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Treatment
You may be advised to make some changes to your lifestyle, such as modifying your diet and avoiding specific foods and drinks. While these changes may help to reduce the symptoms of GERD, most people with GERD will need to take medicine.
Medicines
There are several types of medicine available for the treatment of GERD, the most effective of which are the proton pump inhibitors. Treatment is intended to reduce acid reflux, thereby preventing damage to the esophagus.
Proton pump inhibitors are a group of medicines that includes esomeprazole, omeprazole and pantoprazole.
- Proton pump inhibitors provide rapid relief from the symptoms of GERD.
These medicines block the action of the stomach's proton pump (figure 1), which pumps hydrogen ions into the stomach, making the stomach acidic. Proton pump inhibitors will, therefore, reduce the acidity of the stomach (figure 2).
Figure 2: Proton pump inhibitor
- They therefore reduce the acidity of the stomach contents leaking into the esophagus, which reduces the incidence of heartburn.
- Proton pump inhibitors are available from your doctor on prescription, and in some countries, can be bought over the counter.
Histamine2-receptor antagonists
Histamine2-receptor antagonists are a group of medicines that includes cimetidine, ranitidine and nizatidine.
- These medicines work by stopping (blocking) the action of histamine (a chemical released by the stomach). The presence of histamine in the stomach results in the release of hydrogen ions into the stomach, making the stomach contents more acidic.
- Many histamine2-receptor antagonists can be bought over the counter at low doses but a doctor's prescription is needed for higher doses.
For people who only suffer from the occasional episode of heartburn, antacids can bring relief. However, they are not usually recommended to treat the frequent heartburn suffered by people with GERD
These medicines can be bought over the counter. Antacids provide relief from the symptoms of heartburn by neutralising the acid. If symptoms of heartburn are still present after you have used antacids for 2 weeks, you should consult your doctor. There is a wide range of antacids available. The main ingredients of antacids are:
- Aluminium hydroxide
- Magnesium salts
- Calcium carbonate
- Sodium bicarbonate
- Potassium bicarbonate
- Bismuth salts.
Antacids sold over the counter may contain one or a combination of these products. For example, aluminium and magnesium salts are often combined to reduce the incidence of diarrhoea or constipation.
Antacids are best taken when the symptoms of heartburn first occur, preferably about 1 hour after a meal.
Antacids may interfere with the absorption of other medicines from the digestive system into the blood. A gap of at least 2 hours should be left between using an antacid and taking other medicines.
Alginates
Some antacids contain sodium alginate.
- Sodium alginate forms a 'raft' that floats to the top of the stomach, forming a barrier between the acid and the esophagus, thus preventing acid refluxing into the esophagus.
Other medicines (called prokinetic agents) increase the movement of the stomach. They work by increasing the pressure of the lower esophageal sphincter (the point where the esophagus joins the stomach) and promote emptying of the stomach.