Management of Gastroesophageal Reflux Disease (GERD)

The first line options available for the management of gastroesophageal reflux disease are lifestyle modifications. However, usually they are not enough and the patient requires the addition of other medications for the effective treatment of GERD.

The medications currently used for the treatment of GERD include proton pump inhibitors, H2-receptor antagonist, antacids and Prokinetic drugs.

Proton Pump Inhibitors

Proton pump inhibitors constitute a class of drugs that are considered the most powerful agents currently available for the treatment of GERD. They include medications such as Omeprazole, Esomeprazole, Lansoprazole, and Pantoprazole. There are numerous studies available to support the use of Proton pump inhibitors as number one therapeutic agents for the treatment of GERD as is obvious from the following examples.

An experimental study was conducted to assess the efficiency of a Proton pump inhibitor called Omeprazole for the treatment of GERD patients. They were divided into two groups. The patients in one group received a low dose of Omeprazole and the patient in the other group received a high dose of Omeprazole. This therapy was continued for about 4 week’s time. At the end of treatment, it was observed that about 31% of patients treated with a low dose of Omeprazole and 40% of the patients treated with a high dose were symptoms free. In a similar study, it was reported that the use of Esomeprazole decreases the night time symptoms associated with GERD.

Proton pump inhibitors are usually safe drugs. The serious side effects noted with the use of PPIs although rare include:

A decrease in calcium absorption:

Calcium is of critical importance for the growth of bones. This is why by decreasing the absorption of Calcium long-term use of proton pump inhibitors can make the bones weak and increase the chances of fractures.

Increased risk of infections:

The acid in the stomach can protect us against infection by killing the causative microorganisms. Thus by decreasing the production of acid in the stomach PPIs can decrease the risk of certain infections.

H-2 receptor antagonists

They include drugs such as Cimetidine, Ranitidine (Zantac), Nizatidine, and Famotidine. They also decrease the production of acid in the stomach, although they do so by a mechanism different from that of proton pump inhibitors. Most of the time H-2 receptor antagonists are used in combination with Proton pump inhibitors. H-2 receptor antagonists are usually safe. The rare side effects seen with them are mainly related to gastrointestinal tract such as nausea, vomiting, diarrhea as well as constipation.  Cimetidine is an H-2 receptor that is associated with a number of serious side effects such as a decrease in the sexual ability, mental disturbances manifesting in the form of hallucination and depression as well as a number of drug interactions, this is why it is no longer prescribed in routine.

Antacids

Antacids contain basic solutions of Aluminum and Magnesium. They work by neutralizing the acidic stomach content and provide quick relief from the symptoms of GERD. They are the most common over the counter medications used for the treatment of GERD.  The most famous available Antacids preparations are Gaviscon and Mucaine.

They are usually considered safe. The problem noted with the use of Aluminum-containing antacids is constipation as compared to diarrhea with the Magnesium-containing antacids. To overcome this problem the newer antacid preparation is formulated by mixing the Aluminum as well as Magnesium compounds together.

Drug Enhancing Stomach Motility

They include drugs such as Metoclopramide and Domperidone. They work enhancing the motility and thus emptying of the stomach. They are rarely used in general and are reserved only for the cases of GERD associated with conditions slowing down the process of digestion.

Do you suffer from GERD? Come to Century Medical and Dental Center (Downtown Brooklyn, Gravesend, Flatbush, Fort Greene and Midtown Manhattan) and have your symptoms taken care of.