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Q&A: Gastroesophageal Reflux

A friend and I both have gastroesophageal reflux disease, but while my doctor recommended I take an H2 blocker to manage the symptoms, my friend’s doctor told her to take a proton-pump inhibitor. Why the different advice?

Gastroesophageal reflux disease (GERD) is caused by stomach acid flowing (refluxing) backward into the esophagus, where it irritates the delicate tissue, causing the characteristic burning sensation we refer to as heartburn. H2 blockers and proton-pump inhibitors (PPIs) treat GERD by reducing stomach acid. H2 blockers—which include famotidine (Pepcid®, Pepcid AC®), and cimetidine (Tagamet®)—inhibit the action of a chemical that signals cells in the lining of the stomach to produce acid. PPIs reduce acid by blocking an enzyme needed for acid production. Both options can be purchased over the counter, with stronger formulations available by prescription.

PPIs are considered the gold standard for treating peptic ulcer disease, so if your friend has suffered a peptic ulcer in the past or is considered high risk for developing one, this may be why her doctor advised her to take PPIs. H2 blockers are less likely than PPIs to impact bone density, so if you have osteoporosis this may be a factor in your doctor’s recommendation. The therapeutic effects of H2 blockers don’t last as long as those of PPIs, so it also is possible that your GERD symptoms are less troublesome than your friend’s symptoms are. However, if you reach the point where you are taking the medication more than three times a week, tell your doctor—it’s possible you may need a prescription-strength H2 blocker or a PPI.

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