GERD is treated progressively, beginning with lifestyle modifications (such as weight loss and keeping the head elevated while sleeping); if those modifications aren’t possible or don’t provide complete symptom control, then acid-suppressing drugs, such as proton pump inhibitors (PPIs) or histamine receptor (H2) blockers, may be added. More recently, concerns have grown regarding long-term PPI use and potential side effects.[1] Clinical evidence suggests that long-term PPI use may lead to a less diverse gut microbiome with a greater incidence of potentially pathogenic species.[2] Lower gut health in relation to long-term PPI use may lead to increased risk of pathogenic growth,[3] such as Clostridium difficile,[4] and to community-acquired pneumonia.[5] Less recent reports also cite long-term PPI use as a possible explanation for increased risk of bone fracture[6] through mineral metabolism impairment.[7]
Antidepressants and prokinetics, the latter of which stimulate the digestive tract, are sometimes added to PPI therapy for enhanced symptom relief.[8] Surgery may be required in some cases of GERD to repair a hiatal hernia if present and/or to fortify the esophageal sphincter. The sphincter may be fortified by wrapping it with either the top portion of the stomach (called a fundoplication) or a ring of magnets (called a magnetic sphincter augmentation).[9][10]