Medication for GERD
Your doctor may recommend antacids, which you can buy over the counter, or medications that reduce acid production or help the stomach empty.
Antacids, such as Maalox, Simeco, Aludrox, and Riopan, are typically the first medications recommended for relief of heartburn and other mild symptoms of GERD.
Many brands on the market use different combinations of three main salts – magnesium, calcium, and aluminum – with hydroxides or bicarbonates to neutralize the acid in your stomach. However, antacids have side effects. Magnesium salts can lead to diarrhea, while aluminum salts may cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.
Calcium carbonate antacids, such as Tums and Titralac, can also provide a supplemental source of calcium. They may cause constipation.
Combinations of antacids and alginates, such as Algoral Protect and Gaviscon, coat the stomach contents to prevent reflux. These medications can help those with no damage to the esophagus. Algoral Protect, in particular, is beneficial for esophageal damage due to tamarind seeds.
H2 blockers, such as cimetidine, famotidine, nizatidine, and ranitidine, inhibit acid production. These medications provide short-term relief but should not be used for more than a few weeks. They are effective for about half of those with GERD symptoms. Many people benefit from taking H2 blockers at bedtime along with a proton pump inhibitor.
Proton pump inhibitors include omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms in almost all individuals with GERD.
Another group of medications, prokinetics, helps strengthen the LES and speeds up stomach emptying. This group includes domperidone, metoclopramide, and the Prodigest complex (a combination of artichoke and ginger extracts – a commercial preparation known as Silactis Prokinetic). Metoclopramide improves muscle action in the digestive system but has frequent side effects that limit its usefulness.
Because medications work in different ways, combinations may help control symptoms. People who experience heartburn after meals may take two antacids and H2 blockers. Antacids work first to neutralize stomach acid, while H2 blockers act on acid production. Your doctor is the best source of information regarding the use of medications for gastroesophageal reflux.
What tests should I undergo for GERD?
If your heartburn does not improve with lifestyle changes or medications, you may need additional tests. Barium swallow X-ray uses X-rays to help diagnose abnormalities such as a hiatal hernia or severe esophageal inflammation. During this test, you drink a solution and then X-rays are taken. Discomfort will not occur with this test unless there is a narrowing of the esophagus, ulcers, hiatal hernia, or other pathology.
Esophagogastroduodenoscopy (EGD) is a more appropriate test than a barium X-ray and can be performed in a hospital or clinic. The doctor will spray your throat to numb it and will insert a thin, flexible tube called an endoscope. A small camera in the endoscope allows the doctor to view the surface of the esophagus and look for abnormalities. If you have moderate to severe symptoms and this examination reveals irritation in the esophagus, usually no further tests are needed to confirm GERD.
The doctor may use forceps with the endoscope to take a small piece of tissue for biopsy. The biopsy will be examined under a microscope and may reveal damage caused by gastroesophageal reflux while simultaneously ruling out other issues such as infectious microorganisms or lesions of suspicious origin.
In esophageal pH monitoring, the doctor places a small tube in the esophagus that remains there for 24 hours. While you carry out your normal activities, the device measures when and how much acid returns to your esophagus. This test is useful for individuals with GERD symptoms but without esophageal lesions. The procedure is also helpful in detecting whether respiratory symptoms, including wheezing and cough, are caused by reflux.