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Medical TherapyAntireflux Sugery
If lifestyle modifications do not resolve symptoms, medical therapy is usually the appropriate next step for the treatment of GERD. For many patients, a daily regimen of medical therapy controls heartburn and reflux symptoms. Sufferers with more severe symptoms may only experience partial symptom control with medical therapy.
Acid suppression is the main function of medical therapy for GERD. There are three types of medications commonly used to treat GERD: antacids, h2-receptors (H2RAs) and proton pump inhibitors (PPIs). Some drugs are available as over the counter (OTC) medications and others are available by prescription only. PPIs are the most commonly used drug to treat GERD symptoms and heal esophagitis.
Medication can control symptoms such as heartburn by reducing the acidity of reflux. Because medication does not change the amount or quantity of reflux, it often does not resolve other symptoms such as difficulty swallowing, frequent regurgitation or chronic respiratory problems. Further, if the medication regimen is stopped, reflux-related symptoms typically recur, creating a dependence on these drugs. Over time, the medications can also lose effectiveness, requiring higher doses or more powerful drugs.
Types of Medical Therapy
Antacids directly neutralize gastric acid and provide rapid but temporary relief. Accordingly, antacids are usually consumed in frequent doses as necessary. Most antacids, such as Alka-Seltzer, Maalox, Mylanta and Rolaids, are available over the counter.
H2 receptor antagonists (H2RAs) reduce the amount of acid produced in the stomach by inhibiting the release of histamine, the principal stimulus for acid secretion in the stomach. Clinical trials evaluating histamine for the treatment of GERD demonstrated only modest benefit over placebo. A review of multiple studies demonstrated a 50-75% rate of symptom control and tissue healing when using H2RAs. Further, several studies have revealed pharmacologic tolerance to H2RAs as early as two weeks after therapy initiation. 
Proton Pump Inhibitors (PPIs) are the most effective medical therapy to treat GERD. PPIs block the mechanism that produces stomach acid. This lowers the acidity of the digestive juices, the acidity of associated reflux, and thus reduces reflux symptoms. Examples of different prescription PPIs include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium). Prilosec and Prevacid, among others, are also available in over-the-counter strength.
An analysis of 43 randomized trials demonstrated average tissue healing rates of 84% of patients with esophagitis. While effective at reducing the acidity of digestive juices in the upper GI tract, PPIs do not address anatomic deficiencies which often are the root cause of abnormal reflux. 
Long-Term PPI Use
PPIs are generally approved by the FDA for 8 weeks of use for the healing of esophagitis. While safe and effective for most patients, studies evaluating long-term PPI use demonstrate a series of undesirable side effects including:
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