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In general, drug therapy for gastroesophageal reflux disease (GERD) may include:

• Antacids
• H2-receptor antagonists
• Proton pump inhibitors

Antacid Therapy

Antacid therapy is usually the first-line approach for the medical (drug) therapy of gastroesophageal reflux disease (GERD). Although antacids are effective in neutralizing stomach acid and can, therefore, relieve symptoms of GERD, their duration of action is relatively short (usually less than one-hour). The best way to take antacids is usually one-hour after a meal or just as symptoms of GERD start after a meal. Most antacid medications are available over-the-counter in either liquid, chewable tablet, or chewing gum form. Examples of antacids that may be used for the relief of mild GERD symptoms include:

• Calcium carbonate-based antacids - Examples include Rolaids and Tums. Some patients with GERD may experience a worsening of GERD symptoms with antacids containing calcium carbonate due to a phenomenon known as "acid rebound". Although this is rare, if you experience a worsening or your symptoms, try switching to another type of antacid medication that does not contain calcium carbonate.

• Aluminum and/or magnesium-based antacids - Examples include Mylanta, Maalox, and Gaviscon. Patients with chronic kidney disease should avoid taking these antacid preparations because they can cause an abnormal increase of aluminum or magenesium in the bloodstream.

Although antacid therapy can help to relieve mild GERD symptoms, most patients with moderate to severe GERD will not respond to antacid therpy and will require treatment with other medications such as H2 receptor antagonists and/or proton pump inhibitors.

H2-Receptor Antagonists

Acid-producing cells in the stomach are stimulated by a chemical called histamine. When histamine binds to a specific receptor (binding site) on the surface of acid-producing stomach cells (called the H2-receptor) it stimulates these cells to produce acid. H2-receptor antagonists are a class of medications that suppress acid production by cells in the stomach by binding to the H2-receptor and, thereby, preventing histamine from binding to the surface of these cells. By occupying the H2-receptor, these drugs block the action of histamine and, thereby, help to suppress acid production.

Examples of commonly used H2-receptor antagonists include:

• Cimetidine (e.g., Tagamet)
• Ranitidine (e.g., Zantac)
• Famotidine (e.g., Pepcid)
• Nizatidine (e.g., Axid)

With the exception of cimetidine (e.g., Tagamet; Dyspamet), the H2-receptor antagonists are usually well-tolerated by most patients with few side effects. Common side effects of cimetidine may include:

• Headache
• Fatigue
• Gastrointestinal disturbances (e.g., constipation; diarrhea)
• Dizziness
• Skin rashes

In general, H2-receptor antagonists are used mainly for the treatment of patients with mild to moderate GERD and are effective in about 75% of cases. Most gastroenterologists and primary care physicians, however, have come to the realization that while these medications are somewhat effective for the relief of intermittent heartburn symptoms, they lack sufficient benefit for patients with moderate to severe GERD, especially those patients with moderate to severe esophagitis. For these patients, a successful treatment regimen must include a class of medications known as proton pump inhibitors.

Proton Pump Inhibitors for Gastroesophageal Reflux Disease (GERD)