In most cases, GERD is a chronic condition that people live with for the rest of their lives. The only curative treatment is surgery, but medications and lifestyle changes are helpful for managing the symptoms of GERD.
For most patients, treatment recommendations follow a stepped approach that begins with changes in diet, losing weight and other lifestyle changes.
Medications designed to suppress the production of excess acid are typically the next step. Antacids or histamine H2 receptor agonists therapy can be effective for many individuals with mild to moderate symptoms. Additional H2 blocker therapy or proton pump inhibitor medications may be prescribed for symptoms that are more persistent. Medications, however, are less effective when a large hiatal hernia, regurgitation, aspiration, cough and/or voice problems are present. In addition, they can cause decreased calcium absorption, which can cause bone problems, particularly in post-menopausal women. While medications can lessen or control the symptoms of GERD, they do not cure this chronic disorder. Therefore, patients take the medications for the rest of their lives or as symptoms dictate.
Approximately 20 percent of adults with GERD may be appropriate candidates for surgical treatment using a procedure called Nissen fundoplication (also called anti-reflux surgery). This procedure stops reflux of stomach contents by tightening the valve located between the stomach and the esophagus called the lower esophageal sphincter. Unlike medications that provide only symptomatic heartburn relief, anti-reflux surgery can cure GERD for most patients.
Surgery should be recommended for:
- Individuals with voice or respiratory problems, including hoarseness, cough or asthma due to reflux
- Patients who are young, to avoid the side effects and diminishing effectiveness of taking medications for many decades
- Patients who have a large hiatal or paraesophageal hernias that make it difficult to eat
- Post-menopausal women, for whom some anti-GERD medications raise the risk of osteoporosis