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GERD: Which Treatment Should I Use?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
GERD: Which Treatment Should I Use?
1Get the | 2Compare | 3Your | 4Your | 5Quiz | 6Your Summary |
Get the facts
Your options
- Use medicines to treat symptoms of GERD (gastroesophageal reflux disease).
- Have surgery to treat your symptoms.
Key points to remember
- GERD (gastroesophageal reflux disease) symptoms may not get better on their own. It's important to treat GERD, because it can lead to more serious problems, such as inflammation or narrowing of the esophagus.
- Most people can control symptoms of GERD with over-the-counter medicines and lifestyle changes.
- Stronger prescription medicines often work when over-the-counter medicines don't.
- You may decide to have surgery if:
- Medicine doesn't completely relieve your symptoms.
- Medicine works to stop your symptoms but for other reasons you can't or don't want to take the medicine.
- You have other symptoms, including asthma or hoarseness, that do not get much better with medicines.
- Surgery has risks, some of which may be serious.
- Surgery may cause side effects, such as trouble swallowing and permanent painful gas from not being able to burp.
- The best surgery results are with doctors who have done this surgery many times. Talk to your doctor about how many GERD surgeries he or she has done.
- After surgery, you still may need to take medicines to control symptoms.
What is GERD?
GERD (gastroesophageal reflux disease) is the flow of stomach juices back up into the esophagus. This backup, called reflux, happens if the valve between the lower end of the esophagus and the stomach doesn't close tightly enough.
The most common symptom is heartburn, an uncomfortable feeling of burning or pain just behind the breastbone. Another common symptom is a sour taste in the mouth.
People with very bad, untreated GERD symptoms may get esophagitis (say "ee-saw-fuh-JY-tus"). This means that the esophagus is inflamed and irritated from the constant contact with stomach acids and digestive juices. GERD also can cause Barrett's esophagus, which is a change in the cells lining the esophagus. In rare cases, it may lead to cancer.
How is GERD treated?
Treatment usually starts with lifestyle changes-such as quitting smoking and losing weight-and with medicines that you can buy without a prescription. These medicines reduce or block stomach acid. They include H2 blockers (such as Pepcid and Zantac) and proton pump inhibitors (such as Prevacid and Prilosec).
Talk to your doctor if over-the-counter medicines aren't controlling your symptoms. In most cases, he or she can prescribe other medicine to help control your symptoms.
The most common surgery for GERD is called fundoplication surgery. It involves wrapping part of the stomach around the esophagus to strengthen it. If you have a hiatal hernia, it also will be fixed.
This surgery is often done laparoscopically. Instead of making a large cut (incision) in the belly, the doctor puts a lighted tube, or scope, and surgical tools into small cuts in your belly. This allows the doctor to see into your belly to do the surgery.
You may decide to have surgery if:
- Medicines don't relieve your symptoms enough.
- Medicine works to stop your symptoms, but for other reasons you can't or don't want to take the medicine.
- You have other problems that don't get better with medicine, such as asthma, hoarseness, or a cough caused when the acid backs up in your throat.
Treating GERD in pregnant women
Lifestyle changes and antacids are usually tried first to treat pregnant women who have GERD. Some nonprescription antacids are safe to use during pregnancy to treat symptoms. Antacids that contain sodium bicarbonate can cause fluid to build up, so they should not be taken by pregnant women. And do not use antacids that have magnesium trisilicate, because they may not be safe for your baby. But it is okay to use antacids that contain calcium carbonate (such as Tums).
Be careful when you take over-the-counter antacid medicines. Many of these medicines have aspirin in them. While you are pregnant, do not take aspirin or medicines that contain aspirin unless your doctor says it is okay.
If lifestyle changes and antacids don't help control your symptoms, talk to your doctor about using other medicines.
How well do medicines work for GERD?
Medicines relieve GERD symptoms for most people.
Proton pump inhibitors may work better than H2 blockers depending on your GERD symptoms, but you may need to try more than one medicine to find one that works well for you. And you may still sometimes need to take an antacid (such as Mylanta or Tums) to stop heartburn.
The medicines
- Antacids, such as Gaviscon or Rolaids. Antacids work very well for people who get mild to moderate heartburn now and then. They relieve symptoms quickly. You can buy these without a prescription in grocery stores and drugstores. Antacids probably won't help people who have bad symptoms.
