How is GERD (gastroesophageal reflux disease) treated?

Dr. Gary W. Falk, MD

GERD (gastroesophageal reflux disease) occurs when a muscle at the end of the esophagus does not close properly. This allows stomach contents to leak back—or reflux—into the esophagus and irritate it. A burning in the chest or throat, called heartburn ensues.

Anyone, including infants and children, having these symptoms more than twice a week may have GERD. If not treated, it can lead to more serious health problems. There are many effective therapies for GERD including lifestyle modifications, medication and, in some cases, surgery.

Gastroesophageal reflux disease (GERD) cannot be cured, but it can be managed effectively with over-the-counter and prescription medications such as Pepcid and Prilosec.

This answer provided for NATA by the Southern Connecticut State University Athletic Training Education Program.

Gastroesophageal reflux disease (GERD) is usually treated with acid-reducing medications, which help to alleviate symptoms but do not cure the disease. When acid reduction medications do not relieve symptoms or patients do not want to take lifelong medication, mechanical treatment can reinforce the lower esophageal sphincter and decrease or eliminate reflux.

Historically, surgery called fundoplication was recommended for people who were not responding to medications. Fundoplication can eliminate reflux and provide relief of GERD-associated symptoms. Currently, fundoplication is usually performed through several small incisions (“laparoscopically”). One important part of surgical treatment is repair of the hiatal hernia, if present. When no hiatal hernia is present or if it is small, then endoluminal or incisionless treatment may be appropriate. An incisionless procedure allows the performance of fundoplication through the mouth, without any abdominal incisions—no scalpels, no stitches and no scars. The newest device for incisionless fundoplication combines a surgical stapler, ultrasonic sights for accurate positioning and a miniaturized video camera, all in a single instrument. The incisionless procedure for GERD gives people an even faster recovery and fewer complications than the laparoscopic approach.

Louise Goldberg
Nutrition & Dietetics Specialist

There are several things you can do to combat GERD.

Non-medication therapy includes: 

  • Stay upright for a couple hours after eating.
  • Avoid high fat foods, acidic foods (like tomato sauce and citrus fruits), and caffeine.
  • Eat smaller meals at one sitting but more frequently throughout the day.
  • Excess weight may make the problem worse by putting pressure on your stomach. Talk to your physician or dietitian about how to get you on track to lose weight.
  • Don't smoke.
  • Talk to your doctor about reflux medication if the above precautions have shown no benefit.

If you're dealing with chronic reflux then you might want to watch this clip for treatment tips.

Gastroesophageal reflux disease (GERD) is often treated with the lifestyle changes listed below. If symptoms persist, your doctor may recommend medical treatments. In a few cases, surgery may be necessary.

The lifestyle changes below can reduce the irritation of your esophagus. Often they can even correct mild forms of GERD.

  • Don't lie down for 2 hours after eating. Don't bend over at the waist either. Let gravity help your digestion.
  • Avoid foods that cause symptoms. These often include fatty foods, spicy foods, chocolate, onions, tomato sauce, carbonated beverages and mint.
  • Limit coffee to no more than 2 to 3 cups per day.
  • Avoid alcohol.
  • Avoid tight clothing such as tight belts, tight pants or girdles.
  • Take an antacid at bedtime and 30 to 60 minutes after each meal or as directed by your doctor.
  • Review your medications. Check with your doctor if you're taking certain medications, including sedatives, tranquilizers and some types of blood pressure medicines.
  • Eat smaller meals so your stomach isn't holding too much food at once.
  • Stop smoking. If you can't stop smoking, then at least cut back.
  • Lose extra weight. Too much weight can put pressure on your stomach and cause reflux.

When GERD is moderate to severe, your doctor may recommend one or more of the following:

  • Prescription or over-the-counter medicines. Your doctor may recommend an antacid or other medicine to control acid or to strengthen the lower esophageal sphincter (LES). Be sure to take your medicines regularly and just as your doctor prescribes.
  • Endoscopy. This procedure allows the doctor to view the inside of your esophagus with a camera and identify—and sometimes treat—any problems.
  • Dilation. This procedure is done during an endoscopy and stretches your esophagus if it's constricted.

If other treatments don't relieve your GERD, your doctor may recommend a surgery called laparoscopic fundoplication. This surgery allows the doctor to support the esophagus and strengthen the LES.

