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GERD: Treatment Options

GastrEsophagealRefluxDisease (GERD) is a very common problem that I treat everyday. I am posting a 20 minute talk that I gave at the YMCA last year. I had posted it previously; but, I had some technical difficulties and am redesigning the site slowly. In the past year there has been quite an emphasis on the most popular medication for the treatment of GERD, PPIs or Proton Pump Inhibitors such as Prilosec, Nexium, Protonix and Prevacid, and others. Alarming side effects have been reported; bone fracture secondary to impaired calcium absorption, chronic kidney disease, dementia, and aggravation of pulmonary conditions are examples. The data suggests that there may be some weak associations, and some of the alleged side effects have more data than others.
The primary goal is to control GERD with the least amount of medication. The reported side effects of the PPIs are dose-dependent, so a low-dosed PPI is much less significant than a high-dosed PPI. If medications do not work, or if a patient is dependent on high-dose PPIs, or a PPI-dependent younger patient, then surgical options could be explored.