GERD or NERD? Why Acid Blocking Medications May Not Work For You

With 113 million prescriptions written each year, proton pump inhibitors (PPIs) are the third largest selling drug in the United States. Designed to relieve symptoms of acid reflux – like heartburn, regurgitation and a sore throat – they work by suppressing acid in the stomach so leaking fluids cause less irritation. Medications seem like a straight forward solution, so why are so many GERD (Gastroesophageal Reflux Disease) sufferers still feeling the pain?

Please note: You should always consult with your doctor first before making any changes to your drug regimen.

If you have ongoing reflux but experience little to no relief from acid blocking medications, then you may have what’s known as non-erosive reflux disease or NERD, which is a sub-category of GERD. NERD presents with GERD-like symptoms but doesn’t show any signs of injury to the esophagus when an upper endoscopy is performed. With NERD, there is a significantly lower response rate to PPI treatments. Interestingly, the majority of GERD cases are classified as non-erosive reflux. 

According to Dr. Kevin Gillian, a specialist in treating reflux at Virginia Hospital Center Physician Group,“For some people, it’s not the stomach acid causing the problems. It’s other enzymes in the stomach fluid, so acid reducers like PPIs don’t help.” He goes onto say that for people with a diagnosis of NERD, medication is pointless because it won’t resolve the problem. 

Since medication isn’t the answer, some may turn to surgery. However, anti-reflux surgery is less likely to benefit people with NERD, per a study in the Journal of Neurogastroenterology and Motility. And while most GERD patients who undergo Nissen Fundoplication surgery initially see an improvement, almost half either have symptoms return, have esophagitis (inflammation of the esophagus), require medication for symptoms or need another operation after seven years. (for more details, please see “Is surgery the solution to ongoing acid reflux?”)

A relatively new procedure using magnetic beads is less invasive and has a quicker recovery, bringing hope for a surgical cure. But a recent study published in the New England Journal of Medicine concluded that follow-up studies are necessary to determine the long-term safety of the magnetic device. While 64% of patients had either normal esophageal acid exposure or a 50%, or better, reduction in acid exposure after the first year, 68% of patients reported dysphagia (trouble swallowing) initially following surgery which declined to 11% after one year.

With acid blocking medications failing to provide relief for a majority of GERD sufferers and surgery outcomes uncertain, how do you find reflux relief? 

The best approach is through lifestyle changes. There are many small adjustments you can make to help alleviate reflux symptoms – from avoiding trigger foods to eating smaller meals. However, the only two methods supported by clinical data are weight loss and sleep positioning. Given that weight loss occurs gradually over a period of time, it’s good to know that sleep positioning (or how you sleep at night) can actually provide you with almost immediate symptom relief. 

What's the best sleep position for relief at night? 

Sleeping on your left side while on an incline is #1 sleep position for GERD symptom relief. 

When you position yourself on your left side, your stomach can empty its contents more quickly. When your stomach is empty, then there’s nothing to reflux. No reflux means no symptoms to keep you up during the night, plus it gives your esophagus some time to heal. And when you sleep on an incline, there’s a drastic reduction in acid exposure and acid clearance time (the time that it takes your body to naturally clear acid from the esophagus).

So how do you stay positioned on your left side and on an incline during the night?

The only sleep system designed for GERD that keeps you on your left side and on an incline is MedCline. With its 2-part system, you’ll sleep comfortably in a position that brings real, natural relief from reflux. And while it may seem that you’re only alleviating symptoms during the night, users report a respite that carries over into the day.

When you have GERD, your quality of life suffers with miserable symptoms during the day and acid reflux attacks at night. You may have tried medications, but to no avail, especially if you have non-erosive reflux. So why not make some changes today that can bring relief safely and naturally? Make MedCline a part of your overall strategy to resolve your reflux. Whether you have GERD or NERD, you’ll sleep better, feel better and be on your way to improving your overall health.

References:

1. Tiberiu Hershcovici, M.D. and Ronnie Fass, M.D. Nonerosive Reflux Disease (NERD) – An Update. Journal of Neurogastroenterology and Motility J Neurogastroenterol Motil, Vol. 16 No. 1. DOI: 10.5056/jnm.2010.16.1.8 . January, 2010.

2. Consumer Reports. Drugs to Treat Heartburn and Stomach Acid Reflux: The Proton Pump Inhibitors Comparing Effectiveness, Safety, and Price. ConsumerReportsHealth.org/BestBuyDrugs. May, 2010.

3. NBC News Doctors Finding Medicine May Not Help All Acid Reflux Sufferers. http://www.kndu.com/story/21604172/doctors-finding...may-not-help-all-acid-reflux-sufferers.. March 13, 2013.

4. Ganz, Robert A. M.D., Peters, Jeffrey H. M.D., et al. Esophageal Sphincter Device for Gastroesophageal Reflux Disease. New England Journal of Medicine. DOI:10.1056/NEJMoa1205544. February 21, 2013.

5. Khan BA, et al. Effect of bed head elevation during sleep in symptomatic patients of nocturnal gastroesophageal reflux. J Gastroenterol Hepatol. 2012 Jun;27(6):1078-82. June 27, 2012.

6. Johnson LF, DeMeester TR. Evaluation of elevation of the head of the bed, bethanechol, and antacid foam tablets on gastroesophageal reflux. Dig Dis Sci 1981;26:673-80.

7. Hamilton JW, Boisen RJ, Yamamoto DT, Wagner JL, Reichelderfer M. Sleeping on a wedge diminishes exposure of the esophagus to refluxed acid. Dig Dis Sci 1988; 33: 518-22.

8. Stanciu C, Bennett JR. Effects of posture on gastro-oesophageal reflux. Digestion 1977;15:104–9.