What is the most appropriate treatment for moderate to severe GERD?

The most appropriate treatment for moderate to severe gastroesophageal reflux disease (GERD) involves the use of proton pump inhibitors (PPIs) and may include prokinetic agents. PPIs effectively reduce gastric acid secretion, which helps heal the esophagus and provides symptom relief. They are considered the cornerstone of treatment for moderate to severe GERD because they address the underlying pathophysiology by significantly decreasing acid production.

In contrast, while H2 receptor antagonists can provide relief for milder cases of GERD, they are generally less effective than PPIs in cases where more comprehensive acid suppression is required. OTC antacids might offer short-term symptom relief but do not address the chronic nature of GERD or promote healing of esophageal mucosa. Furthermore, lifestyle changes, while essential and often recommended as part of a comprehensive management plan, might not be sufficient alone for moderate to severe cases, as they do not alter the underlying acid secretion issues. Therefore, combining PPIs with potential prokinetic agents represents the most effective treatment approach to manage and alleviate the symptoms and complications associated with moderate to severe GERD.