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 won't 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.
- 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.

FAQs

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.

See a picture of how reflux happens .

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.

GERD symptoms won't get better on their own. If you don't use some type of treatment, you will keep having symptoms.

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 antacid 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 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.
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. Antacids are safe to use for heartburn symptoms during pregnancy. 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.

H2 blockers relieve mild GERD symptoms in about 60 out of 100 people. They don't relieve symptoms in about 40 out of 100 people.¹ H2 blockers don't work as well as proton pump inhibitors to treat moderate to severe GERD.
Proton pump inhibitors can heal even severe damage of the esophagus in about 80 out of 100 people who take them. In the 20 out of 100 people who don't have healing of the esophagus right away, an increased dose or even the same dose for a longer time will usually work.²

You may need to try more than one medicine to find one that works well for you.

The medicines

Antacids (such as Gaviscon, Mylanta, Tums, or Rolaids) 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 with bad symptoms.
H2 blockers (such as Axid, Pepcid, Tagamet, and Zantac) help most people with mild to moderate heartburn . You can get them with or without a prescription.
Proton pump inhibitors (such as Nexium, Prevacid, Prilosec, Protonix, and Aciphex) are prescription medicines that often help when H2 blockers haven't worked. Prilosec is also available without a prescription (Prilosec OTC).

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 from now on. 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 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. The ingredients are listed on the package or bottle.
H2 blockers are considered very safe. But they sometimes cause headaches, dizziness, diarrhea or constipation, or nausea and vomiting.
Proton pump inhibitors don't usually cause problems. Headaches and diarrhea are the most frequent side effects. These medicines may interfere slightly with the actions of warfarin (such as Coumadin) or phenytoin (such as Dilantin). So it's important to tell your doctor if you are taking those medicines. Proton pump inhibitors also may reduce the amount of calcium your body absorbs. This may be linked to a higher risk of 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 about 60 to 90 out of 100 people who have the surgery (depending on how experienced the surgeon is). But no studies have proven that this surgery works to heal the esophagus over the long term.³
The chance of success is higher with doctors who have done this surgery many times. These very experienced surgeons are usually found at hospitals that specialize in treating GERD.²

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 have other side effects:

Surgery might not make symptoms go away completely. One study showed that 62 out of 100 people who had surgery were still taking medicines after surgery to control GERD symptoms, while 38 didn't need medicines.⁴ But those who were still taking medicines didn't need to take them regularly. And when they didn't take medicines, their symptoms were not as bad as they were before surgery.⁴
About 20 to 30 out of 100 people have new problems after surgery, such as permanent bloating, gas, and trouble swallowing, while 70 to 80 don't.²
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.
You have other symptoms, including asthma or hoarseness, that don't get much better with medicines.

2. Compare Options

	Take medicines	Have surgery
What is usually involved?	You take over-the-counter or prescription medicines when you have symptoms. You make lifestyle changes if needed, such as quitting smoking, losing weight, or changing your eating habits. You can raise the head of your bed to by putting the frame on blocks or placing a foam wedge under the head of your mattress. This can reduce symptoms.	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 can raise the head of your bed to by putting the frame on blocks or placing a foam wedge under the head of your mattress. This can reduce symptoms. You can change your eating habits, such as eating several small meals a day instead of three large meals.
What are the benefits?	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. Over-the-counter medicines don't cost very much.	Surgery often works when medicines haven't worked. The best results from surgery are with doctors who have done a lot of these surgeries.² Surgery lowers the chance of GERD damaging the esophagus.
What are the risks and side effects?	Medicines can cause side effects: H2 blockers can cause headaches, dizziness, diarrhea or constipation, and nausea and vomiting. Proton pump inhibitors may reduce the amount of calcium your body absorbs. This may be linked to an increased risk of broken bones. Prescription medicines can cost a lot.	Any surgery has risks, such as bleeding and infection. Some people have new problems after surgery, such as permanent bloating, gas, and trouble swallowing (if the stomach wrap around the esophagus is too tight). 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

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

If you need more information, see the topic Gastroesophageal Reflux Disease (GERD).

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 finally decided to see my doctor about my heartburn. She discovered I have a hiatal hernia and told me I could take some medication and control my heartburn or have surgery that might eliminate it. I am really not very excited by the thought of having surgery. I suppose it is safe enough, but I just don't like the idea. I am going to lose some weight and eat right. Hopefully, these changes along with the use of medications will control my heartburn. "

— Carlos, age 43

" I was glad to learn that my chest pain was heartburn. I thought I was having a heart attack. My doctor said I could treat the heartburn with medications or surgery. He said if I took medications, I would have to take them every day for the rest of my life. On the other hand, he said that surgery had a good chance of eliminating the problem, or at least the worst of it. I tried some medications and they seemed to work all right, but I wasn't really satisfied with the results. So I decided to have the surgery. 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 medications I bought at the drugstore. That didn't help, so I saw my doctor. He wrote me a prescription for stronger medications than I could get in the drugstore. That helped some, but not enough. So my doctor suggested I could consider having surgery and, after thinking about it, I agreed. "

— Antoine, age 40

" I decided to take medications for my heartburn 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! If I am not satisfied with the effectiveness of the medications, I figure I can always choose to have the surgery later. "

— Susan, age 50

3. Your Feelings

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.

More important

Equally important

More important

I want to avoid having surgery if at all possible.

I'm not worried about having surgery.

More important

Equally important

More important

I can make lifestyle changes and try different medicines.

I have been trying medicines for some time, and my symptoms are still bad.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

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

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts

1. Do frequent heartburn and other symptoms of GERD often go away on their own?

Yes
No
I'm not sure

You're right. GERD symptoms won't go away without treatment. And treatment is important, because symptoms can cause more serious problems if they get worse.

2. Do many people get relief by making lifestyle changes and taking over-the-counter antacids?

Yes
No
I'm not sure

That's right. You may be able to control symptoms by taking antacids and making lifestyle changes like quitting smoking or losing weight.

3. Will having surgery mean that you won't have to take medicines anymore?

Yes
No
I'm not sure

You're right. After surgery, you still may need to take medicines to control symptoms.

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?

Not sure at all

Somewhat sure

Very sure

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.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

Vaezi MF (2007). Esophageal disorders. In DC Dale, DD Federman, eds., ACP Medicine, section 4, chap. 1. New York: WebMD.
Richter JE (2006). Gastroesophageal reflux disease and its complications. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 1, pp. 905–936. Philadelphia: Saunders Elsevier.
Kahrilas PJ (2001). Management of GERD: Medical versus surgical. Seminars in Gastrointestinal Disease, 12(1): 3–15.
Spechler SJ, et al. (2001). Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: Follow-up of a randomized controlled trial. JAMA, 285(18): 2331–2338.