Treatment with Medications
GERD can be treated with medications. These may be over the counter or prescription. Some medications work right away. Others take more time before you find relief. Your doctor will work with you to find the best medications for your symptoms.
Types of Medications
Medications for GERD work in different ways. Based on the severity of your symptoms, you may be advised to take one or more of the following:
- Antacids. These help neutralize stomach acid. They work quickly, but are only useful for mild reflux.
- H2 blockers. These cause the stomach to make less acid.
- Proton pump inhibitors (PPIs). These also cause the stomach to make less acid, but they are stronger than H2 blockers.
- Prokinetics. These strengthen the squeezing action of the esophagus and tighten the LES. They are often used along with H2 blockers. Some of these medications also make the stomach empty faster.
Medications Can Have Side Effects
Both over-the-counter and prescription medications for GERD can have side effects. Talk with your doctor or pharmacist about the possible side effects of any medication you take. For your safety, let your doctor or pharmacist know if you’re taking any other medications or have any known health problems.
If Surgery Is Needed
If other types of treatments fail to relieve your symptoms, surgery may be recommended. Your doctor will discuss benefits and risks of surgery with you. You will be told how to prepare for surgery. Follow all instructions carefully.
Tests Done Before Surgery
To check your health before surgery, your doctor may order certain tests. These can include blood tests, an ECG (electrocardiogram), and a chest x-ray to check your heart and lungs. You may also have a test called esophageal manometry. This test is used to measure the muscle tone of the LES and to tailor the surgery to your needs. The test also shows how well the esophagus moves food along.
Preparing for Surgery
- Tell your doctor about all medications you take. This includes over-the-counter medications, herbs, and supplements. If you take medications to prevent blood clots, be sure to mention them. You may need to stop taking some or all of these before surgery.
- Stop smoking. Smoking increases surgery risks and slows healing.
- Stop eating and drinking as directed before the surgery. If you have been told to take medications, take them with small sips of water.
- Arrange for help after the surgery. You’ll want to take it easy right after surgery, so arrange for help at home. Also, plan to have someone drive you to the hospital and pick you up afterward.
Risks and Complications
Risks of surgery for GERD include:
- Injury to the liver, spleen, esophagus, or stomach
- Increased gas or bloating
- Inability to vomit
- Trouble swallowing
- Failure to relieve symptoms
- Risks of anesthesia
- Need to convert to an open procedure
Treatment with Surgery
Surgery for GERD is called fundoplication. During surgery, the LES is strengthened by wrapping the very top of the stomach around the lower part of the esophagus. The surgery typically takes 2 to 4 hours.
The Day of Surgery
Arrive at the hospital or surgery center on time. As you’re readied for surgery, you may be asked more than once to provide your name and what procedure you’re having. This is for your safety. You’ll be given an IV (intravenous) line to supply fluids and medication. You’ll also be told about the anesthesia that keeps your free from pain during the surgery. You may be drowsy but awake. Or, you may be in a state like deep sleep through the surgery.
Surgery is most often done using laparoscopy. This approach uses a thin, lighted tube called a laparoscope (scope).
- The surgeon makes several small incisions in the abdomen.
- The scope is inserted through one incision. Surgical tools are placed through the other incisions. The scope has a camera attached, which sends live images to a monitor.
- The abdomen is filled with carbon dioxide (CO2) gas. This provides more space for the surgeon to see and work.
- The CO2 gas and all surgical tools are removed after surgery.
- The incisions are closed with stitches or strips of surgical tape.
If Open Surgery is Needed
During surgery, the surgeon may switch from laparoscopy to open surgery (also called open fundoplication). This does NOT mean something has gone wrong. Instead, a larger incision is needed to complete the procedure safely. Having open surgery means a longer hospital stay and recovery.
How the Surgery is Done
Repairing a Hiatal Hernia
If the opening of the hiatus is too large (hiatal hernia), the surgeon may tighten it with a few stitches. This repairs the hiatal hernia. Nothing is opened, removed, or rerouted during the procedure.
Strengthening the LES
To add support, the surgeon wraps the top of the stomach around the outside of the esophagus. This helps prevent reflux. To make sure the wrap is not too tight, a flexible rubber tube (bougie) may be temporarily inserted into the esophagus. The wrap is permanently stitched in place. If needed, the esophagus is widened (dilated) during surgery.
Full or Partial Wrap
Two Wraps may be used for the surgery. A full wrap goes all the way around the LES. A partial wrap goes only part of the way around. The surgeon will choose the wrap that is best for your case.
Recovering from Surgery
Most people go home 1 to 3 days after surgery. Follow your doctor’s instructions on how to care for yourself during recovery. You may be able to start on a liquid diet soon after surgery. Once you’re fully recovered, you’ll be able to eat without the pain and discomfort of GERD.
In the Hospital
After surgery, you’ll move to the recovery area, where you’ll be closely watched. Once you wake up, you’ll be taken to your hospital room. You’ll receive pain medications as needed. Soon, you’ll be out of bed and walking around. A nurse or therapist will teach you coughing and breathing exercises to help prevent lung problems. Within a day or so after surgery, you’ll start a liquid diet. Your doctor will determine when you can begin eating soft foods. These are foods that are moist and easy to swallow and digest. Solid foods will be added back to your diet as you can tolerate them. How long this takes varies for each person.
Back at Home
Take it easy when you return home. Don’t do any heavy lifting or vigorous activities. Follow your doctor’s advice about showering, driving, and returning to work. To help speed your recovery along, walk as often as you feel able. Also, continue the coughing and deep breathing exercises that you learned in the hospital for as long as directed.
Caring for Your Incisions
Your incisions will be covered with bandages. These may be removed a day or two after surgery. If strips of surgical tape were used to close your incisions, don’t pull them off. Let them fall off on their own. Once you’re allowed to get the incisions wet, gently clean the area with warm water and soap. Don’t use oils, powders, or lotions on your incisions.
Eating and Drinking
At first, swallowing may be hard. This will gradually improve as you recover. You’ll be given specific guidelines about what to eat and drink after surgery. These tips may help:
- Eat smaller meals more often. Also, take small bites and chew your food well. These actions may help prevent gas buildup and ease swallowing.
- Sit straight up while eating.
- Avoid drinking alcohol until your doctor says it’s okay.
Follow Up with Your Doctor
See your doctor for follow-up visits as directed. These allow your doctor to check your progress and make sure you’re healing well. During follow-up visits, tell your doctor if you have any new symptoms or any reflux. Also be sure to ask questions you have.
When to Call the Doctor
Once at home, call your doctor if you develop any of these signs of symptoms:
- Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher
- Increased redness, bleeding, swelling, pain, or drainage around any incisions
- Abdomen becomes tender or feels hard
- Nausea or vomiting
- Chest pain or shortness of breath
- Trouble swallowing that continues to worsen
- Bloody vomit or black, tarry stools
Work with Your Doctor
GERD can be uncomfortable, but it can be managed. Work with your doctor to find the treatment options that are right for you. With treatment and help from your doctor, you can get relief from pain and burning so you can feel good again.
Change for Your Health
Make long-term changes that will help control GERD and improve your overall health. To feel your best:
- Maintain a healthy weight.
- Get regular exercise.
- Make healthy food choices.
- Quit smoking.
- Limit alcohol.