, some of which may even require hospitalization. The recommended daily dosage for products with calcium carbonate, such as Tums, will be found on the label.
If you are finding that you’re having to constantly hit or go over the maximum dosage of antacids daily, then it may be time to talk to your doctor about alternative or supplemental GERD treatments.
Histamine H2-receptor antagonists, or H2RAs, reduce the amount of acid produced in the stomach by inhibiting the release of histamine, which is the principal stimulus for acid secretion in the stomach. Clinical trials evaluating histamine for the treatment of GERD showed only modest benefits over a placebo. Also, several studies have revealed drug tolerance to H2RAs as early as two weeks after beginning therapy. This means that patients experience a reduced reaction to a given dosage relatively quickly after starting to use it. This means that H2RAs may be a good short-term treatment, such as if you’ve developed GERD because of another condition like menopause, but may not work in the long run.
PPIs are the most effective medical therapy to treat GERD to date. PPIs work by blocking the mechanism that produces stomach acid. This lowers the acidity of the digestive fluids involved in reflux, and thus reduces reflux symptoms. PPIs are available in both prescription and over-the-counter strengths. While effective at reducing the acidity of digestive fluids in the upper GI tract, research has indicated that PPIs do not address anatomic deficiencies, which often are the root cause of abnormal reflux. Therefore, a PPI may work best as a supplementary treatment for GERD in some, rather than the entire treatment course.
While these medications can help improve symptoms, they cannot eliminate GERD. This is why it’s important to keep up positive lifestyle habits and continue to check in with your care team to continue treating GERD in the best way possible.
Risks of Long-term PPI Use for Treating Reflux
PPIs are generally approved by the FDA (Food and Drug Administration) for eight weeks of use for the healing of esophagitis, and they are safe and effective for most patients. However, studies evaluating PPI use over an extended period demonstrate several potential long-term concerns, including:
- Vitamin B12 deficiency;
- Increased pneumonia risk;
- Increased risk of osteoporosis fractures;
- Reduced gallbladder motility;
- PPI interaction with Plavix;
- Increased risk of stomach polyps;
- Increased risk of bacterial gastroenteritis and other bacterial infections;
- Magnesium deficiency;
- Chronic kidney disease;
See the FDA Proton Pump Inhibitor Safety page for details on the long-term side effects of PPI use. If you experience any of these side effects while using PPI as part of your GERD treatment, talk to your doctor or care team, as prolonged deficiencies and other side effects can lead to more health problems down the line.
Limitations of Medications for Treating GERD
Medication can help control GERD symptoms, such as heartburn, by reducing the acidity of reflux, but it does not change the amount or quantity of reflux. As a result, it can leave other symptoms, such as difficulty swallowing, frequent regurgitation, or chronic respiratory problems unresolved. This is why a multifaceted treatment approach for GERD is often the most recommended.
Lifestyle Treatment Options for GERD
As mentioned, there is no current cure for GERD. This is why it’s important for those who have symptoms to manage their condition with a mixture of lifestyle and medication. This is the best way to reduce possible long-term side effects of medication and increase the overall quality of life.
Some lifestyle changes you can make to help treat symptoms of GERD include:
- Follow a GERD-friendly diet;
- Sleep in an inclined position;
- Eliminate trigger foods or activities;
- Wear clothing that is loose around your stomach.
Each person will experience GERD and GERD symptoms differently and therefore need different treatment styles. Be sure to talk to your doctor about any lifestyle changes that you try, or are interested in trying. If these, combined with regular medication don’t improve your quality of life, then it may be time to consider more serious treatment measures.
Surgery Treatment Options for GERD
For those with serious cases of GERD, you may consider a Transoral Incisionless Fundoplication (TIF) procedure. This procedure helps address the root cause of reflux and can provide long-term relief for people with severe reflux symptoms. While it is not the only surgical treatment option for GERD, the TIF procedure doesn’t require an incision, meaning that you may experience faster recovery than open surgery.
To pursue this treatment option, you’ll need to find a TIF-certified physician in your area. This may be easy, or more difficult, depending on where you live. To qualify for this surgery, you will need the following:
- To be at least 18 years old.
- Regularly experiencing troublesome symptoms of chronic GERD.
- No longer responding to GERD medications or lifestyle changes in a significant way.
Your physician may have other requirements for patients before the surgery and will discuss these with you directly.
If your treatment regimen is stopped, reflux-related symptoms typically recur. This can lead to dependence on these medicines. Over time, the medication can lose its effectiveness, requiring higher doses or more powerful medicines. Having reflux from time to time is normal; having it interrupt your life is not. If you suffer symptoms of reflux twice or more per week over an extended period, you may have GERD. Take the GERD-HRQL survey if you suspect a problem.