How to Manage GERD Without Proton Pump Inhibitors

I have nothing against Prilosec in particular. It can be very helpful. It’s one of several PPIs on the market.

I’ve written several blog posts on the risks of chronic use of PPIs (proton pump inhibitors) for gastro-esophageal reflux disease (GERD). By “chronic use” I mean daily or several days every week. In order to avoid the risks of PPI usage, a recent commenter asked me about non-PPI management options.

I’ll assume that occasional use of antacids, H2 blockers (histamine 2 receptor agonists like famotidine), and proton pump inhibitors is not an adequate remedy. At some point (sooner rather than later), you’ll also want to be sure the diagnosis truly is GERD and not something else. This may well require a consultation with a gastroenterologist.

BTW, having to pop a couple Tums antacids for heartburn once every 2-3 months is not a disease. It’s not GERD. It’s occasional heartburn. Untreated GERD symptoms are much more frequent and may be more intense or more prolonged.

So here are some non-PPI options for management of GERD in adults. Some of these will help one person but not the next, and experimentation may be in order.

  • Lose excess weight. Even common overweight can aggravate the condition.
  • Elevate head of bed on 6-8 inch bricks.
  • Avoid supine posture after meals.
  • No eating for 2-3 hours prior to bedtime.
  • Avoid tobacco and alcohol.
  • Low-carb diet.
  • Avoid tight-fitting garments over the abdomen.
  • Avoid common triggers: spicy food, carbonated beverages, onions (especially raw), chocolate, high-fat foods, caffeine. If you’re sure these don’t trigger your own GERD, then no particular need to avoid. A spicy meal one week ago doesn’t cause your GERD today. Your triggers will typically be ingested 30 minutes to 8 hours prior to symptom onset.

Medication alternatives to PPIs and H2 blockers (histamine 2 receptor agonists like famotidine):

  • Sucralfate if pregnant.
  • Metoclopramide if gastroparesis is present (delayed gastric emptying).
  • Sodium alginate.

Bothersome symptoms that are refractory to all usual treatment? Get EGD (esophagogastroduodenoscopy) and ambulatory esophageal pH-metry from a gastroenterologist.

Final options for refractory GERD:

  • Anti-reflux surgery
  • Transoral incisionless fundoplication

There are probably other options for GERD suppression that I haven’t mentioned.

Finally, I’m not your doctor and don’t know any of the details of your situation. For all you know, I may not even be a real doctor. Work with your personal physician!

Steve Parker, M.D.

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