Acid reflux (GERD)

Introduction
Gastroesophageal reflux disease (GERD), commonly referred to as acid reflux, occurs when stomach contents flow back into the esophagus, leading to symptoms such as heartburn, regurgitation, and chest discomfort. If left untreated, GERD can cause complications including esophagitis, strictures, or Barrett’s esophagus. The goal of treatment is to relieve symptoms, promote healing, and prevent recurrence through pharmacologic, lifestyle, and in some cases, surgical interventions.

1. Proton Pump Inhibitors (PPIs)

• Omeprazole: 20–40 mg once daily, taken before meals.

• Esomeprazole: 20–40 mg once daily, may increase to twice daily in severe cases.

• Pantoprazole: 40 mg once daily; can be increased to twice daily for refractory symptoms.

• Lansoprazole: 15–30 mg once daily, before breakfast.

• Rabeprazole: 20 mg once daily, dose may be adjusted depending on response.

2. H2-Receptor Antagonists (H2RAs)

• Famotidine: 20 mg twice daily or 40 mg at bedtime.

• Nizatidine: 150 mg twice daily or 300 mg once at bedtime.

• Ranitidine: 150 mg twice daily or 300 mg at night (less commonly used due to safety concerns).

3. Antacids and Alginates

• Aluminum hydroxide, magnesium hydroxide, calcium carbonate: Used as needed for rapid symptom relief.

• Alginic acid formulations: Form a protective barrier that reduces reflux episodes.

4. Prokinetic Agents

• Metoclopramide: 10 mg three times daily before meals, limited by risk of extrapyramidal side effects.

• Domperidone: 10–20 mg three times daily before meals, where available, with fewer central nervous system effects.

5. Lifestyle and Dietary Modifications

• Weight reduction for overweight or obese patients.

• Avoiding trigger foods such as caffeine, alcohol, chocolate, citrus, spicy or fatty foods.

• Eating smaller, more frequent meals.

• Elevating the head of the bed and avoiding lying down for at least 2–3 hours after meals.

• Smoking cessation.

6. Surgical and Interventional Options

• Laparoscopic Nissen fundoplication: Reinforces the lower esophageal sphincter to prevent reflux.

• LINX reflux management system: A magnetic device placed around the lower esophageal sphincter to augment barrier function.

• Endoscopic procedures: In selected cases, to reduce reflux when medical therapy fails.