Common Treatment Options

Once you have been diagnosed with GERD, your doctor can offer you a number of medical treatment options, as well as suggest lifestyle changes that can help manage the symptoms of GERD.

When treating GERD, physicians are trying to achieve the following goals:

• Manage GERD symptoms
• Heal the lining of the esophagus in patients who have been diagnosed with erosive esophagitis
• Prevent more damage to the esophagus

To achieve these goals, your doctor may recommend an over-the- counter or prescription medicine. Only your doctor can decide which treatments are right for you.

There are four common treatment options for GERD. They each work in a unique way within the body¹⁰:

1. Antacids neutralize stomach acid
2. Mucosal protective agents protect the lining of the esophagus
3. Promotility agents cause the stomach to empty faster
4. Acid-suppressive agents reduce the amount of acid the stomach makes

Antacids—Antacids help to counteract the acid created by the stomach. They help control symptoms of mild to moderate heartburn.¹⁰ Antacids are available without a prescription.

Mucosal protective agents—There are two types of mucosal protective agents: sucralfate suspension and alginic acid.

Sucralfate suspension, or gel, acts as a protective barrier and blocks the juices the stomach creates (a combination of stomach acid and a digestive enzyme called pepsin) from making contact with the esophagus.^10,11 Sulcrafate can be used for moderate to severe GERD.^11,12 It can also be used to treat erosive esophagitis.¹⁰ It is available only with a prescription.

Alginic acid is thick and floats on top of the pool of stomach juices.^10,13 It blocks contact between the stomach juices and the esophagus.¹⁰ Sometimes alginic acid is mixed with an antacid. Alginic acid can be used for mild to moderate GERD symptoms.^4,10,13 It is available without a prescription.

Promotility agents—Medicines that make the stomach empty more quickly are called promotility agents or prokinetic agents.¹⁴ These medicines work to improve GERD symptoms and heal esophagitis.¹⁰ Metoclopramide is the only one of these medicines available in the United States. A prescription is needed to buy metoclopramide.

Acid-suppressive agents—Two types of medicines reduce the amount of acid the stomach makes: H₂-receptor antagonists and proton pump inhibitors.

H₂-receptor antagonists, “H₂-blockers,” reduce acid production from the stomach. They do this by blocking one of the paths that stimulate acid production, reducing the acid that is produced in the stomach . H₂-blockers are generally well tolerated and are available without a prescription in some dosages. These are useful to treat mild or occasional heartburn.

Proton pump inhibitors, or PPIs, block the final step in making stomach acid. The short- and long-term safety of PPIs has been confirmed in many large studies.¹⁰ They are available in an OTC dose for treatment of frequent heartburn. The most common side effects are headache and diarrhea.^4,10

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