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Gastroesophageal reflux disease - Treatment

Alternative Names

Peptic esophagitis; Reflux esophagitis; GERD; Heartburn - chronic

Treatment:

General measures include:

Avoiding alcohol and tobacco
Avoiding dietary fat, chocolate, caffeine, peppermint, onions, garlic, citrus juices, and tomato products (which may cause lower esophageal pressure)
Avoiding lying down after meals
Sleeping with the head of the bed elevated
Taking medication with plenty of water
Weight reduction

Medications that alleviate symptoms include:

Over-the-counter antacids after meals and at bedtime, although they do not last very long
Histamine H2 receptor blockers, mostly for milder symptoms
Promotility agents
Proton pump inhibitors, which may take up to four days to relieve symptoms

Anti-reflux operations (Nissen fundoplication and others) may help a small number of patients whose symptoms do not go away with lifestyle changes and drugs, Even after surgery, many patients still need to take drugs to relieve their symptoms. There are also new therapies that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach) for reflux.

Expectations (prognosis):

The majority of people respond to nonsurgical measures, with lifestyle changes and medications. However, many patients need to continue to take drugs to control their symptoms.

Complications:

Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of cancer)
Bronchospasm (irritation and resulting spasm of airways due to acid)
Chronic pulmonary disease
Esophageal ulcer
Hoarseness
Inflammation of the esophagus
Stricture (a narrowing of the esophagus due to scarring from the inflammation)

Calling your health care provider:

Call your health care provider if symptoms worsen or do not improve with lifestyle changes or medication.

Also call for any of the following symptoms:

Bleeding
Choking (coughing, shortness of breath)
Early satiety (feeling filled up quickly when eating)
Frequent vomiting
Hoarseness
Loss of appetite
Trouble swallowing (dysphagia) or pain with swallowing (odynophagia)
Weight loss

Digestive system

Gastroesophageal reflux disease

Upper gastrointestinal system

Gastroesophageal reflux - series

Reviewed last on: 9/7/2008
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

References

Wang, KK, Sampliner, R E. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008;103(3):788-97.

Khan, M, Santana, J, Donnellan, C, Preston, C, Moayyedi, P. Medical treatments in the short term management of reflux oesophagitis. Cochrane Database Syst Rev(2). 2007;CD003244.

Wilson, J F. In the clinic. Gastroesophageal reflux disease. Ann Intern Med. 2008;149(3): ITC2-1-15; quiz ITC2-16

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