Gastro-oesophageal reflux: treatment
There are several treatments that are effective in relieving the uncomfortable symptoms of gastro-oesophageal reflux (GOR). The right treatment for you will depend on how often you have reflux symptoms, as well as the severity of your symptoms.
Lifestyle changes, or self-help measures, and the occasional use of over-the-counter medicines may be all that is needed to treat mild reflux. Your doctor may prescribe stronger medicines to control more persistent or severe symptoms. Surgery is also an option for some people.
Lifestyle changes to relieve reflux
Simple lifestyle changes, such as altering your diet, are often all that is needed to treat mild reflux symptoms or symptoms that only occur from time to time. And for those people who do take medicines to control their reflux, lifestyle changes are still recommended.
Your doctor may suggest that you try the following self-help tips.
- Avoid foods and drinks that bring on your attacks of heartburn. Some people find that cutting out chocolate, fatty foods, coffee, citrus fruit, tomato-based foods, carbonated (fizzy) drinks, alcohol or spicy foods helps. You only need to avoid the foods that trigger your symptoms.
- Eat smaller meals.
- Time your meals so that you eat several hours before lying down and raise the head of your bed if you have night-time symptoms.
- Lose weight if you are overweight.
- Quit smoking.
If lifestyle measures aren't enough to control your reflux symptoms and you do need medication, the good news is that many people with gastro-oesophageal reflux get symptom relief from simple over-the-counter antacids.
Antacids are used to relieve symptoms in mild reflux disease and should be taken when symptoms occur.
Various antacid preparations are available. Doctors often recommend preparations that contain:
- antacid plus alginate (e.g. Gaviscon, Mylanta Heartburn Relief); or
- magnesium hydroxide plus aluminium hydroxide (e.g. Mylanta, Gastrogel).
Other available antacids include:
- Rennie Spearmint Flavour (contains magnesium carbonate and calcium carbonate);
- Andrews TUMS Antacid (contains calcium carbonate); and
- Alu-tab (contains aluminium hydroxide).
Antacids usually come as liquid suspensions or tablets. Liquid preparations are more effective than tablets, which need to be chewed thoroughly before swallowing to ensure they dissolve completely in the stomach. However, tablets have the advantage of being more easily portable.
If you find yourself needing antacids for reflux symptoms more than twice a week, see your doctor.
Side effects of antacids
Sometimes magnesium preparations may cause increased burping and diarrhoea, and preparations containing aluminium may cause constipation.
If you are taking other medicines, you should not take antacids at the same time as you take those medicines. Your doctor will be able to advise you about interactions among medicines and how to time the administration of different medicines so that you are not taking them together.
H2 antagonists for reflux
If antacids are not relieving your symptoms, an H2 antagonist (histamine antagonist) can be tried. These medicines work by blocking the action of histamine, a substance that stimulates the secretion of stomach acid. Because less acid is being produced by the stomach, the pain from acid reflux is reduced.
H2 antagonists are available both on prescription and over the counter, and are taken once or twice daily as required. They include:
- famotidine (e.g. Pepzan, Pamacid);
- cimetidine (e.g. Magicul);
- nizatidine (e.g. Nizac, Tacidine, Tazac); and
- ranitidine (e.g. Zantac, Zantac relief, Rani 2).
H2 antagonists are very effective, and compared with antacids can relieve symptoms for longer.
They have relatively few side effects but some people, particularly older people, may experience headaches, confusion and tiredness. Other side effects may include diarrhoea or a rash.
Proton pump inhibitors
Proton pump inhibitors (PPIs) are medicines that reduce the amount of stomach acid by inhibiting (holding back) the system that ‘pumps’ acid into the stomach. Doctors consider proton pump inhibitors to be the most effective medicines for suppressing the production of stomach acid.
A trial of proton-pump inhibitors, taken daily for 4-8 weeks, is often prescribed for people with frequent or moderate-to-severe symptoms. If symptoms are relieved during the trial period, it helps confirm the diagnosis of reflux. After this, your doctor may recommend gradually reducing the dose or stopping regular treatment with PPIs and using them only as needed.
If PPIs do not control your symptoms, your doctor may recommend further tests or refer you to a gastroenterologist (specialist in problems with the digestive system).
Proton pump inhibitors available on prescription include:
- esomeprazole (Nexium);
- lansoprazole (Zoton FasTabs);
- omeprazole (Losec);
- pantoprazole (Somac); and
- rabeprazole (Pariet).
Most people's symptoms of reflux can be relieved with proton pump inhibitors. PPIs should be taken 30-60 minutes before a meal (usually breakfast).
There are also some proton pump inhibitors that are available from pharmacies without a prescription, including:
- rabeprazole (Pariet 10);
- pantoprazole (Salpraz Heartburn Relief, Somac Heartburn Relief, Suvacid Heartburn Relief);
- esomeprazole (Nexium 24HR Once-Daily Dosing); and
- omeprazole (Maxor Heartburn Relief).
These medicines can be used to control symptoms in the short term.
Generally, PPIs are well tolerated. The most common side-effects, when they do occur, include headache, nausea and diarrhoea. Rare side effects include kidney disease, vitamin B12 deficiency and increased risk of pneumonia. There may be an increased risk of bone fractures associated with long-term use of PPIs.
Fundoplication is a surgical procedure that aims to ‘tighten’ the junction between the stomach and the oesophagus to reduce the amount of acid that enters the oesophagus. This procedure is often performed using a ‘key-hole’ approach called laparoscopic fundoplication.
Surgery is generally reserved for people who have reflux symptoms that are not controlled by medicines or those who have significant side effects associated with medications. It may also be recommended for people with a large hiatus hernia.
Your doctor will be able to discuss with you the risks and benefits of surgery for reflux/GORD.
2. Keung C, Hebbard G. The management of gastro-oesophageal reflux disease. Australian Prescriber 2016;39:36-9. https://www.nps.org.au/australian-prescriber/articles/the-management-of-gastro-oesophageal-reflux-disease (accessed Mar 2017).
3. NHS Choices. Gastro-oesophageal reflux disease (updated 2 Mar 2016). http://www.nhs.uk/Conditions/Gastroesophageal-reflux-disease/Pages/Treatment.aspx (accessed Mar 2017).