- H2 blockers, such as Pepcid or Tagamet. H2 blockers help most people with mild to moderate heartburn. You can get them with or without a prescription.
- Proton pump inhibitors, such as Prevacid or Prilosec. These medicines are used to treat GERD symptoms and inflammation of the esophagus (esophagitis). Some are available without a prescription.
No matter which medicines you try, making lifestyle changes is still an important part of your treatment.
If your GERD symptoms are very bad, you will probably need to take medicines every day. That's because symptoms tend to return if you stop taking medicine.
What are the side effects of GERD medicines?
The medicines for GERD are generally safe, but each has different side effects.
- Antacids can contain aluminum, magnesium, or aspirin. Those that contain aluminum may cause constipation. Those that contain magnesium may cause diarrhea. You should not use antacids that contain either aluminum or magnesium if you have serious kidney problems. Also, if you are on a low-salt diet or are pregnant, talk with your doctor or pharmacist before you choose an antacid. Some are high in salt. And some antacids have aspirin in them. Read the label to make sure that you are not taking more than the recommended dose. Too much aspirin can be harmful.
- H2 blockers. They sometimes cause headaches, dizziness, diarrhea or constipation, or nausea and vomiting.
- Proton pump inhibitors. Headaches and diarrhea are the most common side effects. Using PPIs for a long time can increase your risk for infections or broken bones.
How well does surgery work for GERD?
Surgery relieves symptoms for most people, but not for everyone. Laparoscopic surgery improves GERD symptoms in 8 out of 10 people. And surgery heals the damage done by GERD to the esophagus (esophagitis) in about 9 out of 10 people.footnote 1
What are the risks and side effects of surgery?
All major surgery has risks, including a risk of breathing problems caused by the anesthesia. There also is a risk of bleeding, infection, and pain.
Surgery for GERD can involve other problems:
- Surgery might not make symptoms go away completely.
- Some people still need to take medicine for GERD symptoms after surgery.
- Some people have increased flatulence and bloating after surgery.
- It is also possible for the stomach wrap to slide down around the stomach instead of staying around the esophagus. If this rare problem happens, you may need surgery to fix it.
- The stomach wrap could loosen, causing symptoms to return. You might need a second surgery to fix it.
Why might your doctor recommend surgery for GERD symptoms?
Your doctor might recommend surgery if:
- Medicine doesn't completely relieve your symptoms.
- Medicine works to stop your symptoms but for other reasons you can't or don't want to take the medicine.
- You have other symptoms, including asthma or hoarseness, that don't get much better with medicines.
Compare your options
Compare
What is usually involved? |
| |
|---|---|---|
What are the benefits? |
| |
What are the risks and side effects? |
|
- You take medicine every day to prevent GERD symptoms.
- You take over-the-counter medicines if you still get some heartburn.
- You make lifestyle changes if needed, such as quitting smoking, losing weight, or changing your eating habits.
- Medicines such as H2 blockers and proton pump inhibitors work well for most people who have mild to moderate heartburn.
- Medicines can lower the chance of GERD damaging the esophagus.
- Medicines can
cause side effects:
- H2 blockers can cause headaches, dizziness, diarrhea or constipation, and nausea and vomiting.
- Proton pump inhibitors can cause headaches and diarrhea. Using PPIs for a long time can increase your risk for infections or broken bones.
- You stay in the hospital for several days. The hospital stay is usually shorter for laparoscopic surgery.
- You may need to eat only soft foods until you heal.
- You make lifestyle changes if needed, such as quitting smoking, losing weight, or changing your eating habits.
- Surgery may help GERD symptoms a little bit better than medicines (proton pump inhibitors).footnote 2
- Surgery may heal damage to the esophagus a little bit better than medicine (proton pump inhibitors).footnote 2
- Any surgery has risks, such as bleeding and infection.
- Some people have trouble swallowing after surgery.
- Some people have increased flatulence and bloating after surgery.
- Some people are unable to belch after surgery.
- Surgery may not completely get rid of symptoms.
- You still may have to take medicine after surgery.
- Some people need a second surgery.
Personal stories about medicines and surgery to treat GERD
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I was having tests for another health problem when my doctor discovered I have a hiatal hernia. She told me the hiatal hernia could be causing the heartburn I have from time to time. She told me I could take medicine when my heartburn is really bothering me. She also suggested that I try to lose some weight and eat right. I am hoping that these lifestyle changes, along with medicine when I have bad symptoms, will control my heartburn.
