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Treatments and drugs
By Mayo Clinic staff
Treatment for heartburn and other signs and symptoms of GERD usually begins with over-the-counter medications that control acid. If you don't find relief within a few weeks, your doctor may recommend other treatments, including medications and surgery.
Initial treatments to control heartburn
Over-the-counter treatments that may help control heartburn include:
- Antacids that neutralize stomach acid. Antacids, such as Maalox, Mylanta, Gelusil, Rolaids and Tums, may provide quick relief. But antacids alone won't heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects such as diarrhea or constipation.
- Medications to reduce acid production. Called H-2-receptor blockers, these medications include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) or ranitidine (Zantac 75). H-2 receptor blockers don't act as quickly as antacids, but they provide longer relief. Stronger versions of these medications are available in prescription form.
- Medications that block acid production and heal the esophagus. Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC).
Contact your doctor if these medications don't seem to be helping after a few weeks.
Prescription-strength medications
If heartburn persists despite initial approaches, your doctor may recommend prescription-strength medications, such as:
- Prescription-strength H-2-receptor blockers. These include prescription-strength cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac).
- Prescription-strength proton pump inhibitors. Prescription-strength proton pump inhibitors include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec Rx), pantoprazole (Protonix) and rabeprazole (Aciphex).
- Medications to strengthen the lower esophageal sphincter. Called prokinetic agents, these medications help your stomach empty more rapidly and help tighten the valve between the stomach and the esophagus. Side effects, such as fatigue, depression, anxiety and other neurological problems, limit the usefulness of these medications.
GERD medications are sometimes combined to increase effectiveness.
Surgery and other procedures used if medications don't help
Most GERD can be controlled through medications. In situations where medications aren't helpful or you wish to avoid long-term medication use, your doctor may recommend more invasive procedures, such as:
- Surgery to reinforce the lower esophageal sphincter. Called Nissen fundoplication, this surgery involves tightening the lower esophageal sphincter to prevent reflux by wrapping the very top of the stomach around the outside of the lower esophagus. Surgery can be open, meaning the surgeon makes a long incision in your abdomen. Or surgery can be laparoscopic, meaning the surgeon makes three or four small incisions in the abdomen and inserts instruments, including a flexible tube with a tiny camera, through the incisions.
- Surgery to create a barrier preventing the backup of stomach acid. This procedure, called EndoCinch endoluminal gastroplication, uses a tool that's like a miniature sewing machine. It places pairs of stitches (sutures) in the stomach near the weakened sphincter. The suturing material is then tied together, creating barriers to prevent stomach acid from washing into your esophagus. It's not clear who is best suited for this treatment and research is ongoing.
- A procedure to form scar tissue in the esophagus. This approach, called the Stretta system, uses electrode energy to heat esophageal tissue. The heat creates scar tissue and damages the nerves that respond to refluxed acid. The scar tissue that forms as your esophagus heals helps to strengthen the muscles. It's not clear who is best suited for this treatment and research is ongoing.
- Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/index.htm. Accessed April 17, 2009.
- Kahrilas PJ, et al. American Gastroenterological Association Institute Technical Review on the Management of Gastroesophageal Reflux Disease. Gastroenterology. 2008;135:1392.
- Heartburn. American Gastroenterological Society. http://www.gastro.org/wmspage.cfm?parm1=848. Accessed April 17, 2009.
- Richter JE. Gastroesophageal reflux disease and its complications. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2006. http://www.mdconsult.com/das/book/body/133141408-5/0/1389/0.html. Accessed April 17, 2009.
- Liu JJ, et al. Endoscopic treatment of gastroesophageal reflux disease. American College of Gastroenterology. http://www.acg.gi.org/patients/gihealth/grdtrtmnt.asp. Accessed April 17, 2009.
- Kahrilas PJ, et al. American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383.
- Kiefer D. Gastroesophageal reflux disease. In: Rakel D. Integrative Medicine. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/133141408-4/0/1494/0.html. Accessed April 22, 2009.
- Dickman R, et al. Clinical trial: Acupuncture vs. doubling the proton pump inhibitor in refractory heartburn. Alimentary Pharmacology & Therapeutics. 2007;26:1333.
