Lifestyle Modification to Manage GERD
should be used for all patients as a first step in treating GERD. Some lifestyle modification may help with the symptoms of GERD.

-Sleep with head elevated
-Avoid late night meals
-Avoid smoking and alcohol
-Avoid foods/drinks that lower LES such as chocolate, high acid foods like tomato, peppermint, fatty foods, spicy food,caffeine and carbonated beverages
-Weight loss in case of obese or overweight people as it is directly related to the severity of GERD symptoms.

Medications for GERD:
The most common treatment for GERD is the use of proton pump inhibitors or PPI, however H2 antagonist are also effective and have less side effects. In many cases a trial of H-2 receptors will be used for 2 weeks, and if symptoms of GERD still persist, then the patient will be switched into a PPI for 4-8 weeks.

Proton Pump Inhibitors:
Commonly used PPIs include omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole. PPIs work by suppressing the production of gastric acid thereby relieving the symptoms of GERD. PPI relieve heartburn but do not decrease the reflux episodes and so do not control regurgitation in a large percentage of patients. PPIs are associated with side effects of increased risk fractures, cardiac dysfunction, and gastrointestinal infections. Studies have found positive association of PPIs with small intestinal bacterial overgrowth and also for increase the risk for Clostridium difficile infection. Due to side effects, it is best

Histamine-2 receptor antagonists:
H2 receptor antagonists include ranitidine cimetidine, nizatidine, and famotidine. Long term use of these medications is not recommended as the body develops tolerance in 1-2 weeks. Moreover, they are not as effective as PPI in mitigating the symptoms.