Gastroesophageal reflux disease medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Medical Therapy

Lifestyle Modifications

The following measures are recommended as the first line to treat GERD:

• Weight loss
• Elevating head of the bed
• No eating two hours before going sleep

Foods

Certain foods and lifestyle are considered to promote gastroesophageal reflux:

• Coffee, alcohol, and excessive amounts of Vitamin C supplements stimulate gastric acid secretion. Taking these before bedtime especially can cause evening reflux. Although, a study published in 2006 by Stanford University researchers disputes the effect of coffee, acidic, spicy foods etc. as a myth.
• Antacids based on calcium carbonate (but not aluminum hydroxide) were found to actually increase the acidity of the stomach. However, all antacids reduced acidity in the lower esophagus, so the net effect on GERD symptoms may still be positive..
• Foods high in fats and smoking reduce lower esophageal sphincter competence, so avoiding these tends to help. Fat also delays stomach emptying.
• Eating shortly before bedtime (For clinical purposes, this usually means 2-3 hours before going to bed).
• Large meals. Having more but smaller meals reduces GERD risk, as it means there is less food in the stomach at any one time.
• Soda or pop (regular or diet).
• Chocolate and peppermint.
• Acidic foods, such as oranges and tomatoes.
• Cruciferous vegetables: Onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts.
• Milk and milk-based products contain calcium and fat, and should be avoided before bedtime.

Medical therapy

• The medical therapy is indicated for the patients who have persistent GERD regardless the lifystyle and food modifications.
• The following medical therapies are strongly recommended by the American College of Gastroenterology:
  • Antacids:
    • Preferred regimen (1): Aluminum hydroxide 640 mg 5 to 6 times daily PO after meals and at bed time.
    • Preferred regimen (2): Calcium carbonate One gram PO.
  • Histamine-receptor antagonists (H2RA):
    • Preferred regimen (1): Ranitidine 150 mg q12 daily PO
    • Preferred regimen (2): Cimetidine 400 mg q6h or 800 mg q12 PO for 12 weeks
    • Preferred regimen (3): Famotidine 20 mg q12 PO for 6 weeks
  • Proton pump inhibitors:
    • Preferred regimen (1): Omeprazole 20 mg q24 PO for up to 4 weeks
    • Preferred regimen (2): Esomeprazole 20 mg or 40 mg q24 IV
  • Prokinetic medications:
    • Preferred regimen (1): Metoclopramide 10 mg q24 PO for 4 to 12 weeks