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Treating GERD with medications: What you need to know

GERD Medications

Feeling the burn, but not sure what medication is right for you? This overview compares the three types of medications commonly used to treat GERD symptoms, so you can make the best choice when you hit the pharmacy.

A brief search online can lead you to believe that permanent relief from gastroesophageal reflux disease (GERD) is just a quick pill or chewable tablet away. While numerous medications are available for relieving symptoms of reflux disease, be aware that these drugs are incapable of directly treating its root cause – a defective lower-esophageal sphincter (LES). Unable to prevent the backflow of stomach acid into your LES, these medications function instead by neutralizing or reducing the amount of acid produced by the stomach. Because of this treatment approach that aims to control symptoms rather than address the cause of the disease, the long-term management of reflux disease through drugs alone often fails. However, medication may play an important role in improving patient wellness when used correctly.

Types of reflux medications

Acid Neutralizers

Examples: Tums, Rolaids, Maalox, Mylanta, Alka-Seltzer

Acid neutralizers represent one of the most common types of drugs used to treat reflux disease. These over the counter medications are basic compounds (i.e alkaline or high pH), like calcium carbonate, that provide temporary relief from symptoms by neutralizing stomach. They are used during a reflux episode or before eating a meal that is likely to cause heartburn. They neutralize acid in the stomach immediately, and if used in sufficient dosage, increase the pH to a level where pain (heartburn) is reduced if reflux occurs.

Because your stomach is constantly monitoring and adjusting its pH level for optimal digestion, it responds to the increase in pH caused by acid neutralizers by quickly ramping up acid secretion to bring the pH down to where it should be. As a result, acid neutralizers only relieve symptoms for a short period of time. The fact that these drugs have had a large market for over five decades suggests that they are effective in controlling reflux symptoms with intermittent use.

Pros

  • Readily available over the counter
  • Inexpensive
  • Provides quick relief of mild symptoms
  • Can relieve symptoms during a reflux episode
  • Can prevent heartburn if taken before a meal that is known to produce heartburn
  • Safe

Cons

  • Short duration of symptom relief
  • Ineffective in long-term management of symptoms
  • Ineffective in relieving moderate to severe symptoms

Side Effects

Few side effects have been associated with acid neutralizers. In fact, those that have calcium in their formula actually act as a nutritional calcium supplement.

Histamine-2 Receptor Antagonists (H2 Blockers)

Examples: Pepcid, Zantac, Tagamet, cimetidine, ranitidine

H2 blockers are a category of drugs that work by deactivating the cellular receptors within the stomach responsible for signaling the production of acid. When the H-2 receptor is blocked, acid secretion by the cells in the stomach is decreased. If reflux occurs while this blockage is in place, the likelihood of heartburn is decreased. These drugs take longer to reduce gastric acid than acid neutralizers, but produce a more sustained acid reduction. H2 blockers are less effective than proton pump inhibitors (PPIs) in suppressing acid secretion on a long term basis, but they act more quickly to reduce acid than PPIs. They are sometimes used with PPIs to augment the efficacy of those drugs.

Pros

  • Readily available over the counter
  • Provide longer term relief from symptoms than acid neutralizers
  • Act more quickly than PPIs in reducing acid secretion
  • Less expensive than PPIs
  • Fewer complications than PPIs

Cons

  • Less effective than PPIs in the long term
  • Ineffective in relieving severe symptoms because the total amount of acid reduction achieved is much lower than PPIs

Side Effects

Few side effects have been associated with H-2 receptor antagonists, with the exception of cimetidine. Users of this variant of the medication have been known to experience hypotension, headache, fatigue, dizziness, confusion, constipation, diarrhea, and/or rash.

Proton Pump Inhibitors (PPIs)

Examples: Prilosec, Prevacid, Zegarid, Nexium, omeprazole, es-omeprazole, lansoprazole

PPIs provide the most powerful method for decreasing acid production in the stomach. PPIs work by inhibiting the proton pump in the stomach’s acid-producing cells. When used correctly, PPIs can provide relief from acid reflux for 14-18 hours each day. PPIs typically require 3-4 days to begin working and are not very useful when taken to control symptoms as they occur. These drugs are generally prescribed for a period of two weeks or longer. To be effective, PPIs need to be used continuously to keep acidity levels low so that the damage and symptoms are lessened when acid reflux inevitably occurs.

Pros

  • Most powerful option for relief of acid reflux symptoms because they achieve the best control of acid secretion available
  • Provide longer-term relief from symptoms than other medications
  • Heal erosive esophagitis and prevent ulceration and stricture formation in the esophagus

Cons

  • Long-term use of PPIs may carry an increased risk of bone fractures
  • May increase severity of symptoms if treatment is discontinued because of a rebound acid secretion when the drug is withdrawn
  • Ineffective for quickly treating symptoms as they occur
  • Does not address the cause of reflux disease. LES damage is permanent and not reversed by PPIs.
  • Does not prevent Barrett’s esophagus or cancer

Side effects

Direct side effects include headache, diarrhea and abdominal pain. Long-term side effects include increased risk of hip fracture, increased risk of Clostridium difficile (C. diff) infection, and interactions with other medications. 

Remember: No drug can provide permanent relief

When considering medication as a treatment option for reflux disease, remember that no drug can provide permanent relief. Though these medications can help control symptoms, they do not address the cause of acid reflux, a damaged or defective LES. Additionally, complications of reflux disease such as Barrett’s esophagus and esophageal cancer are not addressed through medication. Remember that, improving your diet, losing weight, and making other lifestyle modifications can have a profound effect on your day-to-day symptoms and well being, without exposing you to potential side effects or health complications. Consult your doctor before beginning any treatment regimen for reflux disease.

Interested in learning more about using medications to control reflux symptoms? Dr. Chandrasoma outlines the pros and cons of using medication to control symptoms in this blog post.

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