Doctors may recommend medications to treat gastrointestinal reflux disease (GERD). If medications do not help relieve symptoms, a person may need a medication review or further evaluation.

GERD occurs when stomach contents and acid enter the tube connecting the throat and stomach (esophagus), causing heartburn.

Types of medications a doctor may recommend for GERD include proton pump inhibitors (PPIs), H2 receptor antagonists (H2RAs), and antacids.

In combination with lifestyle changes such as weight management, these medications usually help lower symptoms. If they do not, there may be an explanation for this, such as misdiagnosis or incorrect administration.

This article reviews why symptoms of GERD may not ease with medication, how long medications take to help, and when to contact a doctor.

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Several possible factors can lead to worsening GERD symptoms even when taking medications. However, it may seem difficult to find the cause without contacting a doctor.

One possible explanation could involve not taking medications correctly. According to some older studies in a 2019 article, a person may need to take PPIs about 30–60 minutes before a meal. The article also notes that about 54% of people do not usually take PPIs correctly.

When taking PPIs once daily, medical professionals often recommend taking them when first waking up in the morning.

Other possible causes of GERD worsening or not easing after medication include:

  • presence of genetic factors, such as changes to enzymes known as CYP2C19 and CYP3A4, which make breakdown of PPI difficult or impossible
  • presence of functional esophageal disorders
  • esophageal hypersensitivity
  • functional heartburn, which refers to heartburn symptoms without evidence of acid
  • presence of underlying conditions, such as issues with the esophageal sphincter or when the stomach takes too long to empty food
  • misdiagnosis

Several other conditions can mimic GERD but may require different treatments. If symptoms do not ease with GERD medication, doctors may order tests to rule out other possible causes.

How long GERD medications take to help relieve symptoms can depend on the type of medication. For example, the PPI omeprazole can take 1–4 days to start reducing heartburn.

A person may need to take fast-acting PPIs about 30–60 minutes before they eat. Taking them before or after a meal might not work as well for managing symptoms that occur after eating.

Experts recommend antacids for mild, intermittent GERD. A person will typically need to take antacids 3–4 times per day as necessary. These can work quickly but only provide short-term relief as and when a person needs it.

H2RAs come in both prescription and over-the-counter forms for short-term treatment of GERD. They take about 60 minutes to start working, and relief can last for 4–10 hours.

Learn more about treatments for GERD.

Some foods may worsen GERD symptoms.

In a 2021 review of studies, researchers identified several types of foods and drinks that may raise the risk of GERD. These include:

  • fried foods
  • high fat diets
  • citrus products
  • salty foods
  • carbonated beverages
  • spicy foods
  • chocolate
  • caffeine
  • alcohol

A person may also find it helpful to keep a record of what they eat in a food journal. Recording how symptoms respond to different foods can help with ruling out foods that may trigger or worsen symptoms.

A person may also want to avoid lying down for at least 3 hours after eating a meal.

Learn more about foods to eat and avoid with GERD.

Several underlying conditions can cause symptoms similar to those of GERD. A doctor may misdiagnose a person with GERD due to its prevalence in the U.S. adult population. The condition affects about 20% of adults.

Other conditions that can cause similar symptoms to GERD but will likely require different treatment include:

If symptoms do not ease despite lifestyle changes and medications, a person may consider contacting a doctor. They may recommend an endoscopy or other testing to check for the presence of another underlying condition.

Lifestyle modifications usually form a part of GERD management.

Medical professionals will often recommend weight management, as obesity is a risk factor for GERD. Managing weight where advisable can help lower symptom severity.

Other lifestyle changes a person can make include:

  • eating meals at least 3 hours before bedtime
  • avoiding food or drinks that worsen symptoms
  • getting enough quality sleep

A person may wish to contact a doctor if GERD symptoms continue despite medication and lifestyle changes. It may also be worth contacting a doctor if new or worsening symptoms develop.

A doctor can help ensure that a person is taking their medication correctly. They may also order tests to rule out other possible causes.

GERD typically responds to certain lifestyle changes and medications. If medication does not help lower symptoms, this could be due to several factors. These factors include incorrect administration of medication, the presence of other conditions, or misdiagnosis.

It is best to contact a doctor if symptoms do not ease following the use of medications and lifestyle changes. A doctor can help determine why a person’s symptoms persist and suggest any changes to their treatment plan.