If you suffer from symptoms of gastric reflux disease, consult with your physician and try some of the following tips to help treat your gastric reflux disease:

  • Eat small, more frequent meals.
  • Sit up while you eat and sit or stand for 45 to 60 minutes after you eat.
  • Eat at least three hours before bedtime. Skip late-night meals or bedtime snacks.
  • Limit or avoid foods and beverages that cause discomfort, like chocolate, coffee, tea, cola and alcoholic drinks. If foods like tomatoes or oranges also cause trouble, eat smaller amounts.
  • Achieve and keep your healthy weight.
  • Sleep with your head slightly propped up on pillows.

More serious cases of gastric reflux disease can require changes to lifestyle, medication or sometimes surgery.

Mrs. Hiral Modi
Nutrition & Dietetics Specialist

Depending on the severity GERD is treated by one or more of the following: lifestyle and dietary changes, medications or surgery.


  1. Eat slowly and chew thoroughly;
  2. Drink fluids in between meals instead of with meals;
  3. Avoid tight fitting clothes;
  4. Lose weight if you are overweight;
  5. Avoid gastric stimulants like smoking, alcohol, caffeine (coffee, soda, tea), cocoa (chocolates);
  6. Avoid foods like tomato and tomato based products (like salsa, spaghetti sauce, pizza, ketchup), citrus fruits and juices (oranges, lime, lemon), garlic and onions, pepper, spicy food, fatty and fried foods, peppermint and other mint flavorings all are known to worsen the symptoms.

MEDICATIONS include: Antacids, H2 blockers, proton-pump inhibitors. Medications for GERD are available over the counter. Follow the directions and dosage. If you symptoms persist beyond 2 weeks of medication consult your healthcare provider. Surgery is very rare option for very severe cases. Most of people benefit from lifestyle changes and medications.

Reflux symptoms sometimes disappear if dietary or lifestyle excesses that cause the symptoms are reduced or eliminated. Avoiding coffee, citrus, spicy food and smoking may reduce your discomfort. 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.

Surgery should be considered in patients with well-documented reflux disease who cannot tolerate medications or continue to have regurgitation as a primary symptom. If symptoms persist despite medical treatment, a comprehensive evaluation should be completed prior to considering surgery. The surgery for treating reflux disease is known as fundoplication. In this procedure, a hiatal hernia, if present, is eliminated and part of the stomach is wrapped around the lower end of the esophagus to strengthen the barrier between the esophagus and the stomach. The operation is typically done via a laparoscope, an instrument that avoids a full incision of the stomach. Due to the complexity of this surgery, it is important to seek a skilled surgeon who has experience in performing this procedure and can discuss the risks and benefits of the procedure.

Dr. Kevin A. Ghassemi, MD

Some people find relief from gastroesophageal reflux disease (GERD) with over-the-counter heartburn medications like antacids. However, you should contact your doctor if you’re regularly reaching for these medicines more than once a week or still have symptoms after taking them. You could have another health condition that requires a different treatment.

Doctors typically diagnose GERD based your history of symptoms and how well your symptoms have responded to prescribed treatment. Prescription-strength medications, such as proton pump inhibitors, reduce stomach acid and help the esophagus heal.

GERD can be a long-term (chronic) health condition that requires lifelong treatment, much like high blood pressure and high cholesterol. Some people are able to stop taking medications after making diet and lifestyle changes.

This content originally appeared online at UCLA Health.

Betty Long, RN, MHA
Nursing Specialist

Stop smoking. Pay attention to the foods you eat and then, eat better, lose extra weight, avoid large meals and eating late at night, elevate the head of your bed 4 to 6 inches. Besides making your own dietary and lifestyle changes, see your healthcare provider if your symptoms persist.

Stacy Wiegman, PharmD
Pharmacy Specialist

There are a variety of medications and lifestyle changes that can treat gastroesophageal reflux disease (GERD) and gastroesophageal reflux (GER). Lifestyle changes include:

  • avoiding tobacco
  • eliminating or severly limiting aggravating foods, such as garlic and onions
  • eating small, frequent meals
  • wearing loose clothing
  • weight loss
  • avoiding food three hours before bed
  • using extra pillows at night

Medications that may help GERD or GER include antacids, foaming agents, H2 blockers, proton pump inhibitors and prokinetics. Before taking any of these medications, you should speak to your doctor about the risk for interactions with other medications or medical conditions.

