Heartburn and gastro-oesophageal reflux disease - Treatment 

Treating gastro-oesophageal reflux disease 

Weight loss tips

Losing weight can help improve the symptoms of GORD. In this video people talk about how they have successfully lost weight and an NHS dietitian offers useful tips.

Media last reviewed: 14/11/2013

Next review due: 14/11/2015

Babies and infants

Treatment for babies and infants with mild symptoms of GORD isn't always needed because they often grow out of the condition after a few months.

However, see your GP if your child's symptoms are persistent or troublesome. You may be advised to add a thickener to your breast milk or formula feed, such as alginate (sold under the brand name Gaviscon Infant).

If you're breastfeeding, removing cow's milk from your diet can often improve the symptoms of GORD (if your baby is allergic to cow's milk). Soya milk can also be used as an alternative.

If these treatments don't improve your child's symptoms, they may be referred to a doctor who specialises in treating children (a paediatrician).

A number of treatments are available for gastro-oesophageal reflux disease (GORD), including simple, self-care measures, medication and surgery.

Self care

If you have GORD, you may find the following self-care techniques useful:

  • If you're overweight, losing weight may reduce your symptoms, as it will reduce pressure on your stomach.
  • Giving up smoking can help, as smoke irritates your digestive system and can make your symptoms worse.
  • Eating smaller, more frequent meals, rather than three large meals a day can help. Make sure you have your evening meal three or four hours before bedtime.
  • Alcohol, coffee, chocolate, tomatoes, or fatty or spicy food can trigger the symptoms of GORD. If you suspect that any of these make your symptoms worse, remove them from your diet to see whether your symptoms improve.
  • Raise the head of your bed by around 20cm (8 inches) by placing a piece of wood or blocks under it. This may improve your symptoms. However, make sure your bed is sturdy and safe before adding the wood or blocks. Don't use extra pillows, because it may increase pressure on your abdomen.

If you're currently taking medication for other health conditions, check with your GP to find out whether they may be contributing to your symptoms.

Alternative medicines may be available, but don't stop taking a prescribed medication without consulting your GP first.

Medication

A number of different medications can be used to treat GORD. These include:

  • over-the-counter medications
  • proton-pump inhibitors (PPIs)
  • H2-receptor antagonists (H2RA)

Depending on how your symptoms respond, you may need medication either on a short- or long-term basis.

Over-the-counter medications

A number of over-the-counter medicines can be used to help relieve mild to moderate symptoms of GORD.

Antacids neutralise the effects of stomach acid. However, they shouldn't be taken at the same time as other medicines, because they can stop other medicines being properly absorbed into your body. They may also damage the special coating on some types of tablets. Ask your GP or pharmacist for advice.

Alginates work differently. They produce a protective coating that shields the lining of your stomach and oesophagus from the effects of stomach acid. They work best if taken just after finishing a meal.

Proton-pump inhibitors (PPIs)

If GORD fails to respond to the self-care techniques described above, your GP may prescribe a one-month course of a PPI for you. PPIs work by reducing the amount of acid produced by your stomach.

Most people tolerate PPIs well, and side effects are uncommon. When side effects do occur, they're usually mild and may include:

To minimise any side effects, your GP will prescribe the lowest possible dose of PPIs that they think will be effective in controlling your symptoms. Therefore, tell your GP if they prescribe PPIs for you that prove ineffective, because a stronger dose may be needed.

The symptoms of GORD can sometimes return after a course of PPIs has been completed. Go back to your GP if you have recurring or persistent symptoms. 

In some cases, PPIs may be needed on a long-term basis.

H2-receptor antagonists (H2RA)

If PPIs can't control your GORD symptoms, another medicine known as a H2RA may be recommended to take in combination with PPIs on a short-term basis (two weeks), or as an alternative to them.

H2RAs block the effects of the chemical histamine, which is used by your body to produce stomach acid. H2RAs therefore help reduce the amount of acid in your stomach.

