Medical Management of Acid Reflux & GERD

Hi Dr. Deena,

Thanks for the tips. I have been suffering from acid reflux symptoms and have been taking "Nexium" for the past few months. Is it advisable to continue with this medication? Also could you please explain antacids more in brief. Would be interested in knowing. 
Thanks.

This is a great question, as there are so many people taking Nexium, "The Purple Pill". Many of these people take this medicine because they are unaware of the other treatments for GERD out there, which are just as effective and cheaper! Today I will focus your attention on the current medical treatment options for GERD, since yesterday I mentioned the non-medical alternatives. 

If you are experiencing mild symptoms of heartburn, I would recommend trying non-medical alternatives first. Many people will notice that avoiding certain food triggers will make them feel better fast. 

Treatment of GERD depends on the severity of your symptoms. Are they mild, moderate, or severe? 

Your symptoms are mild if:
-symptoms are NOT frequent (less than 2-3 times weekly)
-symptoms are easy to tolerate
-symptoms last for a short time during each episode
-symptoms do not interfere with your daily life and daily activities 

Your symptoms are moderate if: 
-symptoms are frequent (more than 2-3 times weekly)
-symptoms begin to interfere with daily activities like eating and sleeping

Your symptoms are severe if: 
-symptoms are so disabling and frequent that they prevent you from participating in many daily activities 

If you are concerned about having GERD you should speak to a physician; however, if you are in the moderate or severe category -- you DEFINITELY need to seek out a physician for evaluation.

Now that you know how to judge your severity of symptoms, let's focus on the treatment options that are available for GERD. The main medical treatment options include antacids, H-2 receptor antagonists, and proton pump inhibitors ("PPI's"). I will discuss each in detail below.

If you have mild symptoms of acid reflux then antacids might work for you. Antacids are substances that neutralize the acidity in your stomach. When there is increased acidity in the stomach, the pH (a measure of acid/base status) is low and these substances work by increasing the pH of the stomach to make it less acidic. Antacids are available without a prescription, and can be found in many different forms (oral tablets, liquid, syrup, etc). Depending on the antacid that you choose it may contain different elements,but the most common neutralizers are carbonate, bicarbonate, magnesium hydroxide, and aluminum hydroxide. Brand names for the antacids include Tums, Rolaids, Alka-Seltzer, Mylanta.

Antacids are ONLY BENEFICIAL FOR SHORT-TERM RELIEF since the acid is only neutralized briefly after each dose. 
If you find yourself taking antacid tablets more than 2-3 times a week, or if they are no longer working for you - I would recommend you speak to your physician for further evaluation. 

If antacids are not helpful to you, the next line of treatment medications are "H-2 blockers" or "H-2 receptor antagonists".  These medications block the actions of Histamine, which is a chemical that leads to increased acid production in the stomach. In the US examples of these drugs include (generic name is in parentheses):  Zantac (ranitidine), Pepcid (famotidine) and Tagamet (cimetidine).

If H-2 blockers do not help with your symptoms, the next line of treatment is "Proton Pump Inhibitors" (PPIs). These medications are the most effective at controlling GERD and they have the longest lasting effects. These medications inhibit the proton pump known as the H+/K+/ATPase, which is the final step to acid secretion in the stomach.  The medication you referred to in the website "Nexium" (generic is esomeprazole) is a proton pump inhibitor. Other medications in this class include: Prilosec (omeprazole), Prevacid (lansoprazole) or Protonix (pantoprazole).Since PPIs are the strongest and most effective treatment option - they also carry the most side effects. I will not go into the side effect profile of these medications because they vary, and can easily be found with a quick internet search.

To answer your question -- "if Nexium is a good medication to be taking" -- this can be a great medication in the short-term to give you relief of symptoms, but long-term treatment is associated with many side effects.
There is no concensus in the medical community over how long one should continue medical therapy for GERD. Most physicians will recommend lowering the dosage over time while watching for symptom improvement or progression, with hopes of ultimately stopping the medication completely. Most research has only looked at the short term benefits of medical treatment of GERD.
I would recommend asking your physician if you can attempt to taper off the Nexium over time (especially if you have been on it for greater than 3 months) and see how your symptoms respond. If the symptoms still persist - you may need further evaluation to try to better understand the cause of your acid reflux. As mentioned in my previous blog, there are many causes for GERD including hiatal hernia (due to weakening of the muscles of the diaphragm), H. Pylori (a bacterial infection), Peptic Ulcer Disease, etc. Other causes of GERD may require interventions such as antibiotics or surgery.  These causes need to be evaluated for and treated by your physician in order to see any improvement in your symptoms.

I hope all this information helps you make an informed medical decision on how to control your heartburn. Please feel free to be in touch, and thank you for your questions!

As always email any questions/comments to DoctorDeenaMD@gmail.com.

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**