Manage chronic acid reflux (GERD) with the same medial guidelines doctors follow. First-line treatment includes a proton pump inhibitor (PPI) like omeprazole (20 mg daily, 30–60 minutes before the largest meal) for patients with symptoms 2+ times per week. For additional relief, second-line options include H2-receptor antagonists like famotidine or antacids like calcium carbonate for occasional breakthrough symptoms.
January 11, 2025

Acid Reflux (GERD): American College of Gastroenterology Guidelines

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

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This guide is based on the American College of Gastroenterology 2022 guideline on reflux management.

Chronic acid reflux is primarily caused by an inappropriate, transient relaxation of the lower esophageal sphincter. The initial management of GERD consists of implementing lifestyle changes and initiating acid suppression therapy to treat symptoms and heal esophageal erosion that may have occurred due to acid reflux. 

Evaluation of new onset GERD should be done by a doctor to rule out more serious conditions such heart-related pain.

Lifestyle modifications:

  • Weight loss in overweight and obese patients for improvement of GERD symptoms (strong recommendation, moderate level of evidence).

  • Avoiding meals within 2–3 hours of bedtime (conditional recommendation, low level of evidence).

  • Avoidance of tobacco products/smoking in patients with GERD symptoms (conditional recommendation, low level of evidence).

  • Avoidance of “trigger foods” for GERD symptom control (conditional recommendation, low level of evidence).

  • Elevating head of bed for nighttime GERD symptoms (conditional recommendation, low level of evidence).

First-line recommendations:

  • Omeprazole: Proton pump inhibitors like omeprazole are the most effective therapy for GERD and a trial is warranted if symptoms occur 2+ times per week. This is the most effective therapy. Dose: 20 mg daily 30–60 minutes before largest meal of the day rather than at bedtime. Ask doctor before exceeding recommended dosage or duration; do not self-administer more than one course every 4 months. May relieve symptoms within 24 hours, but 1–4 days may be required for complete relief. Prilosec OTC Omeprazole (FDA NDA 222831). 

Second-line recommendations:

  • Famotidine: H2-receptor antagonist that reduces acid production for longer relief, especially at night. Use as needed before bed. Pepcid AC Maximum Strength Tablet (FDA N020902). 

  • Calcium carbonate: An antacid that can produce rapid symptom relief for occasional or breakthrough symptoms. Should not be used as sole treatment for chronic reflux. Overuse can lead to metabolic abnormalities. TUMS Ultra Strength Antacid Tablets (FDA M001). 

Prescription medications and interventions:

  • High-dose or longer-duration PPIs, with or without additional medications such as H2RAs

  • Endoscopy to evaluate for esophageal damage

  • Surgical treatment in special rare cases

Citations:

Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R., & Spechler, S. J. (2022). ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Official journal of the American College of Gastroenterology| ACG, 117(1), 27-56.

Katz, P. O., Gerson, L. B., & Vela, M. F. (2013). Guidelines for the diagnosis and management of gastroesophageal reflux disease. Official journal of the American College of Gastroenterology | ACG, 108(3), 308-328.

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