GERD: Weighing Benefits and Risks of Treatment Options

Gastroesophageal reflux disease (GERD) is estimated to affect 10-20% of the Western world and up to 30 million people in the United States alone.¹ Increased stress may be a contributor to GERD symptoms, and clinical studies have suggested a relationship between GERD and anxiety, as well as depression,² which may become an increasingly important clinical consideration during the COVID-19 pandemic.

The most popular GERD treatments, stomach acid reducers, are a booming business, with both H2 blockers and proton pump inhibitors (PPIs) used widely. Prescription PPIs are used by an estimated 15 million Americans.³ Taking an over-the-counter acid blocker for occasional heartburn symptoms may not be a big issue, but in practice, many patients with chronic reflux are prescribed acid blockers indefinitely. A significant number of researchers have independently linked PPIs to adverse health problems such as bone fractures,⁴ chronic kidney disease,⁵ and pneumonia,⁴ among others.

Given these risks, is there a better way to treat the increasingly common issue of GERD? In the following video, IFM educator Shilpa P. Saxena, MD, IFMCP, talks about the non-gastrointestinal symptoms of GERD, such as allergies, and identifies some of the steps she takes when developing a treatment plan.

PPIs: comparing the pros and cons

When establishing treatment for patients who require acid suppression, considering PPI benefits and risks associated with dosage amounts and duration is an important component.

Benefits:

Not all research suggests that PPIs are associated with adverse effects. For example, a three-year randomized trial of pantoprazole completed in 2019 did not find significant adverse events, with the exception of an increased risk of enteric infections.⁶ PPIs continue to be a primary therapy for acute and long-term management of GERD due to their: