What Pharmaceutical Treatment Options Are Available?
When first diagnosed, GERD treatment typically involves a combination of lifestyle changes, over-the-counter medications (OTC), and prescription drug regimens, which may provide symptomatic relief. GERD is a progressive disease, however, and prescription medications do nothing to slow or prevent this progression. Some patients who respond well to prescription medication at first may find they require increasing dosage of the medication over time or that they need to switch to a new medication to maintain symptom control.
As the disease progresses, to correct the root cause, the anatomic defect at the gastroesophageal junction, you and your doctor may want to consider surgical intervention, either a laparoscopic procedure or the incisionless procedure called TIF (Transoral Incisionless Fundoplication).
Over-the-counter medications such as antacids and lower dosage H2 receptor antagonists (H2RA) and proton pump inhibitors (PPIs) are an easily accessible, pain-reducing option for people who suffer from occasional mild-to-moderate GERD. Many OTC treatments work to neutralize the acid, reduce gas, and coat the lining of the esophagus and stomach, thereby providing short term relief from symptoms.
Prescription (PPIs and H2RAs)
Prescription doses of PPIs and H2RAs (H2 blockers) work by reducing the amount of acid produced in the stomach and can be effective at reducing both pain and healing esophagitis for patients with moderate and recurrent heartburn. These medications, however, do not prevent neutralized acid from refluxing up into the esophagus, lungs, mouth, and/or nasal cavities. They also do not prevent reflux of other caustic agents, including bile, pepsin and digestive enzymes. In other words, medication treats the symptoms of GERD without addressing the root cause, reflux and regurgitation.
Effective GERD medications have revolutionized the treatment of GERD, yet many GERD patients on pharmaceutical therapy are dissatisfied with their treatment. Some are not able to eat large meals, eat late at night, drink alcohol, coffee, carbonated beverages, or eat fatty foods, chocolate, strawberries, or spicy foods without having symptoms return. Some patients may also have breakthrough symptoms at night, and regurgitate while sleeping. Some even find a pool of yellow fluid (bile) on the pillow when experiencing reflux at night. Some patients are concerned about the costs, potential drug interactions, and possible side effects of a lifetime of taking pills.
Risks of Long-Term Use of Prescription Medications
A 2006 study published in the Journal of the American Medical Association showed a significant increase in the risk of osteoporosis in patients over 50 years of age who were taking PPIs for more than a year. Patients who took PPIs twice a day were at nearly a three-fold risk of developing a hip fracture if they took medication more than one year.1
In 2009, the U.S. Food and Drug Administration (FDA) added a warning to the label of Plavix (clopidogrel) against taking (clopidogrel) and omeprazole together because patients at risk of heart attacks or strokes, who are given Plavix to prevent blood clots, will not get the full anti-clotting effect if they also take omeprazole. Omeprazole is found in prescription products (Prilosec, Zegerid, and generic products) and over-the-counter products (Prilosec OTC, Zegerid OTC, and generic products).
In 2010, the FDA issued a warning about the risk of bone fractures of the hip, wrist and spine with long term (>12 months) and high dose use of PPIs.
1. JAMA. 2006;296:2947-2953. Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture. Yu-Xiao Yang, MD, MSCE; James D. Lewis, MD, MSCE; Solomon Epstein, MD; David C. Metz, MD.
For more information on the TIF procedure, view this site: www.GERDHelp.com.