Side effects of H2RAs are uncommon, but possible side effects may include:

  • diarrhoea
  • headaches
  • dizziness
  • tiredness 
  • a rash

Some types of H2RAs are available over the counter. They're taken in lower doses than H2RAs that are available on prescription. Ask your GP or pharmacist if you're unsure whether these medicines are suitable for you.

Surgery

Surgery is usually only recommended in cases of GORD that fail to respond to the treatments discussed above.

Alternatively, you may want to consider surgery if your symptoms are troublesome and persistent, but you don't want to take medication on a long-term basis.

While surgery for GORD can help relieve your symptoms, there are some associated complications that may cause additional symptoms, such as:

You should discuss the advantages and disadvantages of surgery with your GP before making a decision about your treatment.

You could also ask your GP to refer you to a surgeon who performs the procedure you're considering. They'll be able to discuss the benefits and potential side effects in detail with you.

Surgical and endoscopic procedures used to treat GORD include:

  • laparoscopic nissen fundoplication (LNF)
  • endoscopic injection of bulking agents
  • endoluminal gastroplication
  • endoscopic augmentation with hydrogel implants
  • endoscopic radiofrequency ablation
  • laparoscopic insertion of a magnetic bead band 

These procedures are discussed below.

Laparoscopic nissen fundoplication (LNF)

Laparoscopic nissen fundoplication (LNF) is one of the most common surgical techniques used to treat GORD. It uses "keyhole surgery", avoiding the need for a large incision.

It involves the surgeon wrapping the upper section of your stomach around your oesophagus to form a collar. This helps tighten your lower oesophageal sphincter (LOS), to stop acid moving back out of your stomach.

LNF is carried out under general anaesthetic and takes 60 to 90 minutes.

After having LNF, most people can leave hospital after recovering from the effects of the general anaesthetic. This is usually within two or three days. Depending on the type of job you do, you should be able to return to work within three to six weeks.

For the first six weeks after surgery, you should only eat soft food, such as mince, mashed potatoes or soup. Avoid hard food that could get stuck at the site of the surgery, such as toast, chicken or steak.

Common side effects of LNF include:

  • dysphagia
  • belching
  • bloating
  • flatulence 

These side effects should resolve over the course of a few months. However, they can persist in about 1 in 100 cases. In such cases, further corrective surgery may be needed.

New surgical techniques

In the last decade, a number of new surgical techniques have been developed for GORD.

The National Institute for Health and Care Excellence (NICE) has looked at many of these new techniques and states that they are safe enough to be made available on the NHS.

However, NICE also states that there's little scientific evidence about their effectiveness in the medium- to long-term. They therefore acknowledge that several of these techniques, particularly the endoscopic procedures, are best offered in the context of a properly designed research study.

The techniques discussed below are non-invasive (apart from LINX), which means no incisions need to be made in your body. Therefore, they can usually be carried out under local anaesthetic on a day surgery basis, so you shouldn't have to spend the night in hospital.

Endoscopic injection of bulking agents

Endoscopic injection of bulking agents involves a surgeon injecting a filler where the stomach and oesophagus meet, narrowing the junction and helping to stop acid leaking up from the stomach.

The most common side effect of this type of surgery is mild to moderate chest pain. This develops in around a half of all cases. Other side effects include:

  • dysphagia
  • feeling sick
  • high temperature (fever) of 38ºC (100.4ºF) or above

These side effects should resolve within a few weeks.

For more information, read the NICE guidance for endoscopic injection of bulking agents

Endoluminal gastroplication

Endoluminal gastroplication involves the surgeon using an endoscope to sew a series of pleats (folds) into the lower oesophageal sphincter (LOS). The pleats should restrict how far the LOS can open, preventing acid leaking up from your stomach.

Side effects of this type of surgery include:

These side effects should improve within a few days.

For more information, read the NICE guidance for endoluminal gastroplication.

Endoscopic augmentation with hydrogel implants

This is a similar technique to the endoscopic injection of bulking agents described above, except the surgeon uses a different material  a flexible plastic gel that's very similar to living tissue.

The most common complication is that the hydrogel starts to come out of the gastro-oesophageal junction. One study found this happened in one in five cases. However, this is a relatively new technique, and success rates may improve in the future.

