Information about GERD Symptoms, Diagnosis, Treatment options, and GERD Medication
For information on Irritable Bowel Syndrome (IBS) visit:



Irritable Bowel Syndrome (IBS)



What's New went offline a couple years ago and no longer belongs to Dr. M. Farivar. The material that was presented in that website is now available to you here at Moreover, Dr. Farivar has created a separate new website dedicated to Irritable Bowel Syndrome ( We hope you will find the new website just as helpful.


The information on this page will keep you apprised of significant new developments as they arise.

March 11, 2013

Since the last update in 2005 much has been written about diagnosis and treatment of GERD. Webgerd went off line for a while but believe it or not, you have not missed much. There has been multiple trials of new devices and procedures to strengthen the lower esophageal sphincter, none has been what I can recommend to my patients requiring surgical intervention. In a recent multi-center study, using a magnetic device to augment the lower esophageal sphincter, however, improved symptoms and reduced use of PPIs in 60% of patients. (Ganz R A et al. N Engl J Med, vol 368, no 8, pages 719-727, Feb 2013) I believe laparoscopic surgery using this magnetic device will be easy enough alternative to a more complicated but definite treatment of Nissen's fundoplication, and it will be useful for the right patient.

July 1, 2005

Several new topics have been added as follows:

June 27, 2005

Zantac (Ranitidine) 150 mg is over the counter now; last time I checked the cost of 60 tablet package was $22 at my local pharmacy. The usual dose is 150 mg twice daily.

Prilosec 20 mg is also over the counter and 14 tablets cost $11. Therefore one month supply of both costs about $22. In patients who need to take 2 Zantac tablets daily it is more convenient and more effective to take one Prilosec OTC.

Indeed, in my experience Prilosec 20 mg (omeprazole) is as effective as Prevacid 30 mg (lansoprazole) and in most patients as effective as Nexium 40 mg (esomeprazole) and Aciphex 20 mg (rabeprazole) and more effective than Protonix 40 mg (pantoprazole).

Most of the time patient co-pay is equal or more than the cost of one month Prilosec OTC. Again based on my experience, Protonix (panntoprazole) that is the least effective of all PPIs has the lowest co-pay and is preferred by most HMOs.

Zantaz 150 mg and Prilosec 20 mg, do not require prescription to buy.

In treating Barrett’s esophagitis patients who are found to have high grade dysplasia or superficial carcinoma on biopsy specimens and are not candidate for surgery and esophagectomy, new endoscopic therapeutic modalities have been proven effective and approved by FDA. (check treatment of dysplasia in Barrett’s)

Diagnostic studies: Impedance 24 hour pH studies is, in my opinion, the most useful test developed to date for diagnosis and treatment of difficult to diagnose and treat GERD patients.

Electron microscopic studies show that patients who have Non-Erosive reflux disease (NERD), exhibit dilated intercellular spaces in the superficial esophageal mucosa, which returns to normal after effective treatment.

June 24, 2005

The best news for chronic reflux sufferers is Prilosec going over-the-counter. Prilosec(Omeprazole) has been around for a long time and has an excellent safety record similar to other PPIs (Omeprazole=Prilosec, Esomeprazole= Nexium, Lansoprazole=Prevacid, Pantoprazole=Protonix, and Rabeprazole=Aciphex). It is offered however, for reasons unkown to me, much cheaper than prescription PPIs (typically $1 vs. $3-4/tablet or capsule of similarly effective PPI) even though it is as strong, as good and as safe.

The GERD Prescribed Medication page has been updated. The following new topics were added:

  • Recommended Strategy for Using PPIs
  • Points to Remember about PPIs
  • Potential Side Effects of Long-Term PPI Therapy

Breakthroughs in Barrett’s (Photodynamic Therapy, Argon Plasma Coagulation, Multipolar Electrocoagulation, Endoscopic Mucosal Resection, Endoscopic Ultrasound, Treatment of high grade dysplasia and superficial carcinoma) section was added to Endoscopy Surveillance in Patients with Barrett’s Esophagus.

June 22, 2005

A new section titled "Benefits of Breastfeeding for Infants with Reflux" has been added to GERD in Infants and Children page as well as GERD Treatment Options in Infants and Children.

March 6, 2003

The FAQ section has been updated with recent findings concerning the effectiveness of the various PPIs in GERD treatment.

A Clinical Survey Comparing the Effectiveness of Esomeprazole and Pantoprazole to Traditional PPIs (Omeprazole and Lansoprazole) in Relieving Severe Heartburn.

For your information, we have posted a letter from a practicing physician who has visited our site regarding the Relationship between the combination of GERD and atopy - causing Eustachian tube dysfunction - with progress to recurrent early OM and middle ear effusion. Please send us you comments about this observation.

July 30, 2002

In a preliminary study presented at the 2002 Digestive Disease week in San Francisco, Cleveland Clinic researchers have shown that telomerase activity is upregulated in the area of intestinal metaplasia up to 10 years prior to development of high grade dysplasia and adenocarcinoma by using a telomerase enzyme immunostaining technique. Patients with Barrett’s that do not express telomerase activity in their nuclei do not develop dysplasia.

October 29, 2001

Due to public demand we have added a new section about GERD diagnosis and treatment options in infants and children. Appropriate information is provided for both patients and physicians under their respective buttons.

August 17, 2001

US Food and Drug Administration (FDA) approved in March 2001 the first IV PPI, Pantoprazole. IV Pantoprazole is useful in patients who are unable to take PPI oral therapy, including hypersecretory states, ICU patients with risk factors for stress ulcer, prevention of ulcer bleeding after endoscopic treatment, prevention of aspiration pneumonia and pts with severe GERD who are unable to take oral meds. The recommended dosage is 40 mg once daily, given via intravenous infusion. The infusion should be given over a period of 15 minutes at a rate not greater than 3mg/min. However, the studies have shown that in order to keep intragastric pH around 7 in patients with ZE, one has to give an 80 mg rapid IV bolus followed by infusion of 8 mg / hour (seven vials of 40 mg). In practice, IV Pantoprazole is given in a dose of 80 mg bid.

May 6, 2001

Surpass (an antacid chewing gum) - Recently, Wrigley Healthcare has released a chewing gum that is coated with 450mg of calcium carbonate. Calcium carbonate neutralizes the acid and relieves heartburn immediately. While continuing to chew gum will produce saliva, and since Saliva's pH is alkaline, the swallowed saliva will continue to neutralize the remaining acid. Like Tums, Surpass may be used as calcium supplement as well.

Wrigley Healthcare is recommending as the resource for patients with GERD (slide).

April 15, 2001

Two new medications have recently been released that provide improvement over previous medications prescribed  for relief of heart burn. They are:

Pepcid Complete (over-the-counter) - a combination of Pepcid AC (Famotidin) and a calcium carbonate antacid. Famotidin is an H2-blocker which reduces acid secretion within 45 minutes to an hour of ingestion. The calcium carbonate acts immediately to neutralize the acid already present in the stomach. This combination provides both short term and long term relief.

Esomeprazole, the recently released S-isomer of Omeprazole (Prilosec), has been shown to provide improved acid control (slide 1), healing (slide 2), and symptom resolution in reflux esophagitis patients, when compared to Omeprazole.







         This is an educational site created by M. Farivar, M.D. The information provided is the author's opinion based on years of clinical experience and research.  You are advised to consult your own physician about the applicability of this information to your particular needs.  Also, keep in mind that symptom response to therapy does not preclude the presence of more serious conditions. 

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