Dr. Jonathan E. Aviv, MD
Ear, Nose & Throat (ENT Specialist)

The best way to treat acid reflux is by eating a low acid, high fiber diet, including foods (proteins, fats, carbs) that can help heal the body from years of acid damage. Watch as otolaryngologist Jonathan Aviv, MD, discusses his Acid Watcher diet.

Nadine Pazder
Nutrition & Dietetics Specialist

GERD can be treated with a combination of diet and lifestyle changes, medications and in extreme cases, surgery.

By reducing the size of your meals you can minimize reflux. Avoid substances that are known to increase gastric acidity like smoking, alcohol, caffeine, aspirin, black and red pepper, and chili powder as well as any foods that cause you heart burn. Fatty foods, because they take longer to leave the stomach can also cause reflux symptoms.

Do not wear garments that are tight around the waist. Avoid eating within 2-3 hours of going to bed. And don't lie flat when you do go to sleep. Place a foam wedge under your pillow to raise your head about 30 degrees.

Left untreated, simple heart burn or GERD can progress to Barrett's esophagus so be sure to follow up with your physician as directed. A registered dietitian can help you lose weight if needed or with dietary changes to reduce symptoms.

Physicians will usually begin by prescribing long-acting prescription-strength proton pump inhibitors to suppress the production of stomach acid. Other medications used include H-2-receptor blockers, which also reduce acid production, and prokinetic drugs, which help the stomach empty faster and may tighten the LES.

For most cases of GERD which medication does not correct, anti-reflux surgery may be performed. Called fundoplication, this surgery is performed using general anesthesia. The surgeon makes a small abdominal incision and tightens the LES with sutures to prevent reflux.

Hospital stays and recovery time are shortened from 4-6 days and two weeks recovery time with an open surgery to 1-2 days in the hospital and one week recovery time with this method. Studies show that 90 percent of patients who undergo this procedure will be symptom-free 10 years after surgery. Patients who cannot take medication long-term or for whom it does not work may be candidates for fundoplication. Risks include those associated with anesthesia, bleeding, and infection, discomfort from gas buildup or difficulty swallowing. Some patients may need to continue taking some medication.

Elizabeth Casparro, MPH,RD
Nutrition & Dietetics Specialist

Gastroesophageal reflex disease (GERD) is treated with a combination of diet and medication. Foods that can make reflux worse include acidic (tomatoes, citrus, etc.), spicy (chili peppers) and high fat (fried, butter, nuts) foods. The size of the meals also make a difference because too much food in your stomach at once can push more acid up and burn your esophagus. The medication used is called a Proton-Pump Inhibitor such as Prevacid or Zantac, which reduces the amount of acid in your stomach. The only concern with taking it long-term is that you can develop certain nutrient deficiencies because certain nutrients, such as Vitamin B12, needs an acidic environment to be absorbed.

Shraddha Chaubey
Nutrition & Dietetics Specialist

Avoiding high fat foods, certain spices like red, black pepper, mint and caffeine might help relieving the symptoms. Eat six small low fat balanced in protein and complex carbohydrates. Avoid drinking water while eating meals might help not diluting the digestive enzymes. Try to take a small walk or some other form of light physical activity after the meal before sitting or lying down.

Your doctor can treat GERD (gastroesophageal reflux disease) with either medications or surgery.

The medicines usually involve a proton pump inhibitor such as Nexium, Prilosec or Prevacid. The usual dosage is once a day but for many twice a day dosing is needed to control symptoms. If the medicines start to lose their effectiveness and patients become more symptomatic, or patients don't want to be on medicines long term for concern of side effects, surgery usually becomes the next option.

There are two surgical options. In one procedure, known as a Nissen fundoplication, the hiatal hernia is repaired and the stomach is wrapped around the lower part of the esophagus to help control the reflux. The other less invasive approach is the placement of the LINX device, which is a magnetized string of beads around the lower part of the esophagus, to help augment the lower esophageal sphincter and prevent reflux.

The combination of diet and medication are the most common treatments for reflux disease.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.