Carlos, age 43
I was glad to learn that my chest pain was GERD. I thought I was having a heart attack. My doctor said I could treat the symptoms with medicine. But because I was having symptoms so often, he said the medicine would work best if I took it every day at the same time (30 minutes before breakfast). If I remember to take my medicine, I don't have any heartburn. Now I hope I will be able to get on with my life and not be bothered by this quite so much.
Maria, age 28
My heartburn was really bad. I tried everything. First it was antacids and other medicines I bought at the drugstore. That didn't help, so I saw my doctor. He wrote me a prescription for stronger medicines. That helped some, but not enough. So after doing tests to make sure my symptoms were caused by GERD, my doctor said I could consider having surgery. He told me about the possible new symptoms I could have including trouble swallowing or burping and extra gas or bloating. But my GERD is so bad, I'm willing to take my chances. I decided to have surgery.
Antoine, age 40
I decided to take medicine for my GERD instead of having surgery. It's not so much that I am afraid of surgery, but I really don't have the time to take off right now. Taking a pill every day is not that big a deal. If it works, great! And I don't know what new problems I might have after surgery. If medicine works for me, why would I try something more risky?
Susan, age 50
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take medicines for GERD
Reasons to have surgery for GERD
I'm not worried about the side effects of taking medicines.
I want to avoid taking medicine or at least reduce how much medicine I'll need.
I want to avoid having surgery if at all possible.
I'm not worried about having surgery.
I can make lifestyle changes and try different medicines.
I have been trying medicines for some time, and my symptoms are still bad.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking medicine
Having surgery
What else do you need to make your decision?
Check the facts
Decide what's next
Certainty
1. How sure do you feel right now about your decision?
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you're leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits and References
| Author | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
| Primary Medical Reviewer | Elizabeth T. Russo, MD - Internal Medicine |
| Specialist Medical Reviewer | Arvydas D. Vanagunas, MD - Gastroenterology |
- Lundell L, et al. (2007). Seven-year follow-up of a randomized clinical trial comparing proton-pump inhibition with surgical therapy for reflux oesophagitis. British Journal of Surgery, 94(2): 198-203.
- American Gastroenterological Association (2008). American Gastroenterological Association technical review on the management of gastroesophageal reflux disease. Gastroenterology, 135(4): 1392-1413.
- Agency for Healthcare Research and Quality (2011). Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease: Update (AHRQ Publication No. 11-EHC049-EF). Rockville, MD: Agency for Healthcare Research and Quality. Also available online: http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=781.
- Galmiche J-P, et al. (2011). Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD. JAMA, 305(19): 1969-1977.
GERD: Which Treatment Should I Use?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the Facts
Your options
- Use medicines to treat symptoms of GERD (gastroesophageal reflux disease).
- Have surgery to treat your symptoms.
Key points to remember
- GERD (gastroesophageal reflux disease) symptoms may not get better on their own. It's important to treat GERD, because it can lead to more serious problems, such as inflammation or narrowing of the esophagus .
- Most people can control symptoms of GERD with over-the-counter medicines and lifestyle changes.
- Stronger prescription medicines often work when over-the-counter medicines don't.
- You may decide to have surgery if:
- Medicine doesn't completely relieve your symptoms.
- Medicine works to stop your symptoms but for other reasons you can't or don't want to take the medicine.
- You have other symptoms, including asthma or hoarseness, that do not get much better with medicines.
- Surgery has risks, some of which may be serious.
- Surgery may cause side effects, such as trouble swallowing and permanent painful gas from not being able to burp.
- The best surgery results are with doctors who have done this surgery many times. Talk to your doctor about how many GERD surgeries he or she has done.
- After surgery, you still may need to take medicines to control symptoms.
What is GERD?
GERD (gastroesophageal reflux disease) is the flow of stomach juices back up into the esophagus. This backup, called reflux, happens if the valve between the lower end of the esophagus and the stomach doesn't close tightly enough.
The most common symptom is heartburn, an uncomfortable feeling of burning or pain just behind the breastbone. Another common symptom is a sour taste in the mouth.
