Gastroesophageal Reflux Disease (GERD)

Lifestyle changes along with antacids, H2 blockers (for example, Pepcid), and proton pump inhibitors (for example, Prilosec)—either prescription or nonprescription—are usually tried first to treat symptoms that are likely caused by gastroesophageal reflux disease (GERD). Medicines are used in the treatment of GERD to:

• Relieve symptoms (heartburn, sour taste, or pain).
• Allow the esophagus to heal.
• Prevent complications of GERD.

Nonprescription medicines can be tried when symptoms are mild and infrequent. Prescription medicines will probably be required if symptoms are more severe or if you are using nonprescription medicines to control your symptoms for longer than 2 weeks.

Depending on how bad your symptoms are, you may need to take medicines daily or only occasionally when GERD symptoms occur. Long-term—often lifelong—medication treatment is usually needed for GERD symptoms that are more severe, because symptoms tend to return when medication treatment is stopped.

Medication Choices

The following nonprescription and prescription medicines may be used to treat GERD.

• Antacids (such as Gaviscon, Mylanta, Rolaids, or Tums) neutralize stomach acid and relieve heartburn. Making lifestyle changes and taking antacids are usually tried first when you have infrequent and mild symptoms.
• H2 blockers (acid reducers), such as nizatidine (Axid), famotidine (Pepcid), cimetidine (Tagamet), or ranitidine (Zantac), reduce the amount of acid in the stomach. Most are available in both nonprescription and prescription strength. If nonprescription-strength H2 blockers don't relieve your symptoms, talk to your doctor about trying prescription-strength medicine. Taking H2 blockers and making lifestyle changes often help if you have more frequent GERD symptoms.
• Proton pump inhibitors, such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), or rabeprazole (Aciphex), are prescription medicines that reduce the amount of acid in the stomach. These medicines often help when H2 blockers have failed to control symptoms of GERD. They are also used to treat severe GERD symptoms or inflammation of the esophagus (esophagitis). There is a nonprescription version of omeprazole (Prilosec OTC) available for the treatment of frequent heartburn. But if you have been using nonprescription medicines to treat your symptoms for longer than 2 weeks, talk to your doctor. If you have GERD, the stomach acid could be causing damage to your esophagus. Your doctor can help you find the right treatment. Making lifestyle changes is still an important part of the treatment of GERD when you are using proton pump inhibitors.
• Prokinetic agents such as metoclopramide (Reglan) have several effects. They may make the valve between the esophagus and stomach (lower esophageal sphincter) close more tightly, which helps prevent stomach juices from getting into the esophagus. They may also help the stomach empty quicker. Prokinetic agents are sometimes combined with an acid reducer, but their use is limited by frequent, sometimes severe side effects.

What To Think About

Doctors usually try to choose a treatment that uses enough medicine to control your symptoms but not so much that side effects become a serious problem.

Depending on how bad your symptoms are, you may need to take medicines every day or only occasionally when GERD symptoms occur. Long-term—often lifelong—medication treatment is usually needed for GERD symptoms that are more severe, because symptoms tend to return when medication treatment is stopped. Surgery is the only other effective option to prevent GERD symptoms from recurring.

Should I use medications or surgery to treat gastroesophageal reflux disease (GERD)?

Up to 80% of pregnant women have symptoms of gastroesophageal reflux disease (GERD) during pregnancy.¹Heartburn is common during pregnancy because hormones cause the digestive system to slow down. The muscles that push food down the esophagus also move more slowly during pregnancy. In addition, as the uterus grows, it pushes on the stomach and sometimes forces stomach acid up into the esophagus. Lifestyle changes and antacids are usually tried first to treat pregnant women who have GERD. Antacids are safe to use for heartburn symptoms during pregnancy. If lifestyle changes and antacids don't help control your symptoms, talk to your doctor about using other medicines.