Abstract
Medical treatment is effective in the majority of patients with gastroesophageal reflux disease (GERD). Lifestyle modifications are often recommended for patients with GERD, although the data supporting lifestyle recommendations are limited. Antacids are often used to treat the symptoms of GERD, but their effect is short-lived. H2-receptor antagonists and proton-pump inhibitors provide more effective options for remission of GERD symptoms and healing of esophagitis. Prokinetic medications (e.g., metoclopramide) have not been proven to help in the control of symptoms. Baclofen, which inhibits transient lower esophageal sphincter relaxations, provide an additional option for patients with persistent symptoms related to GERD; however its use is limited by side effects. Long-term medical therapy for GERD should be tailored to each patient to provide symptomatic control and maintain esophageal mucosal healing.
Similar content being viewed by others
References
Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R (2006) The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 101(8):1900–1920 quiz 1943
Dent J, El-Serag HB, Wallander MA et al (2005) Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 54:710–717
Shaker R, Castell DO, Schoenfeld PS, Spechler SJ (2003) Nighttime heartburn is an under-appreciated clinical problem that impacts sleep and daytime function: the results of a Gallup survey conducted on behalf of the American Gastroenterological Association. Am J Gastroenterol 98(7):1487–1493
Becher A, El-Serag H (2011) Systematic review: the association between symptomatic response to proton pump inhibitors and health-related quality of life in patients with gastro-oesophageal reflux disease. Aliment Pharmacol Ther 34:618–627
Katz PO, Gerson LB, Vela MF (2013) Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 108(3):308–328
Kaltenbach T, Crockett S, Gerson LB (2006) Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med 166(9):965–971
Johnson T, Gerson L, Hershcovici T et al (2010) Systematic review: the effects of carbonated beverages on gastro-oesophageal reflux disease. Aliment Pharmacol Ther 31:607–614
Piesman M, Hwang I, Maydonovitch C, Wong RK (2007) Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter? Am J Gastroenterol 102(10):2128–2134
Johnson LF, DeMeester TR (1981) Evaluation of elevation of the head of the bed, bethanechol, and antacid form tablets on gastroesophageal reflux. Dig Dis Sci 26(8):673–680
Hamilton JW, Boisen RJ, Yamamoto DT, Wagner JL, Reichelderfer M (1988) Sleeping on a wedge diminishes exposure of the esophagus to refluxed acid. Dig Dis Sci 33(5):518–522
Jacobson BC, Somers SC, Fuchs CS et al (2006) Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med 354:2340–2348
Fraser-Moodie CA, Norton B, Gornall C et al (1999) Weight loss has an independent beneficial effect on symptoms of gastro-oesophageal reflux in patients who are overweight. Scand J Gastroenterol 34:337–340
Nocon M, Labenz J, Jaspersen D, Meyer-Sabellek W, Stolte M, Lind T, Malfertheiner P, Willich SN (2007) Association of body mass index with heartburn, regurgitation and esophagitis: results of the Progression of Gastroesophageal Reflux Disease study. J Gastroenterol Hepatol 22(11):1728–1731
Mathus-Vliegen LM, Tytgat GN (1996) Twenty-four-hour pH measurements in morbid obesity: effects of massive overweight, weight loss and gastric distension. Eur J Gastroenterol Hepatol 8:635–640
Singh M, Lee J, Gupta N, Gaddam S, Smith BK, Wani SB, Sullivan DK, Rastogi A, Bansal A, Donnelly JE, Sharma P (2013) Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: a prospective intervention trial. Obesity 21(2):284–290
Labenz J, Malfertheiner P (2005) Treatment of uncomplicated reflux disease. World J Gastroenterol 11(28):4291–4299
McRorie JW Jr, Gibb RD, Miner PB Jr (2014) Evidence-based treatment of frequent heartburn: the benefits and limitations of over-the-counter medications. J Am Assoc Nurse Pract 26(6):330–339
Maton PN, Burton ME (1999) Antacids revisited: a review of their clinical pharmacology and recommended therapeutic use. Drugs 57(6):855–870
Decktor DL, Robinson M, Maton PN, Lanza FL, Gottlieb S (1995) Effects of aluminum/magnesium hydroxide and calcium carbonate on esophageal and gastric pH in subjects with heartburn. Am J Ther 2(8):546–552
Grove O, Bekker C, Jeppe-Hansen MG, Karstoft E, Sanchez G, Axelsson CK, Nielsen HO, Andersen B, Rask-Madsen J (1985) Ranitidine and high-dose antacid in reflux oesophagitis. A randomized, placebo-controlled trial. Scand J Gastroenterol 20(4):457–461