People with very bad, untreated GERD symptoms may get esophagitis (say "ee-saw-fuh-JY-tus"). This means that the esophagus is inflamed and irritated from the constant contact with stomach acids and digestive juices. GERD also can cause Barrett's esophagus, which is a change in the cells lining the esophagus. In rare cases, it may lead to cancer.
How is GERD treated?
Treatment usually starts with lifestyle changes-such as quitting smoking and losing weight-and with medicines that you can buy without a prescription. These medicines reduce or block stomach acid. They include H2 blockers (such as Pepcid and Zantac) and proton pump inhibitors (such as Prevacid and Prilosec).
Talk to your doctor if over-the-counter medicines aren't controlling your symptoms. In most cases, he or she can prescribe other medicine to help control your symptoms.
The most common surgery for GERD is called fundoplication surgery. It involves wrapping part of the stomach around the esophagus to strengthen it. If you have a hiatal hernia, it also will be fixed.
This surgery is often done laparoscopically. Instead of making a large cut (incision) in the belly, the doctor puts a lighted tube, or scope, and surgical tools into small cuts in your belly. This allows the doctor to see into your belly to do the surgery.
You may decide to have surgery if:
- Medicines don't relieve your symptoms enough.
- Medicine works to stop your symptoms, but for other reasons you can't or don't want to take the medicine.
- You have other problems that don't get better with medicine, such as asthma, hoarseness, or a cough caused when the acid backs up in your throat.
Treating GERD in pregnant women
Lifestyle changes and antacids are usually tried first to treat pregnant women who have GERD. Some nonprescription antacids are safe to use during pregnancy to treat symptoms. Antacids that contain sodium bicarbonate can cause fluid to build up, so they should not be taken by pregnant women. And do not use antacids that have magnesium trisilicate, because they may not be safe for your baby. But it is okay to use antacids that contain calcium carbonate (such as Tums).
Be careful when you take over-the-counter antacid medicines. Many of these medicines have aspirin in them. While you are pregnant, do not take aspirin or medicines that contain aspirin unless your doctor says it is okay.
If lifestyle changes and antacids don't help control your symptoms, talk to your doctor about using other medicines.
How well do medicines work for GERD?
Medicines relieve GERD symptoms for most people.
Proton pump inhibitors may work better than H2 blockers depending on your GERD symptoms, but you may need to try more than one medicine to find one that works well for you. And you may still sometimes need to take an antacid (such as Mylanta or Tums) to stop heartburn.
The medicines
- Antacids, such as Gaviscon or Rolaids. Antacids work very well for people who get mild to moderate heartburn now and then. They relieve symptoms quickly. You can buy these without a prescription in grocery stores and drugstores. Antacids probably won't help people who have bad symptoms.
- H2 blockers, such as Pepcid or Tagamet. H2 blockers help most people with mild to moderate heartburn. You can get them with or without a prescription.
- Proton pump inhibitors, such as Prevacid or Prilosec. These medicines are used to treat GERD symptoms and inflammation of the esophagus (esophagitis). Some are available without a prescription.
No matter which medicines you try, making lifestyle changes is still an important part of your treatment.
If your GERD symptoms are very bad, you will probably need to take medicines every day. That's because symptoms tend to return if you stop taking medicine.
What are the side effects of GERD medicines?
The medicines for GERD are generally safe, but each has different side effects.
- Antacids can contain aluminum, magnesium, or aspirin. Those that contain aluminum may cause constipation. Those that contain magnesium may cause diarrhea. You should not use antacids that contain either aluminum or magnesium if you have serious kidney problems. Also, if you are on a low-salt diet or are pregnant, talk with your doctor or pharmacist before you choose an antacid. Some are high in salt. And some antacids have aspirin in them. Read the label to make sure that you are not taking more than the recommended dose. Too much aspirin can be harmful.
- H2 blockers. They sometimes cause headaches, dizziness, diarrhea or constipation, or nausea and vomiting.
- Proton pump inhibitors. Headaches and diarrhea are the most common side effects. Using PPIs for a long time can increase your risk for infections or broken bones.
How well does surgery work for GERD?
Surgery relieves symptoms for most people, but not for everyone. Laparoscopic surgery improves GERD symptoms in 8 out of 10 people. And surgery heals the damage done by GERD to the esophagus (esophagitis) in about 9 out of 10 people.1
What are the risks and side effects of surgery?
