Gastroesophageal Reflux Disease (GERD) Treatment

  • Treatment

    Blood in your stool or vomit can be serious and requires medical attention.

    Go to the emergency room if:

    • There is more than just a spotting of blood present in the stool or vomit
    • You are dizzy or weak (especially if you have been having black, tarry stools)
    • You are having severe abdominal cramping
    • You are having chest pain

    Notify your doctor if you are having difficulty swallowing food or if you have lost weight without trying.

    Unusual pain when swallowing food or having difficulty getting food to go down into your stomach are symptoms that require medical attention. A clinician should always evaluate significant, unexplained weight loss.

    There are a number of simple lifestyle changes you can adopt to avoid or reduce symptoms of GERD Figure 02.

    Taking these simple steps can alleviate some symptoms of GERD:

    • Eat smaller meals.
    • Stay upright or take a walk after eating.
    • Avoid late-night snacks, or eating and drinking 3 hours before going to sleep.
    • Elevate the head of your bed 6 to 8 inches to avoid lying flat Figure 02.
    • Avoid stooping, bending, and wearing tight-fitting garments.
    • Avoid eating or drinking things that make your symptoms worse:
      • Tomato products
      • Fatty or spicy foods
      • Citrus fruits or drinks
      • Chocolate
      • Onions
      • Coffee
      • Alcohol
      • Carbonated beverages
    • Take an antacid 1 to 3 hours after a meal.
    • If you are overweight, lose excess body weight.
    • Avoid anti-inflammatory medications, such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve), unless directed by your clinician who knows that you have GERD.
    • Quit smoking.

    Click to enlarge: How to elevate the head of your bed

    Figure 02. How to elevate the head of your bed

    If lifestyle changes do not work for you, your clinician may recommend certain medications. It is best for you to talk to your clinician about possible medications to treat GERd.

    Surgery may be a reasonable treatment option in patients with severe and long-lasting GERD that does not respond to medication or lifestyle changes.

    Surgery may completely stop regurgitation. Compared with long-term drug treatment, which does not cure patients and has unknown long-term side effects, surgery is considered the superior therapy for patients with chronic, severe GERD.

    Heartburn is a frequent complaint in pregnant women.

    More than 50% of pregnant women first experience heartburn in their first trimester, while others will not have heartburn until their second or third trimesters. If you had trouble with GERD symptoms in your first pregnancy, GERD will likely happen again in your next pregnancy. Your clinician will recommend that you make the same lifestyle changes as other patients. Eat multiple small meals instead of three large ones, do not lie down until 2-3 hours after meals, and raise the head of your bed at night. If you wish to take medication for your GERD, speak with your clinician first.

    Infants and children can develop GERD.

    In infants, reflux symptoms usually resolve by 18 months of age. For children with severe symptoms (apnea, choking, persistent vomiting), surgery may be necessary. Children with Down syndrome, mental retardation, cerebral palsy, or a repaired tracheoesophageal fistula (an abnormality of the esophagus that is present at birth) are at higher risk for developing GERD.

    Symptoms experienced by the elderly may be deceptively mild.

    There are several factors that make the elderly at risk for GERD and its complications:

    • The aging process can weaken the defenses that the esophagus has against damage from stomach acid. This increases the risk complications from GERD.
    • The elderly are often on many medications that can cause inflammation of the esophagus (esophagitis). They also may not drink enough water when taking their pills, to keep from having to go to the bathroom during the night.
    • GERD symptoms in the elderly may be mild, even with more advanced damage to the esophagus.

    The majority of patients with GERD respond well to lifestyle changes and drug therapy.

    It is important to continue to take your medication as prescribed and adhere to recommended lifestyle changes. When treatment is stopped, symptoms of GERD often return quickly.

    GERD may cause esophageal complications.

    Some conditions that may result due to chronic acid reflux into the esophagus include:

    • Esophageal ulcers that can bleed
    • Esophagitis (inflammation of the esophagus) that can bleed
    • Narrowing of the esophagus (stricture)

    Approximately 10% of patients with GERD will eventually develop Barrett's esophagus, a precancerous condition.

    In Barrett's esophagus, cellular changes occur that can increase the risk of cancer in the inner lining of the esophagus. The condition is caused by chronic, severe exposure to acid and bile reflux. Patients who develop GERD at an early age and whose symptoms last longer than average are at a higher risk for developing Barrett's esophagus.

    Although cancer due to Barrett's esophagus is one of the most rapidly increasing types of cancer in North America, it is rare in comparison to other forms of cancer. Patients with Barrett's esophagus must be monitored periodically with endoscopy and biopsy in order to detect cancer early.

    The kind of follow-up treatment you receive will depend on your specific needs.

    If you have frequent symptoms that are serious, you will require more rigorous follow-up. If you have Barrett's esophagus you need frequent endoscopy and tissue biopsies to check for abnormal cell growth and precancerous cells.

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I'm Kristen Dore, PharmD. Welcome to PDR Health!

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