Gastro-oesophageal reflux: treatment
The oesophagus is the tube that connects your throat to the stomach. Food is pushed down the oesophagus by a series of muscle contractions. Gastro-oesophageal reflux means the return, or reflux, of the stomach's contents back up into the oesophagus, which can eventually damage the oesophagus because it ends up being regularly bathed in stomach acid. It is a very common condition. It is estimated that 15 to 20 per cent of adults experience symptoms of gastro-oesophageal reflux at least once a week.
If you have gastro-oesophageal reflux disease (GORD), treatment will be based on how severe your symptoms are and whether or not you have complications from the condition. Complications might include:
- bleeding (which can result in vomiting blood, although this is rarely severe, or iron-deficiency anaemia);
- stricture (a narrowing of the oesophagus that can cause difficulty swallowing);
- Barrett's oesophagus (where there is an increased risk of oesophageal cancer due to a change in the type of cells lining the oesophagus); or
- respiratory symptoms such as cough or wheeze.
Lifestyle changes
If you have only mild symptoms that don't cause you much pain, or your symptoms occur only from time to time, your doctor may recommend lifestyle measures before suggesting you try medication. Your doctor may suggest you avoid foods that bring on attacks of heartburn. Some people find that cutting out chocolate, fatty foods and spicy foods helps. Your doctor may also advise you to avoid alcohol, reduce your weight if you are overweight, and/or stop smoking.
If lifestyle measures aren't enough to control your symptoms of reflux and you do need medication, the good news is that many people with gastro-oesophageal reflux can have their symptoms relieved with a relatively simple medication regimen.
Antacids
These are used to relieve symptoms in mild reflux disease and should be taken when symptoms occur, or between meals and at bedtime. Various preparations are available, including:
- magnesium salts, including magnesium carbonate (e.g. Rennie), magnesium trisilicate (Gastrogel) and magnesium hydroxide (e.g. Mylanta);
- aluminium hydroxide (e.g. Alu-Tab), which acts fairly slowly and has a relatively low acid neutralising ability, but which may have the additional action of helping to protect the lining of the stomach; and
- calcium carbonate (e.g. Andrews Tums Antacid).
Combination products are available which contain these and other ingredients, such as alginates (e.g. Gaviscon, Mylanta Heartburn Relief).
Antacids usually come as liquid suspensions or tablets. Liquid preparations are more effective than tablets, which need to be chewed thoroughly before swallowing to ensure they dissolve completely in the stomach. However, tablets have the advantage of being more easily portable.
Side effects
Sometimes magnesium preparations may cause increased burping and diarrhoea, and preparations containing aluminium may cause constipation. If you have heart or kidney failure you should avoid products containing sodium.
If you are taking other medicines, you should not take antacids at the same time as you take those medicines. Your doctor will be able to advise you about interactions among medicines and how to time the administration of different medicines so that you are not taking them together.
H2 antagonists
If you are getting symptoms on most days, an H2 antagonist (histamine-receptor antagonist) can be used for mild-to-moderate disease. These medicines are available both on prescription and over the counter. They include famotidine (e.g. Pepcidine, Pepzan), nizatidine (e.g. Tazac) and ranitidine (e.g. Zantac, Zantac relief).
They work by blocking the action of histamine, a substance that stimulates the secretion of stomach acid. Because less acid is being produced by the stomach, the pain from acid reflux is reduced.
H2 antagonists are very effective and have relatively few side effects, even with long-term use, but some people, particularly older people, may experience central nervous system related effects such as headaches, confusion and tiredness.
Proton pump inhibitors
Doctors consider these medicines to be the most effective in suppressing the production of stomach acid and one of these may be prescribed if you have frequent or moderate-to-severe symptoms.
Proton pump inhibitors reduce the amount of stomach acid by inhibiting the system that ‘pumps’ acid into the stomach, and are very effective in allowing oesophageal ulcers to heal. They include esomeprazole (Nexium), lansoprazole (Zoton), omeprazole (Losec), pantoprazole (Somac) and rabeprazole (Pariet). Most people's symptoms of reflux can be suppressed with proton pump inhibitors. Generally they are well tolerated, but the most common side-effects, when they do occur, include headache, nausea and diarrhoea.
There are also some low-dose proton pump inhibitors that are available from pharmacies without a prescription, including rabeprazole (Pariet 10) and pantoprazole (Salpraz Heartburn Relief, Somac Heartburn Relief, Suvacid Heartburn Relief). Omeprazole (Maxor Heartburn Relief) is a proton pump inhibitor that is available in standard dose from pharmacies without a prescription. These medicines can be used to control symptoms in the short term.
Surgical treatment
Surgery is generally reserved for people who have reflux symptoms that are not controlled by medicines, and for those who do not want to take medicines long term and are willing to accept the small risks involved with surgery. Fundoplication is a procedure that aims to ‘tighten’ the junction between the stomach and the oesophagus and reduce the amount of acid that enters the oesophagus. This procedure can be performed using a ‘key-hole’ approach called laparoscopy.
Last Reviewed: 01 June 2011
- 1. Gastro-oesophageal reflux (revised February 2011). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2011 Mar. http://online.tg.org.au/complete/ (accessed May 2011).
2. Pariet 10 Prescribing Information. J&J Pacific. Accessed via eMIMS. Date of TGA approved information: 01/04/2010.
3. Somac Heartburn Relief Prescribing Information. Nycomed. Accessed via eMIMS. Date of TGA approved information: 31/07/2008.
