You may be advised to make some changes to your lifestyle, such as modifying your diet and avoiding specific foods and drinks. While these changes may help to reduce the symptoms of GERD, most people with GERD will need to take medicine.
There are several types of medicine available for the treatment of GERD, the most effective of which are the proton pump inhibitors. Treatment is intended to reduce acid reflux, thereby preventing damage to the esophagus.
Proton pump inhibitors Proton pump inhibitors are a group of medicines that includes esomeprazole, omeprazole, lansoprazole, pantoprazole and rabeprazole.
Proton pump inhibitors provide rapid relief from the symptoms of GERD.
These medicines block the action of the stomach’s proton pump (figure 1), which pumps hydrogen ions into the stomach, making the stomach acidic. Proton pump inhibitors will, therefore, reduce the acidity of the stomach (figure 2).
Figure 1: Proton pump
Figure 2: Proton pump inhibitor. Acetylcholine, gastrin and histamine can increase the acid production with increasing the activity of proton pump. Proton pump inhibitor blocks the final step of acid production.
They therefore reduce the acidity of the stomach contents leaking into the esophagus, which reduces the incidence of heartburn.
Proton pump inhibitors are available from your doctor on prescription, and in some countries, can be bought over the counter.
Histamine2-receptor antagonists Histamine2-receptor antagonists are a group of medicines that includes cimetidine, ranitidine and nizatidine.
These medicines work by stopping (blocking) the action of histamine (a chemical released by the stomach). The presence of histamine in the stomach, results in the release of hydrogen ions into the stomach, making the stomach contents more acidic.
Many histamine2-receptor antagonists can be bought over the counter at low doses but a doctor’s prescription is needed for higher doses.
Antacids For people who only suffer from the occasional episode of heartburn, antacids can bring relief. These medicines can be bought over the counter. Antacids provide relief from the symptoms of heartburn by neutralising the acid. If symptoms of heartburn are still present after you have used antacids for 2 weeks, you should consult your doctor. There is a wide range of antacids available. The main ingredients of antacids are:
Antacids sold over the counter may contain one or a combination of these products. For example, aluminium and magnesium salts are often combined to reduce the incidence of diarrhoea or constipation.
Antacids are best taken when the symptoms of heartburn first occur, preferably about 1 hour after a meal.
Antacids may interfere with the absorption of other medicines from the digestive system into the blood. A gap of at least 2 hours should be left between using an antacid and taking other medicines.
Alginates Some antacids contain sodium alginate.
Sodium alginate forms a ‘raft’ which floats to the top of the stomach, forming a barrier between the acid and the esophagus, thus preventing acid refluxing into the esophagus.
Surgery can be performed to either improve the action of the LES or to widen a narrowed esophagus.
Laparoscope This involves keyhole surgery (where the cut made is as small as possible to improve recovery) and is carried out to tighten the tissue around the lower esophagus to reduce or prevent acid reflux. This surgery will normally mean that you stay in hospital for 2–3 days.
Widening of the esophagus There are a number of procedures that may be carried out to widen a narrowed esophagus.
Guided wire – Dilators are passed over a thin wire, which is positioned in the narrowed tube.
Balloons – Long, narrow balloons can be passed into the esophagus and then gently inflated to open up the narrowed tube.
Bougie – A series of increasingly larger, soft rubber or plastic dilators are placed over the narrow part of the esophagus, gently widening the tube.
Patients with swallowing difficulties will normally obtain complete relief after one of these procedures. During, or after the procedure you may experience a small amount of bleeding from the esophagus. Complications from the procedure, such as excessive bleeding due to damage to the esophagus, are rare.