All major surgery has risks, including a risk of breathing problems caused by the anesthesia. There also is a risk of bleeding, infection, and pain.
Surgery for GERD can involve other problems:
- Surgery might not make symptoms go away completely.
- Some people still need to take medicine for GERD symptoms after surgery.
- Some people have increased flatulence and bloating after surgery.
- It is also possible for the stomach wrap to slide down around the stomach instead of staying around the esophagus. If this rare problem happens, you may need surgery to fix it.
- The stomach wrap could loosen, causing symptoms to return. You might need a second surgery to fix it.
Why might your doctor recommend surgery for GERD symptoms?
Your doctor might recommend surgery if:
- Medicine doesn't completely relieve your symptoms.
- Medicine works to stop your symptoms but for other reasons you can't or don't want to take the medicine.
- You have other symptoms, including asthma or hoarseness, that don't get much better with medicines.
2. Compare your options
| Take medicines | Have surgery | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
| |
| What are the risks and side effects? |
|
|
Personal stories
Personal stories about medicines and surgery to treat GERD
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I was having tests for another health problem when my doctor discovered I have a hiatal hernia. She told me the hiatal hernia could be causing the heartburn I have from time to time. She told me I could take medicine when my heartburn is really bothering me. She also suggested that I try to lose some weight and eat right. I am hoping that these lifestyle changes, along with medicine when I have bad symptoms, will control my heartburn."
— Carlos, age 43
"I was glad to learn that my chest pain was GERD. I thought I was having a heart attack. My doctor said I could treat the symptoms with medicine. But because I was having symptoms so often, he said the medicine would work best if I took it every day at the same time (30 minutes before breakfast). If I remember to take my medicine, I don't have any heartburn. Now I hope I will be able to get on with my life and not be bothered by this quite so much."
— Maria, age 28
"My heartburn was really bad. I tried everything. First it was antacids and other medicines I bought at the drugstore. That didn't help, so I saw my doctor. He wrote me a prescription for stronger medicines. That helped some, but not enough. So after doing tests to make sure my symptoms were caused by GERD, my doctor said I could consider having surgery. He told me about the possible new symptoms I could have including trouble swallowing or burping and extra gas or bloating. But my GERD is so bad, I'm willing to take my chances. I decided to have surgery."
— Antoine, age 40
"I decided to take medicine for my GERD instead of having surgery. It's not so much that I am afraid of surgery, but I really don't have the time to take off right now. Taking a pill every day is not that big a deal. If it works, great! And I don't know what new problems I might have after surgery. If medicine works for me, why would I try something more risky?"
— Susan, age 50
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take medicines for GERD
Reasons to have surgery for GERD
I'm not worried about the side effects of taking medicines.
I want to avoid taking medicine or at least reduce how much medicine I'll need.
I want to avoid having surgery if at all possible.
I'm not worried about having surgery.
I can make lifestyle changes and try different medicines.
I have been trying medicines for some time, and my symptoms are still bad.
My other important reasons:
My other important reasons:
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking medicine
Having surgery
5. What else do you need to make your decision?
Check the facts
1. Do frequent heartburn and other symptoms of GERD often go away on their own?
- Yes
- No
- I'm not sure
2. Do many people get relief by making lifestyle changes and taking over-the-counter antacids?
- Yes
- No
- I'm not sure
3. Will having surgery mean that you won't have to take medicines anymore?
- Yes
- No
- I'm not sure
Decide what's next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I'm ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
| Primary Medical Reviewer | Elizabeth T. Russo, MD - Internal Medicine |
| Specialist Medical Reviewer | Arvydas D. Vanagunas, MD - Gastroenterology |
- Lundell L, et al. (2007). Seven-year follow-up of a randomized clinical trial comparing proton-pump inhibition with surgical therapy for reflux oesophagitis. British Journal of Surgery, 94(2): 198-203.
- American Gastroenterological Association (2008). American Gastroenterological Association technical review on the management of gastroesophageal reflux disease. Gastroenterology, 135(4): 1392-1413.
- Agency for Healthcare Research and Quality (2011). Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease: Update (AHRQ Publication No. 11-EHC049-EF). Rockville, MD: Agency for Healthcare Research and Quality. Also available online: http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=781.
- Galmiche J-P, et al. (2011). Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD. JAMA, 305(19): 1969-1977.
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Current as of: November 29, 2017
