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GERD (Heartburn) Treatment

GERD Treatment, Services & Surgery

What is GERD (Gastroesophageal Reflux Disease)?
GERD treatment overview
Changes in lifestyle
Medication treatments for GERD
When GERD symptoms persist
GERD Surgery
Schedule an appointment

GERD treatment overview

It is recommended that you see your doctor if you have been using antacids or other over-the-counter forms of GERD treatment for more than two weeks and are exhibiting symptoms of GERD. Your doctor may refer you to a gastroenterologist, a specialist who treats diseases of the stomach and intestines. Depending on the severity of your GERD, treatment may involve one or multiple lifestyle changes, medications, or surgery for GERD.

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Abbas Abbas, MD, Chief, Thoracic Surgery at Temple, discusses a new surgical procedure to help cure Chronic Acid Reflux.

Changes in lifestyle

The following lifestyle changes can help you control and manage your GERD:

  • Stop smoking
  • Lose weight if needed
  • Wear loose-fitting clothing
  • Eat small, frequent meals
  • Avoid foods and beverages that worsen your symptoms
  • Avoid lying down for three hours after meals
  • Raise the head of your bed six to eight inches by securing wood blocks under the bedposts (just using extra pillows will not help)

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Medication treatments for GERD

Your doctor may recommend over-the-counter antacids or medications that stop acid production or assist the muscles that empty your stomach. These medications can be purchased over-the-counter without a prescription. However, see your doctor before starting or adding a medication.

  • Antacids, such as Mylanta®, Alka-Seltzer®, Riopan®, Maalox®, and Rolaids®, are typically the initial drugs recommended as GERD treatments for relieving heartburn and other mild symptoms. Many antacid brands on the market use different combinations of three basic salts – aluminum, magnesium, and calcium – with bicarbonate or hydroxide ions to neutralize the stomach acid. Be aware that antacids can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt may cause constipation. Magnesium and aluminum salts are frequently combined in a single product to balance these effects.
  • Calcium carbonate antacids, such as Alka-2®, Tums®, and Titralac®, can also be a supplemental source of calcium, although they can lead to constipation as well.
  • Foaming agents, such as Gaviscon®, work by covering the stomach contents with foam to prevent reflux from occurring.
  • H2 blockers, such as famotidine (Pepcid AC®), cimetidine (Tagamet HB®), ranitidine (Zantac 75®), and nizatidine (Axid AR®), reduce acid production. Available in both prescription and over-the-counter strength, these drugs provide short-term relief and are effective for about half of those with GERD symptoms.
  • Proton pump inhibitors include esomeprazole (Nexium®), lansoprazole (Prevacid®), omeprazole (Prilosec®, Zegerid®), pantoprazole (Protonix®), and rabeprazole (Aciphex®). All of these drugs are available by prescription, although Prilosec® is also available in over-the-counter strength. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms and heal the esophageal lining in almost all individuals with GERD.
  • Prokinetics are prescribed to help strengthen the lower esophageal sphincter (LES) and cause the stomach to empty faster. This group includes bethanechol (Urecholine®) and metoclopramide (Reglan®). Metoclopramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness, including sleepiness, fatigue, anxiety, depression, and problems with physical movement.

Because drugs work in different ways, your doctor may recommend a combination of medications to help control your symptoms. Individuals who experience heartburn after eating may be advised to take both antacids and H2 blockers. The antacids neutralize existing acid in the stomach, while the H2 blockers hinder further acid production. Your doctor is the best source of information regarding GERD treatments and medication use.

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When GERD symptoms persist

If your heartburn does not improve with lifestyle changes or drugs, additional tests may be needed.

Barium swallow radiograph

Barium swallow radiograph uses X-rays to help spot abnormalities such as a hiatal hernia and other structural or anatomical problems of the esophagus. In this test, the patient drinks a solution and then has X-rays taken. The test can observe strictures (narrowing of the esophagus) and ulcers, but it will not detect mild irritation.

Upper endoscopy

Upper endoscopy is a more accurate test than a barium swallow radiograph and may be performed in a hospital or a doctor's office. The patient's throat may be numbed with a spray, and then, after a mild sedative is administered, a thin flexible plastic tube with a light and lens on the end called an endoscope is slid down the patient's throat. The endoscope acts as a very small camera and allows the doctor to examine the surface of the esophagus and search for abnormalities. Typically, if moderate to severe symptoms have been reported and this procedure reveals injury to the esophagus, no other tests are needed to confirm GERD.

In some cases, the doctor may also perform a biopsy. During this procedure, tiny tweezers called forceps are passed through the endoscope. These forceps allow the doctor to remove small pieces of tissue from the patient's esophagus. The tissue sample is then examined under a microscope to look for damage caused by acid reflux and to rule out other problems if infection or abnormal growths are not found.

pH monitoring examination

In a pH monitoring examination, the doctor either inserts a small tube into the patient's esophagus or clips a tiny device to the esophagus that will remain for 24 to 48 hours. While the patient goes about his or her normal activities, the device measures when and how much acid comes up into the patient's esophagus. This test can be useful if combined with a carefully completed diary – recording what, when, and how much food the patient eats. This type of diary allows the doctor to identify correlations between symptoms and reflux episodes. The procedure can sometimes help detect whether respiratory symptoms, including coughing and wheezing, are triggered by reflux.

A completely accurate diagnostic test for GERD does not exist. In addition, tests have not consistently shown that acid exposure to the lower esophagus directly correlates with damage to the esophageal lining.

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GERD Surgery

Surgery is an option when lifestyle changes and medication are unable to control GERD. Surgery for GERD may also be a reasonable alternative to a lifetime of drugs and discomfort.

Fundoplication

Fundoplication is the standard surgical GERD treatment. A specific type of this procedure called Nissen fundoplication is typically performed. During the Nissen fundoplication, the upper part of the patient's stomach is wrapped around the lower esophageal sphincter (LES) to strengthen the sphincter, prevent acid reflux, and repair a hiatal hernia.

The Nissen fundoplication may be performed using a laparoscope, an instrument that is inserted through tiny incisions in the patient's abdomen. The doctor then uses small instruments that hold a camera to examine the patient's abdomen and pelvis. When performed by experienced surgeons, the laparoscopic fundoplication procedure is safe and effective in patients of all ages, including infants. The procedure is reported to have the same results as the standard fundoplication, allowing patients to leave the hospital in one to three days and return to work in two to three weeks.

Endoscopic techniques

Endoscopic techniques used to treat chronic heartburn include the Stretta® system, NDO Plicator®, and the Bard EndoCinch® system. These techniques require the use of an endoscope to perform the anti-reflux operation. The Stretta® system utilizes electrodes to create tiny burns on the LES. When the burns heal, the scar tissue helps to toughen the muscle. The NDO Plicator® and EndoCinch® systems involve placing stitches in the LES to create pleats that help strengthen the muscle. The long-term effects of these three procedures are not known.

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Schedule an appointment

To schedule an appointment with a Temple Digestive Disease Center Physician, click here or call 1-800-TEMPLE-MED [1-800-836-7536].

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Return to the Temple Digestive Disease Center homepage.

Sources: 

National Digestive Diseases Information Clearinghouse (NDDIC), National Institutes of Health (NIH) - NIH Publication No. 07–0882, May 2007

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