Heartburn from GERD

TABLE OF CONTENTS

Heartburn from GERD

Treatments

Non-drug

Prescription Drugs

Nexium (Esomeprazole) Protonix (Pantoprazole)

Over-the-counter Drugs

What Leading Medical Organizations Recommend When Treating Heartburn from GERD

WHAT TO TRY FIRST

The American College of Gastroenterology recommends...

  • Everyone with GERD symptoms try lifestyle changes such as elevating the head of the bed at least 30 degrees, avoiding food within 2-3 hours of before bed for all patients (note:  There is NO good evidence for avoiding trigger foods such as chocolate, caffeine, alcohol, acidic or spicy foods).
  • Weight loss for people who are overweight
  • People with certain additional symptoms go for testing (such as an upper endoscopy to rule out a cancer or EKG or a stress test to rule out heart problems).  Testing is suggested if the patient has symptoms such as difficult or painful swallowing, blood in vomit or black, tarry bowel movements, unexplained weight loss or chest pain.
  • H2 blockers (such as ranitidine) for mild and infrequent symptoms (less than 2 times a week)
  • Starting a proton pump inhibitor (PPI such as omeprazole) for people with months of typical GERD symptoms such as heartburn and acid reflux. According to the College, there is no evidence that any one proton pump inhibitor is superior to another.

WHAT ELSE TO TRY

  • Surgery is an option - it works as well as medicines - though some patients may still need medications to treat symptoms.
  • Newer interventions like endoscopic treatments are not recommended since there is not enough evidence to definitively show that benefits outweigh harms.
  • If symptoms respond only partially - or not at all - to initial treatment, next steps are adding antacids, increasing the PPI dose or seeing a gastroenterologist for possible endoscopy.

SOURCE

American College of Gastroenterology. Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease. American Journal of Gastroenterology 2013; 108:308-328; doi: 10.1038/ajg.2012.444