Weberg R, Berstad A (1989) Symptomatic effect of a low-dose antacid regimen in reflux oesophagitis. Scand J Gastroenterol 24(4):401–406
Graham DY, Patterson DJ (1983) Double-blind comparison of liquid antacid and placebo in the treatment of symptomatic reflux esophagitis. Dig Dis Sci 28(6):559–563
Portale G, Peters J, Hsieh CC, Tamhankar A, Arain M, Hagen J, DeMeester S, DeMeester T (2007) When are reflux episodes symptomatic? Dis Esophagus 20(1):47–52
Thomas E, Wade A, Crawford G, Jenner B, Levinson N et al (2014) Randomised clinical trial: relief of upper gastrointestinal symptoms by an acid pocket-targeting alginate–antacid (Gaviscon Double Action)—a double-blind, placebo-controlled, pilot study in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 39(6):595–602
Beaumont H, Bennink RJ, de Jong J, Boeckxstaens GE (2010) The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD. Gut 59(4):441–451
Rohof WO, Bennink RJ, Smout AJ, Thomas E, Boeckxstaens GE (2013) An alginate-antacid formulation localizes to the acid pocket to reduce acid reflux in patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol 11(12):1585–1591
Tytgat GN, Simoneau G (2006) Clinical and laboratory studies of the antacid and raft-forming properties of Rennie alginate suspension. Aliment Pharmacol Ther 23(6):759–765
Hampson FC, Farndale A, Strugala V, Sykes J, Jolliffe IG, Dettmar PW (2005) Alginate rafts and their characterisation. Int J Pharm 294(1–2):137–147
Sweis R, Kaufman E, Anggiansah A, Wong T, Dettmar P et al (2013) Post-prandial reflux suppression by a raft-forming alginate (Gaviscon Advance) compared to a simple antacid documented by magnetic resonance imaging and pH-impedance monitoring: mechanistic assessment in healthy volunteers and randomised, controlled, double-blind study in reflux patients. Aliment Pharmacol Ther 37(11):1093–1102
Leiman DA, Riff BP, Morgan S, Metz DC, Falk GW, French B, Umscheid CA, Lewis JD (2017) Alginate therapy is effective treatment for gastroesophageal reflux disease symptoms: a systematic review and meta-analysis. Dis Esophagus 30(2):1–8.
Ip S, Chung M, Moorthy D, Yu WW, Lee J, Chan JA, Bonis PA, Lau J (2011) Comparative effectiveness of management strategies for gastroesophageal reflux disease: update. Comparative Effectiveness Review No. 29. (Prepared by Tufts Medical Center Evidence-based Practice Center under Contract No. HHSA 290-2007-10055-I.) AHRQ Publication No. 11-EHC049-EF. Agency for Healthcare Research and Quality, Rockville. www.effectivehealthcare.ahrq.gov/reports/final.cfm
Sigterman KE, van Pinxteren B, Bonis PA, Lau J, Numans ME (2013) Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev 31(5):CD002095
Gralnek IM, Dulai GS, Fennerty MB, Spiegel BM (2006) Esomeprazole versus other proton pump inhibitors in erosive esophagitis: a meta-analysis of randomized clinical trials. Clin Gastroenterol Hepatol 4(12):1452–1458
Wang WH, Huang JQ, Zheng GF, Xia HH, Wong WM, Lam SK, Wong BC (2005) Head-to-head comparison of H2-receptor antagonists and proton pump inhibitors in the treatment of erosive esophagitis: a meta-analysis. World J Gastroenterol 11(26):4067–4077
Peura DA, Freston JW, Haber MM, Kovacs TO, Hunt B et al (2009) Lansoprazole for long-term maintenance therapy of erosive esophagitis: double-blind comparison with ranitidine. Dig Dis Sci 54(5):955–963
Eggleston A, Wigerinck A, Huijghebaert S, Dubois D, Haycox A (1998) Cost effectiveness of treatment for gastro-oesophageal reflux disease in clinical practice: a clinical database analysis. Gut 42(1):13–16
Inadomi JM, Jamal R, Murata GH, Hoffman RM, Lavezo LA, Vigil JM, Swanson KM, Sonnenberg A (2001) Step-down management of gastroesophageal reflux disease. Gastroenterology 121(5):1095–1100
Tsuzuki T, Okada H, Kawahara Y, Takenaka R, Nasu J et al (2011) Proton pump inhibitor step-down therapy for GERD: a multi-center study in Japan. World J Gastroenterol 17(11):1480–1487
Dickman R, Boaz M, Aizic S, Beniashvili Z, Fass R, Niv Y (2011) Comparison of clinical characteristics of patients with gastroesophageal reflux disease who failed proton pump inhibitor therapy versus those who fully responded. J Neurogastroenterol Motil 17(4):387–394
Lee RD, Mulford D, Wu J, Atkinson SN (2010) The effect of time-of-day dosing on the pharmacokinetics and pharmacodynamics of dexlansoprazole MR: evidence for dosing flexibility with a Dual Delayed Release proton pump inhibitor. Aliment Pharmacol Ther 31(9):1001–1011
Hatlebakk JG, Katz PO, Camacho-Lobato L, Castell DO (2000) Proton pump inhibitors: better acid suppression when taken before a meal than without a meal. Aliment Pharmacol Ther 14(10):1267–1272
