M. Brian Fennerty with the National Digestive Diseases Information Clearinghouse explains that GERD symptoms occur when the lower esophageal sphincter (LES) either spontaneously opens or fails to close allowing the contents of the stomach to flow back up the esophagus toward the back of the mouth. More specific causes for GERD are still unknown, but some speculation and testing suggest a hiatal hernia, obesity, pregnancy and smoking may all contribute either alone or in tandem. It is also clear that GERD can affect people at any age including children. There are many foods that have been identified as irritating the condition including citrus fruits, caffeine, alcohol, fried foods, fatty foods, garlic, onions, tomato-based foods, spicy foods and minty foods. Without treatment, constant exposure of the esophageal lining to the stomach acids and bile can lead to serious medical conditions. Because there is no known precipitating cause for this condition, though, it cannot be prevented and is therefore considered to be a chronic condition. Treatment can include lifestyle changes such as quitting smoking, losing weight, changing dietary preferences and sleeping in a slightly elevated position but is more commonly treated with medication. Several options are available, including over-the-counter Prilosec and prescription Nexium, both of which run advertisements encouraging viewers to seek out their product.
There are several medication strategies that have been devised to combat the symptoms of GERD. The first line of defense is over the counter antacids such as Maalox, Rolaids or Tums. Fennerty explains that these remedies are based on magnesium, calcium and/or aluminum combined with either hydroxide or bicarbonate ions. They work by neutralizing the acid in the stomach so that it doesn't build up. While they can add additional benefits, such as calcium, they can have unpleasant side effects including diarrhea or constipation. Foaming agents cover the stomach contents with foam and thus prevent the acids from coming back up the esophagus while H2 blockers prevent the body from creating so much acid to begin with. Prokinetics are another class of drugs that work by increasing activity in the digestive tract and thus help the stomach to empty faster, reducing the likelihood of backup. Common side effects associated with this drug class include fatigue, depression, anxiety and body movement control. Currently, the most popular form of treatment is proton pump inhibitors such as Nexium and Prilosec. These drugs are more effective than H2 blockers. Kristi Monson explains that the two medications are very similar and yet profoundly different: "Prilosec was available first and is a mixture of R and S enantiomers of omeprazole. Nexium is just the S enantiomer of omeprazole. Enantiomers are forms of molecules that are almost exactly the same, but are opposites." Essentially, what these drugs do is inhibit the stomach's production of hydrochloric acid, much like the H2 inhibitors, but in a much more effective way. The absence of reflux gives the esophagus time to heal. While both pharmaceutical companies promote their drugs to a mostly unfiltered audience, neither one provides all of the information a patient should have before deciding upon the right medication for their specific condition. Capitalizing on its unique purple color and small pill size, Nexium commercials are often framed with purple at the top and bottom of the TV screen. This