For more information, read the NICE guidance for endoscopic augmentation with hydrogel implants.

Endoscopic radiofrequency ablation

In endoscopic radiofrequency ablation, a tiny balloon is lowered down an endoscope to your gastro-oesophageal junction.

Once in place, the balloon is inflated and electrodes attached to the outside produce pulses of heat. The heat creates small scars, which narrow your oesophagus.

Possible complications and side effects may include:

  • chest pain
  • dysphagia
  • injury to the oesophagus

For more information, read the NICE guidance for endoscopic radiofrequency ablation.

Laparoscopic insertion of a magnetic bead band (LINX)

Laparoscopic insertion of a magnetic bead band was introduced in 2011.

The procedure is carried out under general anaesthetic and uses keyhole surgery (laparoscopy) to implant magnetic beads around the lower part of the oesophagus.

The magnetic beads reinforce the LOS muscle and help keep it closed when at rest, preventing stomach acid leaking upwards. The LOS opens normally when swallowing.

This type of surgery appears to be safe and effective in the short term, but its safety and effectiveness in the long term is unknown.

The availability of LINX on the NHS is currently limited, but it's available privately. The price for private treatment is in the region of £8,000-£9,000.

Read about the NICE guidance for LINX.




Page last reviewed: 29/05/2014

Next review due: 29/05/2016

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The 7 comments posted are personal views. Any information they give has not been checked and may not be accurate.

lorns1 said on 18 August 2014

i was diagnosed with gastitis , an ulcer hiatus hernia and a gallstone three yrs ago after 10yrs of pain, i am over weight but not obese and have been refused any type of surgery to remove gallbladder or stones, the meds i have been given i have suffered side affcts the omeprazole and lanzoprazol all make my chest and stomach burn,i have difficulty dieting as i can't eat much and exercise is a nono as i am having frequent flair ups, all my GP can do is keep changing my meds, im sort of at my whits end now with this and would so like an asnwer to relief all symptoms,especially when they all flair up at once

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lorns1 said on 18 August 2014

i was diagnosed with gastitis , an ulcer hiatus hernia and a gallstone three yrs ago after 10yrs of pain, i am over weight but not obese and have been refused any type of surgery to remove gallbladder or stones, the meds i have been given i have suffered side affcts the omeprazole and lanzoprazol all make my chest and stomach burn,i have difficulty dieting as i can't eat much and exercise is a nono as i am having frequent flair ups, all my GP can do is keep changing my meds, im sort of at my whits end now with this and would so like an asnwer to relief all symptoms,especially when they all flair up at once

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Belsane said on 26 June 2014

I'm another long term sufferer on long term meds. Nausea is my worse problem, especially when waking in early hours. Endoscopy ok, awaiting appointment with consultant again, but suspect nothing to be done apart from surgery, which has its own risks/side effects. A bit like Erica H & am equally frustrated by worsened symptoms and lack of effective meds!

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EricaH said on 18 July 2013

I've been stuck on PPIs, peptac liquid and ranitidine for two years and given no further advice or help. They have done absolutely nothing to relieve the symptoms and each time I mention this to my GP he says there is nothing more he can do! I cough cough cough all day long and am sick of it I really am. I am now considering going down the herbal route because I'm at the end of my tether.

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David L said on 08 November 2012

The new device is called LINX, not LINK.
Its there is little good quality evidence on its effectiveness and harms, but it looks promising. Its use in the UK should be within a national research framework, with a clinical audit register.
Also see NICE guidance 431
http://publications.nice.org.uk/laparoscopic-insertion-of-a-magnetic-bead-band-for-gastro-oesophageal-reflux-disease-ipg431

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Phil bus driver said on 31 July 2012

I was diagnosed with a reflux last October and since then I have been sick quite a few times and one time it was a load of blood came up and I have had an endoscopy procedure done and I take 40mg Omerprozole per day is this common?

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weesie3 said on 30 April 2012

How long do doctors usually prescribe PPIs? I have been on 40mg of omeprazole every day for the last seven years.

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