ACID REFLUX -- THE PESKY KIND

I recently saw a nice lady in her late 30s suffering from persistent and intractable acid reflux. Her GI doctor performed a scope (esophagogastroduodenoscopy) on her esophagus and found a stricture and evidence of significant reflux. The stricture was dilated.  Long story short, she is not responding to the Tagamet, Prilosec, Carafate or anything. Here is a list of the current remedies and one that she is not taking that might cause her to obtain relief. The different interventions are as follows:

MECHANICAL
Elevate the head of the bed with 6-inch blocks
Do not lay down after eating; remain standing or sitting for at least 2 hours.

MEDICATION
To reduce acid:
Proton pump inhibitors (Prilosec, Protonix, etc.)
H2 blockers (Tagamet, Zantac, etc.)
Antacids (Maalox, Mylanta, etc.)
Carafate ® (coats the stomach and esophagus lining) – Note: the tablets are cheaper, but the suspension is more effective

To reduce anxiety and sleep issues:
Sleeping pills (prescription, non-benzodiazepine)
Chamomile or valerian tea before bed (avoid peppermint, it worsens reflux)
Mechanical:
Alginate therapy (Reflux Gormet ®, etc.) 

Marshmallow root tea or slippery elm tea
Aloe vera juice (sometimes sooths)
Sugar free chewing gum (increases saliva, washes esophagus)

DIETARY 
Avoid trigger foods (spicy, fried, tomato-based, citrus, chocolate, caffeine, alcohol, peppermint).
Eat smaller, more frequent meals rather than large ones.
Stay upright for at least 2–3 hours after eating.
Avoid eating within 2–3 hours of bedtime.

LIFESTYLE
Elevate the head of the bed 6–8 inches to reduce nighttime reflux.
Maintain a healthy weight (extra abdominal pressure worsens reflux).
Quit smoking if applicable (nicotine weakens the lower esophageal sphincter).
Maintain a healthy weight
A 20-minute walk after eating (improves mood, digestion, and sleep)
Cognitive behavioral therapy (CBT) is very effective for anxiety, if severe
Journaling can help reduce racing thoughts
Tai chi or Qigong can engage the parasympathetic system improving digestion

ANXIETY AND SLEEP INTERVENTION
Deep breathing, mindfulness, or progressive muscle relaxation before meals and bedtime.
Yoga or gentle stretching (though avoid poses that increase abdominal pressure right after eating).
Meditation, even for 5 or 10 minutes
Keep a consistent sleep and wake time
Limit screens/bright light in the hour before bed.
Make the bedroom dark, cool, and quiet.
A warm bath, reading, or meditation can signal the body it’s time to wind down.
Caffeine and nicotine should be avoided in the afternoon and evening.
MEDICATION EFFECTS (AVOID)
Consider oral contraceptives (can induce acid reflux)
Estrogen and progesterone in birth control pills (and in pregnancy) can relax the lower esophageal sphincter (LES) — the valve that normally keeps stomach contents from refluxing upward.

Progesterone in particular decreases LES tone, which makes it easier for acid to flow back into the esophagus.

Calcium channel blockers (for high blood pressure/heart disease): amlodipine, nifedipine, diltiazem, verapamil.

Nitrates (for angina): nitroglycerin, isosorbide dinitrate/mononitrate.

Anticholinergics: oxybutynin, tolterodine, some Parkinson’s medications.

Sedatives: benzodiazepines (diazepam, lorazepam, alprazolam).

MEDICATIONS THAT IRRITATE THE ESOPHAGUS (AVOID)
Bisphosphonates (for osteoporosis): alendronate, risedronate. (For osteoporosis)
Certain antibiotics: doxycycline, tetracycline, clindamycin.
NSAIDs: ibuprofen, naproxen, aspirin.
Potassium supplements (oral tablets).
Iron supplements (ferrous sulfate).

MEDICATIONS THAT SLOW STOMACH EMPTYING (AVOID)
Opioids: morphine, codeine, hydrocodone, oxycodone.
Tricyclic antidepressants: amitriptyline, nortriptyline.
GLP-1 receptor agonists (for diabetes/weight loss): semaglutide, liraglutide (Ozempic, Wegovy, etc.)  

---- Another patient claims she received the best relief with the alginate therapy. 

Please consult your physician to determine what is best for you. These are pretty much the best list of sorts for treating this pesky problem.

Stay well.

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