Most patients with gastroesophageal reflux disease (GERD) treat the condition with only medications and have excellent symptom control. Should symptoms persist, over-the-counter antacids may decrease discomfort. Antacids, however, only work for a short time and for this reason they have a limited role in treating reflux disease. Histamine H2-receptor antagonists (cimetidine, ranitidine, famotidine and nizatidine) decrease acid production in the stomach. These medications work well for treating mild reflux symptoms and are quite safe, with few side effects. They are available over the counter at a reduced dose, or at a higher dose when given by prescription by your doctor. Proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, esomeprazole, rabeprazole and dexlansoprazole) are all highly effective in treating reflux symptoms. These medications act by blocking the final step of acid production in the stomach and are typically taken once or twice daily prior to meals. For reflux symptoms that occur frequently, proton pump inhibitors are the most effective medical treatment. Prokinetics, or medications that stimulate muscle activity in the stomach and esophagus, are sometimes provided for the treatment of reflux disease. The only available drug in the market is metoclopramide, which has little benefit in the treatment of reflux disease and has many side effects, some of which can be serious.
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The long-term safety profile of medications for gastroesophageal reflux disease (GERD) is generally good, but they do suppress a normal bodily function -- the production of stomach acid - and a number of problems have been identified. The most notable concerns have been with the decrease in the absorption of vitamins and minerals, such as calcium, vitamin D, and iron. Some studies have documented a higher rate of osteoporosis and hip fracture, which may be due to a lack of absorption. There have also been some concerns raised about infections that can develop. The acid in our stomach kills bacteria that we swallow, and without that acid production, some bacteria may get through to the rest of the body and cause infection. One of the biggest concerns relates to the higher incidence of cancer of the gastroesophageal junction. Rates of this kind of cancer have increased by 600 percent in the last 30 years, which overlaps with the time that these strong anti-acid medications were first introduced. Some studies suggest that there may be a link between the two.