Gunaratnam NT, Jessup TP, Inadomi J, Lascewski DP (2006) Sub-optimal proton pump inhibitor dosing is prevalent in patients with poorly controlled gastro-oesophageal reflux disease. Aliment Pharmacol Ther 23(10):1473–1477
Fass R, Sontag SJ, Traxler B, Sostek M (2006) Treatment of patients with persistent heartburn symptoms: a double-blind, randomized trial. Clin Gastroenterol Hepatol 4(1):50–56
Fass R, Murthy U, Hayden CW, Malagon IB, Pulliam G, Wendel C, Kovacs TO (2000) Omeprazole 40 mg once a day is equally effective as lansoprazole 30 mg twice a day in symptom control of patients with gastro-oesophageal reflux disease (GERD) who are resistant to conventional-dose lansoprazole therapy—a prospective, randomized, multi-centre study. Aliment Pharmacol Ther 14(12):1595–1603
Rackoff A, Agrawal A, Hila A, Mainie I, Tutuian R, Castell DO (2005) Histamine-2 receptor antagonists at night improve gastroesophageal reflux disease symptoms for patients on proton pump inhibitor therapy. Dis Esophagus 18(6):370–373
Fackler WK, Ours TM, Vaezi MF, Richter JE (2002) Long-term effect of H2RA therapy on nocturnal gastric acid breakthrough. Gastroenterology 122(3):625–632
Mainie I, Tutuian R, Castell DO (2008) Addition of a H2 receptor antagonist to PPI improves acid control and decreases nocturnal acid breakthrough. J Clin Gastroenterol 42(6):676–679
Vela MF (2014) Medical treatments of GERD: the old and new. Gastroenterol Clin N Am 43(1):121–133
Champion MC (1997) Prokinetic therapy in gastroesophageal reflux disease. Can J Gastroenterol 11(Suppl B):55B–65B
Grande L, Lacima G, Ros E, García-Valdecasas JC, Fuster J, Visa J, Pera C (1992) Lack of effect of metoclopramide and domperidone on esophageal peristalsis and esophageal acid clearance in reflux esophagitis. A randomized, double-blind study. Dig Dis Sci 37(4):583–588
Richter JE, Sabesin SM, Kogut DG, Kerr RM, Wruble LD, Collen MJ (1996) Omeprazole versus ranitidine or ranitidine/metoclopramide in poorly responsive symptomatic gastroesophageal reflux disease. Am J Gastroenterol 91(9):1766–1772
Rao AS, Camilleri M (2010) Review article: metoclopramide and tardive dyskinesia. Aliment Pharmacol Ther 31(1):11–19
Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer RC, Petrie DJ (1980) Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest 65(2):256–267
Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK, Egide MS (1982) Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 307(25):1547–1552
Mittal RK, McCallum RW (1988) Characteristics and frequency of transient relaxations of the lower esophageal sphincter in patients with reflux esophagitis. Gastroenterology 95(3):593–599
Boeckxstaens GE, Smout A (2010) Systematic review: role of acid, weakly acidic and weakly alkaline reflux in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 32(3):334–343
Kessing BF, Conchillo JM, Bredenoord AJ, Smout AJ, Masclee AA (2011) Review article: the clinical relevance of transient lower oesophageal sphincter relaxations in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 33(6):650–661
Dent J (2010) Reflux inhibitor drugs: an emerging novel therapy for gastroesophageal reflux disease. J Dig Dis 11(2):72–75
van Herwaarden MA, Samsom M, Rydholm H, Smout AJ (2002) The effect of baclofen on gastro-oesophageal reflux, lower oesophageal sphincter function and reflux symptoms in patients with reflux disease. Aliment Pharmacol Ther 16(9):1655–1662
Zhang Q, Lehmann A, Rigda R, Dent J, Holloway RH (2002) Control of transient lower oesophageal sphincter relaxations and reflux by the GABA(B) agonist baclofen in patients with gastro-oesophageal reflux disease. Gut 50(1):19–24
Vela MF, Tutuian R, Katz PO, Castell DO (2003) Baclofen decreases acid and non-acid post-prandial gastro-oesophageal reflux measured by combined multichannel intraluminal impedance and pH. Aliment Pharmacol Ther 17(2):243–251
Cossentino MJ, Mann K, Armbruster SP, Lake JM, Maydonovitch C et al (2012) Randomised clinical trial: the effect of baclofen in patients with gastro-oesophageal reflux—a randomised prospective study. Aliment Pharmacol Ther 35(9):1036–1044
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflict of interest.
Rights and permissions
About this article
Cite this article
Kroch, D.A., Madanick, R.D. Medical Treatment of Gastroesophageal Reflux Disease. World J Surg 41, 1678–1684 (2017). https://doi.org/10.1007/s00268-017-3954-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-017-3954-2