The issue of acid breakthrough!
If you deal with acid reflux and are being treated with a PPI you may also be well aware of the problem of acid breakthrough. It is quite common and has been noted that as many as half of patients on a PPI therapy will have acid breakthrough at some point. Most find their breakthrough pain to be in the evening or at bedtime (1).
Should you deal with acid breakthrough pain while taking a PPI be sure to discuss the problem with your physician. In some instances it may be that your PPI dose is too low. In children some medications for acid reflux may need to be adjusted as they gain weight. This can be especially true for h-2 blockers and antacids. PPI medications may also be started at the lowest dose known to provide relief and may need to be adjusted over time.
Once you know that your PPI dose is adequate your doctor may want to discuss with you whether you have made the appropriate lifestyle changes to deal with your acid reflux. Some of these changes might include loosing weight if you are overweight, elevating the head of the bed at night, eating smaller more frequent meals and limiting foods that are known triggers.
When lifestyle changes and adequate doses of PPI medications still do not control your symptoms your doctor may want to add another medication to help deal with the acid breakthrough. H2 blockers and antacids, or a combo medicine, are frequently added to alleviate the breakthrough acid pain. While these medicines are available over the counter you should still consult your physician before adding them to your treatment plan.
Your physician will want to let you know the appropriate timing for taking other acid controlling medications while you are being treated with a PPI. If taken incorrectly you could diminish the usefulness of your PPI medication unknowingly. It is also important to discuss the breakthrough pain with your physician in case they want to rule out complications or additional problems caused by uncontrolled acid.
Acid breakthrough pain can be very frustrating but there are treatments available. Talk with your physician and make the lifestyle changes you need. Hopefully you will be on the road to feeling better quickly!