GERD Treatments Overview

Treatments for GER

Initial treatment of reflux consists of avoiding reflux triggers and making life style changes.

Medications will often be used for patients with significant reflux. There are several classifications of medicine that can be used to treat GERD.

Patients may react quite differently to different brands of medication.

Alternative and complementary medicines have been used successfully by many parents, but members of PAGER typically have such severe reflux that alternative medicine is of little benefit to them.

Antireflux surgery tends to be reserved for reflux that doesn't respond to strong medication or those children with such dangerous reflux that the doctors don't want to wait for the disease to go away by itself.

All medications have possible side effects. Parents must weigh any potential side effects against the dangers of untreated GERD, which can also be significant. Most of the GERD medications, with the exception of prokinetics, have few side effects.

Lifestyle Changes

The first treatments for mild and moderate GER are "lifestyle" changes. These techniques are often used in conjunction with medication for children who have moderate to severe reflux disease.

In children these Lifestyle Changes include:

Keeping the child upright, particularly after meals and avoiding a lot of movement afer meals.
Feeding slowly, not overfeeding, burping well, avoiding foods that aggravate reflux, avoiding foods that are not well tolerated by the individual. (See the Frequently Asked Questions and under the GERD heading above)
Adding 1T of infant cereal flakes per ounce of formula - ONLY IF instructed by your doctor
Avoiding clothes that constrict the waist, bending at the waist after meals, laying down on a full stomach. In older children, this includes losing extra weight which pushes on the abdomen.
Avoiding second hand smoke which can greatly aggravate reflux
Treating constipation which can compound GERD

All of this seems very simple until you try it at home. We joke that the best gift the mother of a baby with reflux can receive is a third arm. Most of our mothers can make dinner with one hand and some use the toilet while holding their child upright and sleep in a chair while holding their child. PAGER started out as simply a way for parents to learn homecare tricks from each other.

Medications

The links page has a full list of brand names and links to the physician prescribing information label

Antacids are typically used for quick control of mild cases of acid reflux. They are not used for treating chronic or severe reflux. They come in many flavors and most brands are available in chewable and liquid forms. Antacids can bring relief within a minute, but the stomach may simply make more acid and the symptoms may begin again.

Antacids typically contain calcium, aluminum or magnesium as the main ingredient. Many brands of antacid contain a mixture of these ingredeints because aluminum causes constipation and magnesium causes diarrhea. Amphagel brand of antacid contains alginic acid slurry. This chemical is not absorbed by the body. It becomes foamy in the body and forms a floating barrier that sits on top of the stomach acid. Prelief is a type of antacid that is designed to be added to acidic foods. It also comes in a pill form.

Caution: self medicating severe or chronic reflux with antacids can allow symptoms to get worse over time. Taking antacids with other medications such as acid suppressors or acid blockers may inactivate the other medication.

Acid suppressors are typically used for moderate to severe reflux. They reduce the amount of acid that is produced in the stomach. They don't prevent the stomach contents from backwashing, but less acid means less burning and damage to the esophagus and airway.

Many acid supprssors are now available over-the counter-without a prescription: Zantac, Tagamet, Pepcid, Axid. Do not use these medications without permission from your doctor. Infants and children too young to swallow pills may need a liquid form acid blocker which is available by prescription. Zantac liquid contains a lot of alcohol so many parents have their pharmacist make a liquid by dissolving pills. Acid suppressors take about a week to start working well and it may take another week for your child to feel relief from pain.

Acid blockers In the past, acid blockers were used only after trying several brands of acid suppressors. They are rapidly becoming a first line drug for moderate to severe reflux.

Barriers
Barrier medications are designed to keep acid from touching the esophagus. Carafate is a medication that coats the inside of the esophagus and stomach. It is useful for healing errosive esophagitis. Alginic acid slurry is an ingredient in Gaviscon that creates a foam that floats on top of the stomach contents and minimizes splashing. Neither of these drugs are absorbed by the body.

Prokinetic medications are medications that help the food keep moving downward in the digestive system. They work by tightening the sphincters and valves so that the food doesn't sit in the stomach too long. When food clears slowly out of the stomach, it becomes increasingly acidic and a single backwash episode can be very damaging. These medications are typically used for children who have significantly delayed emptying or severe constipation that doesn't respond to other treatments.

PAGER staff wrote an article which appeared in the May issue of Practical Gastroenterology warning of potentially serious side effects of these medications.

DO NOT DISCONTINUE THESE MEDICATIONS. STOPPING THEM CAN CAUSE MEDICAL PROBLEMS AND SHOULD ONLY BE DONE WITH MEDICAL SUPERVISION.

Surgery - there is an entire issue of Reflux Digest devoted to the questions parents need to ask when considering surgery.

Check with your
doctor first!