GERD Medications: Over the Counter and Prescription
Therapy though medicines may be the most appropriate next step for the treatment of GERD, if diet and lifestyle changes alone do not resolve symptoms. 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.
Acid suppression is the main function of GERD medical therapy. Three types of medicines are commonly used to treat GERD: 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.
Types of Medications Used for Treating GERD
- Antacids: 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.
- H2RAs: H2RAs reduce the amount of acid produced in the stomach by inhibiting the release of histamine, the principal stimulus for acid secretion in the stomach. Clinical trials evaluating histamine for the treatment of GERD showed only modest benefit 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.
- PPIs: PPIs are the most effective medical therapy to treat GERD . 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.
Risks of Long-Term PPI Use for Treating Reflux
PPIs are generally approved by the FDA 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 of time demonstrate several potential long-term concerns including:
- Vitamin B12 deficiency [link to study]
- Increased pneumonia risk [link to study]
- Increased risk of osteoporosis fractures [link to study]
- Reduced gallbladder motility [link to abstract]
- PPI interaction with Plavix [link to abstract]
- Increased risk of stomach polyps [link to study; link to abstract]
- Increased risk of bacterial gastroenteritis [link to abstract]
- Magnesium deficiency [link to study]
- Increased risk of small intestine bacterial infection [link to abstract]
- Chronic kidney disease [link to abstract]
- Dementia [link to abstract]
See the FDA Proton Pump Inhibitor Safety page for details on long-term side-effects of PPI use.
Limitations of Medications for Treating GERD
Medication can help control 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.
If the medication 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, you may have GERD. Take the GERD-HRQL survey if you suspect a problem.