Reflux disease is a chronic and progressive condition. Treatment options depend on the disease stage. The disease stage is determined by the severity of reflux into the esophagus. This in turns depends on how frequent and how long are the reflux episodes. 

GERD is also associated with a spectrum of symptoms that ranges from mild heartburn to severe chest pain mimicking a heart attack. GERD treatment options are highly dependent upon an individual’s GERD stage.

Treatment according to stages of GERD

The management of GERD can be divided into stages.

Stage 1: Mild GERD

Patients experience mild symptoms once or twice a month.

Treatment relies on lifestyle changes like smoking cessation, weight reduction, decreased fat intake, avoidance of large meal and certain foods.

Stage 2: Moderate GERD

Patients experience more frequent symptoms requiring daily prescription acid suppressive medications. Untreated GERD symptoms affect patient daily activities and are associated with esophageal inflammation.

Treatment ‘As-Needed’ Pharmacologic Therapy

In addition to lifestyle modifications, patients with moderate symptoms often require periodic drug therapy for symptom relief. This is typically achieved through the as-needed use of antacid or antacids plus alginate or H2 receptor blockers.

Stage 3: Severe GERD

Patients with severe GERD have poorly controlled symptoms on prescription medications. Their quality of life is substantially lower. Patients are more likely to have erosive esophageal inflammation.

Treatment of Scheduled pharmacologic therapy

·        H2 receptor blocker for 8-12 weeks.

·        For persistent symptoms high dose H2 receptor blocker or Proton pump inhibitor for another 8-12 weeks.

·        With documented erosive esophagitis, may use Proton pump inhibitor as first line therapy.

·       Low dose H2 receptor blocker or PPI for maintenance therapy for patient with symptomatic relapse or complicated disease.

Stage 4: Pre-cancerous condition or reflux-induced esophageal cancer

Stage 4 is the result of many years of untreated severe reflux. 10% of patients with long-term GERD progress to stage 4. They develop a pre-cancerous condition called Barrett’s esophagus. Barrett’s esophagus may progress to cancer if untreated.

May need surgical interventions.

Source:

https://www.aafp.org/afp/1999/0301/p1161.html

https://www.iersurgery.com/general/the-different-stages-of-gerd/

https://houstonheartburn.com/four-stages-of-gerd/

Note: For informational purposes only. Consult your textbook for advising your patients.