11. What is the goal of medical therapy for GERD?

The mainstay of therapy for GERD is acid suppression.  The most effective medications are the proton pump inhibitors such as Nexium, Prilosec, Prevacid, and Protonix.

Medical therapy can heal esophagitis in the overwhelming majority of patients.  Medical therapy can usually control heartburn symptoms.  Atypical symptoms respond to high dose medical therapy approximately 60% of the time.

What are the principles of medical therapy?

In patients with GERD, esophageal acid exposure is reduced by up to 80% with H2 receptor antagonist such as Zantac or Pepcid and up to 95% with proton pump inhibitors such as Nexium, Protonix and Prevacid.

The mainstay of medical therapy is acid suppression.  Medical therapy is usually sufficient to heal mild esophagitis.  In patients with severe esophagitis, healing may occur in only 75%.

Even with proton pump inhibitor therapy, periods of acid breakthrough can occur.  This occurs most commonly during nighttime and is a reason to give two doses a day.  Acid breakthrough may occur in the absence of symptoms and may be responsible for persistent esophagitis in some patients.