Gastroesophageal Reflux Disease (GERD): Overview for Clinicians

An integrative approach to GERD includes a variety of evidence-based options including:

• Lifestyle changes
• Nutrition and exercise
• Botanical (herbal) medicine
• Pharmaceuticals
• Mind-body therapy
• Traditional Chinese medicine
• Surgery

Risks of prolonged acid suppression therapy:

• Increased risk of community-acquired pneumonia
• Increased risk of community-acquired Clostridium difficile infection
• Increased risk of bone fracture
• Decreased absorption of iron, specifically non-heme iron
• Decreased absorption of vitamin B12
• Decreased absorption of calcium
• Gastric hyperplasia (due to gastrin stimulation)

Be cautious using acid suppression in:

• Patients with iron deficiency anemia (unless due to bleeding ulcers)
• Elderly individuals at risk of community-acquired pneumonia
• Children for long periods of time due to risk of gastric hyperplasia
• Post-menopausal women, or other individuals at risk for fractures

Rebound hyperacidity can occur when discontinuing a PPI and last for 10-14 days even if GERD has resolved. A suggested plan to help patients taper off PPIs is included in the downloads section on the right.

Please see the downloads section for more detailed clinician and patient information.

Disclaimer: This information is for general education. Please work with your health care practitioner to use it in the best way possible to promote your health.