Gastroesophageal reflux disease, better known as GERD, is a common digestive disorder that affects millions of people around the world. GERD occurs when the acid from your stomach flows back into the oesophagus, the tube that connects your throat to your stomach. This backward flow of acid can cause a range of symptoms, from mild discomfort to severe pain, and if left untreated, it can lead to more serious health issues.

What is GERD and Who is Affected?

GERD is not just a single condition but rather a spectrum of disorders that can vary widely in severity. The most common symptoms include heartburn, which is a burning sensation in the chest, and acid regurgitation, where stomach acid rises up into the back of your mouth, leaving a bitter taste. For some people, these symptoms are occasional and relatively harmless. However, when they become frequent or severe enough to interfere with daily life, GERD is considered a chronic disease that needs medical attention.

GERD can present itself in different ways. Some people have non-erosive reflux disease (NERD), where they experience symptoms without any visible damage to the oesophagus. Others may develop erosive esophagitis, where the lining of the oesophagus becomes inflamed and damaged, sometimes without even causing noticeable symptoms. In more advanced cases, GERD can lead to Barrett’s oesophagus, a condition in which the oesophageal lining changes, increasing the risk of developing oesophageal cancer. The most severe outcome of long-term GERD is adenocarcinoma, a type of cancer that affects the lower part of the oesophagus.

The prevalence of GERD varies, but it is particularly common in Europe and North America, where studies suggest that 10-20% of the population is affected. Worryingly, the number of people diagnosed with GERD has been steadily increasing. A longitudinal study from Sweden revealed that GERD cases have risen by 2% per decade since 1988. Several factors contribute to this trend. One of the most significant is the rising rates of obesity, which increases pressure within the abdomen, pushing stomach contents back into the oesophagus. Another factor is the declining prevalence of Helicobacter pylori, a type of bacteria that used to be more common in the stomach. While this bacterium is known for causing ulcers, it also plays a role in reducing stomach acid production, so its decline has led to higher levels of acid and more frequent GERD symptoms.

Continuous vs. On-Demand Medication

Managing GERD effectively is crucial to preventing complications and maintaining a good quality of life. For most people, treatment involves the use of proton pump inhibitors (PPIs), a class of medications that reduce the production of stomach acid. PPIs can be taken in two main ways: continuously, meaning every day, or on-demand, meaning only when symptoms appear.

There is ongoing debate in the medical community about which approach is more effective. Continuous use of PPIs is often recommended for those with more severe symptoms or damage to the oesophagus, as it provides consistent acid suppression. However, continuous use can also lead to long-term side effects, such as nutrient deficiencies and an increased risk of infections. On-demand use, on the other hand, might be a better option for those with milder symptoms, as it can reduce medication costs and minimise the risk of side effects.

A recent study set out to explore how these two different approaches affect people with GERD. The study found that, in general, there were no significant differences in symptom control or overall health outcomes between those who took PPIs continuously and those who used them on-demand. This finding suggests that for many people, on-demand PPI use could be just as effective as continuous use, potentially offering a way to manage symptoms without the need for daily medication.

Interestingly, the study also found that patients who were already taking PPIs on a continuous basis were often reluctant to switch to on-demand use. As a result, both groups ended up using similar amounts of the medication. This reluctance may be due to a fear of symptom recurrence or a belief that continuous medication is necessary to control their condition.

Despite the lack of significant differences between the two approaches, the study did find that those who took higher doses of PPIs tended to have better control of their symptoms and reported feeling healthier overall. This suggests that for those who respond well to PPIs, sticking to their prescribed regimen, whether continuous or on-demand, is crucial for managing symptoms effectively and maintaining a good quality of life.

Future Directions in GERD Management

While PPIs remain the cornerstone of GERD treatment, ongoing research is exploring new medications and treatment strategies that may offer better results for patients. One area of interest is Potassium-Competitive Acid Blockers (P-CABs), a newer class of drugs that may provide more effective acid suppression with fewer side effects than PPIs. These medications could potentially change the way GERD is managed, particularly for those who do not respond well to current treatments.

It is also important to consider the role of lifestyle modifications in managing GERD. Simple changes, such as losing weight, avoiding trigger foods, and not lying down immediately after eating, can significantly reduce symptoms and improve quality of life. For those with more severe or persistent symptoms, however, medication is often necessary.

This study highlights the importance of individualised treatment plans for GERD patients. Whether you are taking PPIs continuously or on-demand, the key is to find a regimen that works for you and helps you manage your symptoms effectively. If you are experiencing frequent heartburn or other GERD symptoms, it is important to talk to your doctor about your treatment options. With the right approach, GERD can be managed successfully, allowing you to live a healthier, more comfortable life.

Reference

Andreasson A, Agréus L, Mastellos N, Bliźniuk G, Waśko-Czopnik D, Angelaki A, Theodosaki E, Lionis C, Hek K, Verheij R, Wright E, Durbaba S, Muris J, Bródka P, Saganowski S, Ethiér JF, Curcin V, Delaney B. Effect of on-demand vs continuous prescription of proton pump inhibitors on symptom burden and quality of life: results of a real-world randomised controlled trial in primary care patients with gastroesophageal reflux disease. Ann Med. 2024 Dec;56(1):2354683.

Andreasson A, Talley NJ, Walker MM, et al. An increasing incidence of upper gastrointestinal disorders over 23 years: a prospective population-based study in Sweden. Am J Gastroenterol. 2021;116(1):210–213. doi: 10.14309/ajg.0000000000000972.