GERD Treatment Options: From Antacids to Surgery
How to manage acid reflux and prevent complications
How to manage acid reflux and prevent complications
Key Takeaways
- GERD occurs when stomach acid flows into the esophagus.
- Symptoms include heartburn and regurgitation.
- Treatments range from lifestyle changes and medications to surgery.
Some people experience a burning pain in their chest that rises toward their throat. Others notice a sour or bitter taste in their mouth, as if food or liquid is coming back up.
When these symptoms happen regularly, the cause may be from gastroesophageal reflux disease, commonly known as GERD. Although GERD can disrupt sleep, meals and daily life, most people can manage it effectively with the right treatment.
“GERD is highly treatable in most cases. The key is recognizing symptom patterns and tailoring treatment to the individual,” says Fouad Moawad, MD, a gastroenterologist at Scripps Clinic Anderson Medical Pavilion in La Jolla. “For many patients, a combination of lifestyle changes and medication provides reliable long-term relief.”
If left untreated, GERD can lead to complications that affect the esophagus, including:
- Esophagitis (irritation or inflammation of the esophagus lining)
- Strictures (abnormal narrowing that can make swallowing difficult)
- Barrett’s esophagus (a pre-cancerous change in the esophageal lining)
- Esophageal cancer (rare)
What is GERD?
GERD is a digestive condition that happens when the muscle at the bottom of the esophagus, called the lower esophageal sphincter (LES), does not close the way it should.
Normally, the LES acts like a valve. It keeps stomach acid from flowing back into the esophagus. When this muscle weakens or relaxes too often, acid can travel upward irritating the esophagus lining and causing symptoms.
Symptoms often worsen after large meals, when lying down or bending over. Certain trigger foods may make symptoms worse.
Common symptoms include:
- Heartburn
- Regurgitation
- Chronic cough
- Hoarseness
- Difficulty swallowing
- Chest discomfort
Certain symptoms need prompt medical attention including worsening difficulty swallowing, bleeding, anemia or unexplained weight loss.
Who gets GERD?
About 20% of adults in the U.S. experience GERD symptoms at least once a week.
Several factors can raise the risk, including:
- Obesity
- Smoking
- Pregnancy
- Hiatal hernia
- Certain medical conditions, such as gastroparesis
Pregnancy and GERD
Studies estimate that 30% to 80% of pregnant women have reflux symptoms. It happens most often in the second and third trimesters. Hormone changes and increased abdominal pressure can cause reflux. Symptoms usually improve after delivery.
What is a hiatal hernia?
A hiatal hernia occurs when part of the stomach moves up through the diaphragm, the muscle that separates the chest from the abdomen. This can weaken the valve between the esophagus and stomach, increasing the risk of acid reflux.
“Hiatal hernias are common, especially as you get older, mainly due to age-related changes in muscle strength and tissue support,” Dr. Moawad says. “Many are small and do not cause symptoms. But in some patients, they can worsen reflux and may need treatment if GERD is severe.”
Surgery is typically considered only when symptoms are severe or when complications develop.
Common food triggers
Certain foods and drinks can trigger GERD symptoms in some people. They do not cause GERD itself. Common triggers include:
- Chocolate
- Peppermint
- Fatty or fried foods
- Coffee
- Alcohol
- Spicy foods
Triggers can vary from person to person. Tracking meals and symptoms can help identify personal dietary patterns and reduce reflux episodes.
GERD medications
Treatment for GERD depends on how often symptoms occur and how severe they are.
Antacids provide quick, short-term relief by neutralizing stomach acid.
H2 blockers reduce acid production and are commonly used for mild to moderate GERD symptoms.
Proton pump inhibitors (PPIs) are the most widely used medications for healing esophageal inflammation and treating moderate to severe GERD. A newer class of medications called potassium competitive acid blockers (PCABs) work similarly and may be used when PPIs are not fully effective.
“PPIs and PCABs are the most effective medical treatment for GERD,” Dr. Moawad explains. “When used as directed and with medical supervision, they are safe for most patients. The goal is always to use the lowest dose that works.”
Long-term use of these medications have been linked to certain risks, including nutrient deficiencies. However, for people who need them to control GERD symptoms, the benefits often outweigh the risks.
Prokinetic agents can help the stomach empty faster and can reduce reflux episodes. They are used less often than other medications because they may cause side effects.
Surgery for GERD
Surgery may be an option for people with severe GERD symptoms or symptoms that do not improve with treatment or those who want to avoid long-term medication. Before recommending surgery, doctors use tests, such as endoscopy or esophageal function tests, to confirm the diagnosis and understand its severity.
Fundoplication is a surgery used to treat GERD by strengthening the valve between the esophagus and stomach to reduce acid reflux.
The most common type, Nissen fundoplication, involves wrapping the upper part of the stomach around the lower esophagus to reinforce the valve and prevent acid from flowing back up.
Possible side effects include difficulty swallowing, gas-bloat syndrome or trouble burping. However, many patients experience significant symptom relief.
Transoral Incisionless Fundoplication (TIF) is a minimally invasive procedure performed through the mouth. Using a flexible endoscopic device, the surgeon reconstructs the anti-reflux valve without making external incisions.
- TIF may be an option for people with:
- Mild to moderate GERD
- Small hiatal hernias
- Patients not responding fully to medication
Most patients return to normal activities within days.
Lifestyle changes
For many people with GERD, lifestyle changes are essential and may be enough to control symptoms.
Helpful strategies include:
- Eating smaller, more frequent meals
- Avoid eating 2–3 hours before lying down or going to bed
- Elevating the head of the bed
- Sleeping on your left side
- Losing excess weight, if needed
- Quitting smoking
- Identifying and limiting personal trigger foods
“Lifestyle strategies are not optional — they’re foundational,” Dr. Moawad says. “Even patients on medication often see better control when they adjust habits that trigger reflux.”
Consult a doctor if you often have reflux symptoms. Early treatment can help prevent problems and improve quality of life.
At Scripps, gastroenterologists and surgeons across San Diego County provide comprehensive GERD care, including advanced diagnostics and minimally invasive treatment options.