Treatment of Daily Bothersome Symptoms of Heartburn and Regurgitation
Initial Treatment Approach
- The American Gastroenterological Association recommends beginning with a 4-8 week trial of a single-dose proton pump inhibitor (PPI) as first-line therapy for symptomatic relief 1
- PPIs are more effective than histamine-2 receptor antagonists (H2RAs), which are in turn more effective than placebo for treating esophageal GERD syndromes 2, 3
- Taking PPI 30-60 minutes before the first meal of the day can maximize efficacy 4
Lifestyle Modifications
- The American Gastroenterological Association suggests that weight loss should be advised for overweight or obese patients with GERD symptoms 2, 5, 6
- Elevating the head of the bed can help patients who experience symptoms when recumbent 2, 5, 6
- Avoiding food intake at least 2-3 hours before lying down can help alleviate symptoms 6
Adjunctive Therapy
- Alginate-containing antacids can be used for breakthrough symptoms 8, 7
- Nighttime H2RAs may help with nocturnal symptoms, though tachyphylaxis can limit long-term use 8
Treatment Optimization and Monitoring
- After symptom control is achieved, tapering PPI to the lowest effective dose is recommended 4, 1
- Exceptions to PPI tapering include patients with erosive esophagitis, Barrett's esophagus, or peptic stricture 8