Left untreated GERD can lead to serious, perhaps irreversible damage. Treatment can be very effective.

There are several possible complications or consequences from GERD, including esophagitis (an irritated and/or inflamed esophagus) and stricture (narrowing in the esophagus that can make swallowing difficult). Some studies suggest that GERD may worsen the symptoms of asthma, chronic cough, and pulmonary fibrosis.

However, the most serious complication is the slightly increased risk of esophageal cancer (cancer of the espophagus). Some people with GERD develop a condition called Barrett's esophagus, in which cells in the lining of the esophagus become abnormal in color and shape. These cells (called "specialized intestinal metaplasia") may become precancerous - that is, undergo further changes that increase the risk of eventually becoming cancerous. However, precancerous cells do not necessarily become cancer. 

The number of GERD sufferers who develop Barrett's esophagus is relatively small, and the number of those who develop precancerous cells and then esophageal cancer is smaller still. Nevertheless, esophageal cancer is often fatal. Therefore, anyone with GERD, and especially with Barrett's esophagus, should be checked regularly.

Despite these possible complications, treatment for heartburn and GERD is usually successful. Ordinary heartburn and GER can be treated with simple lifestyle changes and over-the-counter (OTC) medicines. 

Lifestyle changes include:

• Stop smoking. Smoking relaxes the LES and increases production of stomach acid.
• Avoid alcoholic drinks.  Alcohol relaxes the LES.
• Lose weight if overweight. Extra weight adds pressure to the stomach, which can cause acid reflux.
• Eat smart.  This means three things.
• Avoid food and drink that relax the LES or have acids that can irritate the esophagus, such as:
• Caffeinated drinks, including coffee, tea, and soft drinks
• Non-caffeinated coffee
• Carbonated soft drinks, especially colas
• Chocolate
• Citrus fruits
• Fatty and fried foods
• Garlic and onions
• Mint flavorings
• Spicy foods
• Tomato sauce and tomato-based spaghetti sauce, salsa, chili, pizza
  
• Eat small, frequent meals rather than fewer large ones. Large meals also put pressure on the stomach and LES.
  
• Avoid eating habits that put pressure on the lower abdomen and LES.  In other words:
• Don't lie down for 3 hours after a meal.
• Don't eat close to bedtime.
• Don't stoop or bend for long periods right after eating.
  
• Raise the head of your bed 6 to 8 inches to give gravity the chance to keep food in your stomach. You can put wooden blocks under the bedposts or use a foam wedge under the mattress to raise yourself from the waist. 
  
• Don't use piles of extra pillows. That actually increases pressure on the abdomen.
  
• Wear loose belts and clothes. Tight clothing also adds pressure to the lower abdomen and LES.

Most common over-the-counter antacids (such as Alka-Seltzer, Axid, Gaviscon, Gelusil, Maalox, Mylanta, Pepcid, Riopan, Rolaids, Tagamet, Tums, and Zantac, etc.) neutralize stomach acid and relieve most people's heartburn symptoms. But overusing some antacids (more than two or three times a week or for more than two weeks in a row) not only can cause side effects such as diarrhea or constipation but is also a sign of something more serious than heartburn. And antacids alone won't heal an esophagus damaged or inflamed by stomach acid.

If these treatments don't relieve the symptoms, or you have been diagnosed with GERD, then you will need stronger treatments, such as prescription medicines or possibly surgery.  Prescription medications include:

• H2 blockers (also called H2-receptor antagonists). Unlike antacids that neutralize stomach acid, this class of drugs reduces acid production. This, in turn, reduces or eliminates reflux symptoms and helps heal esophagitis (irritated or inflamed esophagus).  The success rate for eliminating symptoms is about 50%; for healing esophagitis about 25%.  Some are also available in non-prescription strength.  They include cimetidine (trade name: Tagamet HB), famotidine (trade name: Pepcid AC), nizatidine (trade name: Axid AR), and ranitidine (trade name: Zantac 75).
  
• Proton pump inhibitors (PPIs).  These drugs also reduce stomach acid production, but they are stronger, usually more effective, (and more expensive) that H2 blockers. Their success rate for eliminating symptoms and healing esophagitis is about 80 to 90%. They're also useful for managing stricture (narrowing of the esophagus). Proton pump inhibitors include omeprazole (trade names: Prilosec, Zegerid), lansoprazole (trade name: Prevacid), pantoprazole (trade name Protonix), rabeprazole (trade name Aciphex), and esomeprazole (trade name Nexium). Prilosec is also available in non-prescription strength.
  
• Prokinetics (also known as promotility drugs.)  These drugs help strengthen the LES and make the stomach empty faster (increase motility).  This group includes bethanechol (trade name: Urecholine) and metoclopramide (trade name: Reglan). Metoclopramide also improves muscle action in the digestive tract. Unfortunately, these drugs have more frequent side effects (fatigue, sleepiness, depression, anxiety, and problems with physical movement) that make their success less certain.

GERD can be a chronic (long term) condition; its symptoms may be controlled, but the disease itself remains. Therefore, you may need to take a maintenance dose of a drug for a long time, perhaps the rest of your life. Anyone taking any medication for the long-term should be seen by their doctor at regular intervals.

If none of the medical and other options succeed in controlling GERD, then your doctor may suggest a surgical procedure, called fundoplication. This has been a standard surgical treatment for GERD for more that fifty years. 

In fundoplication, the upper part of the stomach is wrapped around the LES to strengthen it and repair any hiatal hernia. Today, this procedure can be done laparoscopically, that is, using the techniques of minimally invasive surgery. The surgeon makes tiny incisions through which tiny instruments with attached mini-cameras are inserted, then manipulates the instruments while watching a video monitor. Compared to traditional surgery, minimally invasive surgery leads to faster recovery, less post-operative pain, and smaller scars. The surgery has an extremely high success rate.

More recently, a number of non-surgical endoscopic techniques have been developed that are also designed to strengthen the LES.  However, they are so new that there is no long-term data about their success or side effects. 

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