Treatment		Comments
Acid suppressants
	Proton pump inhibitors	Most effective agents; long-term therapy beneficial for chronic or complicated GERD; higher-than-approved dosages may be appropriate in certain situations. Little evidence favoring one agent over another; should be taken before breakfast or evening meal for optimal benefit
	Histamine H2-receptor antagonists	Can be used as premedication before meals; may remain effective for longer than antacids; once-daily dosages not appropriate long-term
	Over-the-counter antacids and antirefluxants	Viable for milder GERD and short-term treatment; patients should not self-medicate for more than 14 days without seeing a physician because of the risk for complications.
Lifestyle modifications
	Elevate the head of the bed; reduce fat intake; quit smoking; remain upright three hours or more after meals	Widely recommended, although true efficacy unclear; lifestyle modifications alone are unlikely to control symptoms.
Promotility agents (e.g., tegaserod [Zelnorm], baclofen [Lioresal])		Correct esophagogastric motility problems that are root cause of GERD, making acid suppression unnecessary; not proven effective as monotherapy for GERD; high side-effect profiles; may be useful as adjunctive acid suppressant
Surgery
	Open	More effective in patients with typical symptoms of GERD that respond to medication; more data needed
	Laparoscopic	Lower cost and decreased length of hospital stay compared with open surgery; more accepted by patients; may increase dysphagia; possibly less effective in obese patients
	Endoscopic	More data needed