There is no such thing as a medicine that is 100 percent safe and free of side effects. H2 blockers are thought to be safer than PPIs for long-term use to treat acid reflux. H2 blockers can be over-the-counter or prescription medicines.
Continuous exposure to acid can also change the cell lining of the esophagus, a condition called Barrett’s Esophagus, and those cellular changes can lead to cancer. It’s a low risk of progression-less than 1 percent per year-but it happens. Yes, it sure can cause the same problem…enlarged belly, regardless of what that’s made of, or even certain exercises that compress the abdomen, can push the stomach up through the diaphragm’s esophagus opening, stretching/herniating that, which triggers more reflux of stomach contents. Although it’s usually not the primary impetus, excess weight-especially in the abdominal region-can contribute to increased IAP and GERD.
A study of 106 individuals with typical reflux symptoms persisting despite treatment with proton pump inhibitors (PPIs), which limit acid secretion in the stomach, aimed to determine the underlying cause of reflux symptoms not responding to PPI therapy. The study found that approximately one-third of the patients suffer from disorders other than gastroesophageal reflux disease (GERD), predominantly functional heartburn, concluding that this explains, at least partly, why many patients will not benefit from acid inhibitory treatment. Gastroesophageal reflux disease (GERD) characterized by heartburn and/or regurgitation symptoms is one of the most common gastrointestinal disorders managed by gastroenterologists and primary care physicians. There has been an increase in GERD prevalence, particularly in North America and East Asia.
Weight loss in patients who are overweight or have recent weight gain has been proven to improve GERD symptoms, as well as elevation of the head of the bed.(31) Patients should also avoid a supine position immediately after meals and having meals up to two hours before bedtime. Dietary triggers for reflux include caffeine, chocolate, carbonated beverages and foods with high fat content. There is no gold standard for the diagnosis of GERD. In our daily practice, we often rely on the subjective reporting of a constellation of symptoms and attribute these to GERD. For patients who fail to respond to PPIs, a variety of causes are possible, both GERD-related and non-GERD-related.
Most doctors simply take what works for GERD and tell people with silent reflux to use the same. Diagnostic value of the proton pump inhibitor test for gastro-oesophageal reflux disease in primary care. Risk factors for the detection of Barrett’s esophagus in patients with erosive esophagitis. Combination of PPI with a prokinetic drug in gastroesophageal reflux disease.
26. Gunaratnam NT, Jessup TP, Inadomi J, Lascewski DP. Sub-optimal proton pump inhibitor dosing is prevalent in patients with poorly controlled gastro-oesophageal reflux disease. 12. Dean BB, Gano AD, Jr, Knight K, Ofman JJ, Fass R. Effectiveness of proton pump inhibitors in nonerosive reflux disease.
Acid clearance and mucosal sensitivity modulate the effect of reflux by prolonging the exposure of the esophageal mucosa to refluxate and diminishing the sensory threshold of what is perceived as painful. Modified from . The ensuing PPI euphoria broadened through the turn of the century leading many clinicians to conclude that, not only were these drugs tremendously effective in treating GERD, but that the therapeutic response to PPIs constituted a clinical definition of GERD .
However, research now suggests that certain risks may be involved with long-term use of these drugs. Most people will benefit from first-stage treatments by adjusting how, when, and what they eat. However, diet and lifestyle adjustments alone may not be effective for some. In theses cases, doctors may recommend using medications that slow or stop acid production in the stomach.
42. Khan F, Maradey-Romero C, Ganocy S, Frazier R, Fass R. Utilisation of surgical fundoplication for patients with gastro-oesophageal reflux disease in the USA has declined rapidly between 2009 and 2013.
Long-term acid suppression therapy for gastroesophageal reflux disease should be titrated to the lowest effective dose. Endoscopy should be limited to patients who have alarm symptoms or persistent GERD symptoms after an adequate trial of PPI therapy.
Koek GH, Sifrim D, Lerut T, Janssens J, Tack J. Effect of the GABA(B) agonist baclofen in patients with symptoms and duodeno-gastro-oesophageal reflux refractory to proton pump inhibitors. 25.