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: Ahmed Elsaiey, MBBCH [2]

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
• Avoidance of the following foods and lifestyles is recommended in treatment of GERD:
  • Coffee
  • Alcohol
  • Excessive amounts of Vitamin C supplements
  • Foods high in fats
  • Smoking
  • Eating shortly before bedtime
  • Large meals
  • Chocolate and peppermint.
  • Acidic foods, such as oranges and tomatoes.
  • Cruciferous vegetables such as: Onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts
  • Milk and milk-based products

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