Many
people can relieve symptoms of GERD by changing
habits and making small lifestyle changes. But if
symptoms continue or interfere with sleep or work
or other daily activities of living and are not
relieved self-care measures, more comprehensive
intervention is absolutely necessary. That is
because chronic GERD can often cause serious
complications. Inflammation of the esophagus
caused by the stomach hydrochloric acid may lead
to bleeding or ulcers. The scar tissue can narrow
the esophagus causing esophageal stricture, making
swallowing difficult. Some may even develop
Barrett's esophagus where the cells of the
esophageal lining become abnormal in shape and
color and over time may lead to cancer. Also,
studies have shown that asthma, chronic cough,
pulmonary fibrosis may be aggravated or even
caused by GERD.
There
are several types of medicine available for the
treatment of GERD and the aim of the
treatment is to reduce acid production and reduce
the LES pressure.
(1)
Antacids like Maalox, Alka-Seltzer, Mylanta,
Rolaids, and Pepto-Bismol are usually the first
drugs recommended for mild symptoms of GERD. Most
of them contain a combination of three basic
salts-magnesium, calcium, and aluminum with
hydroxide or bicarbonate ions to neutralize the
acid. Antacids are good for occasional bouts of
acidity but long-term use leads to many side
effects like diarrhea or constipation. Those with
magnesium may also lead to dementia in patients
with renal failure.
(2)
Foaming agents such as Gaviscon cover the stomach
contents with foam to prevent reflux.
(3)
H2 blockers such as Tagamet HB, Pepcid
AC, Axid AR, and Zantac
impede acid production. They provide short-term
relief but should not be used for more that a few
weeks at a time. Many people benefit from taking
H2 blockers at bedtime along with a
proton pump inhibitor. They are effective in
relieving symptoms of acidity. However, they are
known to interact with other drugs and it is
important to consult a doctor before taking them.
Occasionally, they may also cause central nervous
system toxicity.
(4)
Proton-pump inhibitors like Prilosec, Prevacid,
and Nexium are extremely effective in reducing
acid production of the stomach. They are better at
healing esophagitis than H2 blockers,
have a longer lasting effect and can relieve
symptoms in almost everyone who has GERD. But
there is a significant relapse in both symptoms
and esophagitis after stopping the drug, which
leads to a long term dependency.
(5) Prokinetics strengthen
the LES and causes the stomach to empty out
faster. However they have dangerous side effects
like cardiac arrhythmias are generally not
prescribed. In fact, some like cisapride are no
longer available in
America.