General and Gastrointestinal Surgery
Treatment Options: Medication
The following medications are available to treat reflux:
- Antacids are commonly used by people with heartburn. Antacids are calcium-, magnesium- or aluminum-based drugs that neutralize acid in the stomach. They generally work for 30 minutes to two hours. They are most effective if taken one hour after a meal, when acid production by the stomach is the greatest. A dose at bedtime will help to neutralize acid produced while patients are asleep.
- Prokinetic agents, also known as promotility drugs, such as Propulsid (cisapride) and Reglan (metoclopramide), are medications that increase the strength of esophageal contractions and the resting pressure at the lower esophageal sphincter. These drugs appear to be effective in some patients, especially at night.
- H2 blockers or antagonists, such as Zantac, Tagamet, Axid and Pepcid, act directly on the acid-producing cells of the stomach. These drugs prevent the stimulation of histamine type 2 receptors. Up to 50% of patients will have their symptoms eliminated and their esophagitis healed with a twice a day dosage of H2 blockers.
- Proton pump inhibitors, such as Prilosec (omeprazole) and Prevacid (lansoprazole), are the newest and strongest class of medications that suppress acid in the stomach. These drugs work by blocking the release of acid from the stomach cells, no matter how the cell is stimulated. These drugs are effective in eliminating symptoms and healing esophagitis in 75% to 90% of patients with GERD. However, doses greater than the recommended single dose per day may be required.
- What are the side effects of medications used to treat GERD?
All drugs have side effects which vary from individual to individual. Common complaints with H2 blockers and proton pump inhibitors are headache, nausea, diarrhea, difficulty digesting food and loss of taste of food.
- How much do these drugs cost?
One of the biggest drawbacks of proton pump inhibitors, pro-kinetic agents and even H2 blockers is their cost. In general, they cost about $2,500 per year for the average dose no matter which drug is used.
- How long can these medications be taken?
GERD is often a lifetime disorder so that maintenance on drugs will be necessary for the remainder of a patient's life. Although there is concern about the long-term use of these drugs and the subsequent development of tumors in the stomach, there is no evidence in humans to date to support that. Therefore, it would appear that they are safe for long-term use.