When over-the-counter Medication, in the form of antacids, are ineffective in the treatment of GERD, physicians will prescribe stronger medicines. They are our topic this week At Digestive Disease Consultants Orlando blog.
We have been following the story of GERD patient, Elena. Thus, in recent blogs, we have seen Elena embrace new behaviors and dietary restrictions to encourage her esophagus to heal. Her GERD had gotten difficult to control, and in fact, some of the over the counter antacids were actually giving her diarrhea.
As the severity of her attacks continued to escalate, her primary care physician referred her to a gastroenterologist at Digestive Disease Consultants. She hoped her doctor would give her new medications that would help her condition. Given that she had already had some difficulty with swallowing, she dreaded the idea of taking pills. She wondered what they would be, and she dreaded side effects. What medications could she expect her doctor to prescribe?
In this blog, we will take a look at the drugs available for the treatment of GERD.
Medication to Block the Burn: Helpful H2 Blockers
Helpful H2 blockers or Histamine Blockers are available by prescription in higher doses than their over-the-counter counterparts. So don’t think they are not strong medicine.
The way this medication works is that it travels to very specific receptors that line the surface of the cells in the stomach. As it happens, those cells have charge of sending out digestive acids. “The medication inhibits certain chemical reactions in these cells so that they aren’t able to produce as much acid.”
Some patients have reported amazing results, and studies have shown that the drug can reduce acid secretions by as much as 70 percent within 24 hours. Therefore, since the medication lowers the amount of acid released by the stomach, the inflammation will subside.
Names of H2 blockers include:
- Nizatidine (Axid),
- Cimetidine (Tagamet HB200),
- Ranitidine (Zantac)
On the one hand, some patients have reported generalized side effects such as gas, headache, diarrhea, abdominal pain. On the other hand, other patients reported sore throat and dizziness, but usually, they tolerate these medications very well.
Medication to Prevent Symptoms: Powerful Proton Pump Inhibitors (PPIs)
Proton Pump Inhibitors (PPI’s) are considered to be stronger blockers of acid production than H-2-receptor blockers. These medications are famous for helping to heal an inflamed esophagus. Doctors usually tell GERD patients to take their PPIs before meals.
Mayo clinic has lined up names of the most popular “prescription-strength proton pump inhibitors.” They include:
- esomeprazole (Nexium),
- lansoprazole (Prevacid),
- omeprazole (Prilosec, Zegerid),
- pantoprazole (Protonix), rabeprazole (Aciphex)
- and dexlansoprazole (Dexilant).
While Elena was researching this type of medication, she took note that if taken for long periods of time, PPI’s might increase the risk of broken bones or a deficiency of vitamin B-12.
Medication: Strengthening the LES (lower esophageal sphincter)
Physicians sometimes prescribe medication called Baclofen that takes a different approach to the GERD symptoms. “Baclofen is a muscle relaxant and anti-spastic used for treating spasm of skeletal muscles, muscle clonus, rigidity, and pain…” It decreases the “frequency of relaxations of the lower esophageal sphincter.”
Therefore the response of the Baclofen to the medication decreases gastroesophageal reflux. If the reflux is really severe, then Baclofen might be especially useful in spite of its side effects such as mental confusion and general fatigue, headache, low blood pressure and insomnia.
Testing To Ascertain Risks of GERD Complications
In addition to some of these medications, Elena’s specialist has also recommended extensive testing to determine the cause of her GERD symptoms. It is important to note that testing itself should not alarm patients with GERD symptoms. According to our own Dr. Sanje Reddy at DDC Orlando, over 90 % of the people who take endoscopy actually do have GERD from dyspepsia in a manageable form.
However, we need to ascertain your risks for more serious diseases. A small percentage of patients like Elena and perhaps you, are found to have a high risk for Barrette’s Syndrome and esophageal cancer. So, avoiding a test, such as an upper endoscopy can be very detrimental to your health. Besides, as Elena later discovered, endoscopy and comfortable sedation for it are a refined art at centers such as DDC Orlando. And we will explain some of the details about modern endoscopy and other GERD tests in our next blog.
Beyond Medication: Coming Features for Future Blog Articles
Just remember, if your healthcare provider recommends an ECG or “endoscopy,” your symptoms might not be simple dyspepsia. And the sooner we know your risk level for Barrett’s esophagus or esophageal cancer, the sooner proper treatment can begin.
The general public is also unaware that there are many new technologies and techniques for treating the diseases of the digestive system. That is why the dedicated doctors of DDC Orlando are here for you.
Elena dutifully filled her new prescriptions and scheduled her endoscopy. She found herself looking forward to a better understanding of her condition.
At long last, she was resolved to learn how to get along with her GERD, or as her child put it, just “Get along with Gertie!”
So please visit our blog again soon to learn more about endoscopy and other tests we do for patients like Elena.