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Heartburn / GERD
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Heartburn / GERD
Diseases & Conditions A-Z

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DIGESTIVE SYSTEM
Diseases & Conditions  

Treatment

Whether you have mild, moderate or severe heartburn, many treatment options are available. The most common treatments involve medications, but surgical and other procedures also are available.

Over-the-counter remedies
If you experience only occasional, mild heartburn, you may get relief from an over-the-counter (OTC) medication. OTC remedies include:

  • Antacids. Antacids, such as Maalox, Mylanta, Gelusil, Rolaids and Tums, neutralize stomach acid and can provide quick relief. But antacids alone won't heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects such as diarrhea or constipation.

  • H-2-receptor blockers. H-2-receptor blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) or ranitidine (Zantac 75), are available at half the strength of their prescription versions. Instead of neutralizing the acid, these medications reduce the production of acid. They don't act as quickly as antacids, but they provide longer relief. Take these medications before a meal that you think may cause heartburn because it takes them about 30 minutes to work. They're also effective in reducing reflux at night if taken at bedtime. H-2-receptor blockers cause infrequent side effects, including bowel changes, dry mouth, dizziness or drowsiness. In rare instances they can also react dangerously with other medications.

  • Proton pump inhibitors. These medications block acid production and allow time for damaged esophageal tissue to heal. Omeprazole (Prilosec) was previously available only by prescription, but now is available in an over-the-counter form for treatment of heartburn.

Prescription-strength medications
If you have frequent and persistent heartburn, you may have GERD, leading to an inflamed esophagus (esophagitis). GERD usually requires prescription-strength medication. Prescription medications can help reduce and eliminate GERD symptoms, as well as help heal an inflamed esophagus — the result of continual exposure to stomach acid. The main types of prescription drugs are:

  • Prescription-strength H-2-receptor blockers. These significantly reduce acid production and have few side effects. They include prescription-strength Axid, Pepcid, Tagamet and Zantac.

  • Prescription-strength proton pump inhibitors. These are long acting and are the most effective medications for suppressing acid production. They're safe and have few side effects for long-term treatment (at least 10 years). To prevent possible side effects, such as stomach or abdominal pain, diarrhea or headaches, your doctor will likely prescribe the lowest effective dose. Prescription-strength proton pump inhibitors include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix) and rabeprazole (Aciphex).

  • Prokinetic agents. These don't reduce acid production. Instead, they help your stomach empty more rapidly and may help tighten the valve between the stomach and the esophagus. Because the prokinetic agents thus far sometimes cause serious side effects, researchers are working to develop safer versions.

Surgical and other procedures
Because of the effectiveness of medications, surgery for GERD is uncommon. However, it may be an option if you can't tolerate the medications, the medications are ineffective, or you can't afford their long-term use. Your doctor also may recommend surgery if you have any of these complications:

  • Large hiatal hernia

  • Severe esophagitis, especially with bleeding

  • Recurrent narrowing (stricture) of the esophagus

  • Barrett's esophagus, especially with progressive precancerous or cancerous changes

  • Severe pulmonary problems, such as bronchitis or pneumonia, due to acid reflux

Before 1991, a procedure called open Nissen fundoplication was the surgery of choice for severe GERD. Today, doctors are able to perform the same surgery with similar success laparoscopically — through a few small abdominal incisions, instead of one large one. The advantages of laparoscopic surgery are a shorter recovery time and less discomfort.

Nissen fundoplication involves tightening the lower esophageal sphincter to prevent reflux by wrapping the very top of the stomach around the outside of the lower esophagus. During laparoscopic surgery, a surgeon makes three or four tiny incisions in the abdomen and inserts small instruments, including a flexible tube with a tiny camera, through the incisions. To provide more space for your surgeon to see and work, your abdomen is inflated with carbon dioxide. The surgery takes about 2 hours and typically requires an overnight hospital stay.

More than 90 percent of the people who undergo Nissen fundoplication remain free of GERD symptoms for at least 1 year. At least 60 percent are symptom-free for several years. This success rate applies to both the laparoscopic and open procedures.

Other surgical procedures include Toupet partial fundoplication, Hill repair and the Belsey Mark IV operation. All involve restructuring the lower esophageal sphincter to improve its strength and ability to prevent reflux. These surgeries are done less often, and their success is often dependent on the skill of the surgeon.

Complications from surgery generally are mild, but may include difficulty swallowing, bloating, diarrhea and a sense of feeling full after eating only a moderate amount (early satiety).

Newer, less invasive procedures
Your doctor may suggest one of several procedures for tightening the lower esophageal sphincter. The procedures generally take an hour or less to perform, they don't require any incisions, and you can go home the same day. The procedures are performed endoscopically through a long, flexible tube that's inserted into your mouth and threaded through your esophagus. None of the procedures are recommended if you have a hiatal hernia or Barrett's esophagus.

  • EndoCinch endoluminal gastroplication. This procedure uses a tool that's like a miniature sewing machine. It places pairs of stitches (sutures) in the stomach near the weakened sphincter. The suturing material is then tied together, creating barriers (placations) to prevent stomach acid from washing into your esophagus. The barriers are located at and just below the junction of the esophagus and stomach. The procedure may cause a sore throat or chest pain. The long-term effectiveness of the procedure is still unknown.

  • Stretta procedure. This approach uses controlled radiofrequency energy to heat and melt (coagulate) tissues within the portion of the esophagus that contains the malfunctioning valve and at the junction of the esophagus and upper stomach. The procedure appears to work by creating scar tissue and altering the sensory nerves that respond to refluxed acid. The procedure may cause a sore throat or chest pain. The long-term effectiveness of the procedure is still unknown.

  • Enteryx. This procedure involves the injection of a compound called ethylene polyvinyl alcohol into the lower esophageal sphincter, just within the stomach. The injection is done with guidance from real-time X-ray. The compound is in liquid form outside the body, but when it comes into contact with the tissues inside the body, it turns into an expanding, spongy material. The procedure may cause a sore throat or chest pain, and the long-term effectiveness of the procedure is still unknown.

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