Gastroesophageal reflux disease medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
Overview
The mainstay treatment of GERD is lifestyle modifications which include weight loss, elevating head of the bed and no eating before going sleep. The pharmacologic medical therapy is recommended among patients with persistent GERD despite following the lifestyle modifications. Antacids, histamine receptor antagonists, proton pump inhibitors, and prokinetics medications are used in treatment of GERD.
Medical Therapy
Lifestyle Modifications
- The following measures are recommended as the first line to treat GERD:[1][2][3][4]
- Weight loss
- Elevating head of the bed
- No eating two hours before going sleep
- Avoidance of the following foods and lifestyles is recommended in treatment of GERD:
- Coffee
- Alcohol
- Excessive amounts of Vitamin C supplements
- Foods high in fats
- Smoking
- Eating shortly before bedtime
- Large meals
- Chocolate and peppermint.
- Acidic foods, such as oranges and tomatoes.
- Cruciferous vegetables such as: Onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts
- Milk and milk-based products
Medical therapy
- The medical therapy is indicated for the patients who have persistent GERD regardless the lifystyle and food modifications.[5][6]
- The following medical therapies are strongly recommended by the American College of Gastroenterology:
- Antacids:
- Preferred regimen (1): Aluminum hydroxide 640 mg 5 to 6 times daily PO after meals and at bed time.
- Preferred regimen (2): Calcium carbonate One gram PO.
- Histamine-receptor antagonists (H2RA):
- Preferred regimen (1): Ranitidine 150 mg q12 daily PO
- Preferred regimen (2): Cimetidine 400 mg q6h or 800 mg q12 PO for 12 weeks
- Preferred regimen (3): Famotidine 20 mg q12 PO for 6 weeks
- Proton pump inhibitors:
- Preferred regimen (1): Omeprazole 20 mg q24 PO for up to 4 weeks
- Preferred regimen (2): Esomeprazole 20 mg or 40 mg q24 IV
- Prokinetic medications:
- Preferred regimen (1): Metoclopramide 10 mg q24 PO for 4 to 12 weeks
- Antacids:
References
- ↑ 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): 2128–34. doi:10.1111/j.1572-0241.2007.01348.x. PMID 17573791.
- ↑ 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): 965–71. doi:10.1001/archinte.166.9.965. PMID 16682569.
- ↑ Ness-Jensen E, Hveem K, El-Serag H, Lagergren J (2016). "Lifestyle Intervention in Gastroesophageal Reflux Disease". Clin Gastroenterol Hepatol. 14 (2): 175-82.e1-3. doi:10.1016/j.cgh.2015.04.176. PMC 4636482. PMID 25956834.
- ↑ Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease. Am J Gastroenterol 1999;94:2069-73. PMID 10445529.
- ↑ Tran T, Lowry A, El-Serag H (2007). "Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease drugs". Aliment Pharmacol Ther. 25 (2): 143–53. doi:10.1111/j.1365-2036.2006.03135.x. PMID 17229239.
- ↑ Decktor DL, Robinson M, Maton PN, Lanza FL, Gottlieb S. Effects of Aluminum/Magnesium Hydroxide and Calcium Carbonate on Esophageal and Gastric pH in Subjects with Heartburn. Am J Ther 1995;2:546-552. PMID 11854825.