These agents have no affect against non-acid reflux, such as bile back-up.
Adverse Effects. Proton-pump inhibitors may pose the following concerns:
- Side effects are uncommon but may include headache, diarrhea, constipation, nausea, and itching.
- Proton-pump inhibitors should be avoided by pregnant women and nursing mothers, although recent studies suggest that they do not pose an increased risk of birth defects.
- They may interact with certain drugs, such as antiseizure agents (e.g., phenytoin), anti-anxiety drugs (e.g., diazepam), and blood thinners (e.g., warfarin).
- Long-term use of high-dose PPIs may produce vitamin B12 deficiencies, but studies are needed to confirm any significance of this risk.
There is some evidence that acid reflux may contribute to the higher risk of cancer in BE, but it is not known yet if acid-blockers have any protective effects against cancer in these patients. In fact, the long-term use of proton-pump inhibitors by people with H. pylori may, in theory at least, reduce acid secretion enough to cause atrophic gastritis (chronic inflammation of the stomach). This condition, in turn, is a risk factor for stomach cancer. To compound concerns, long-term use of PPIs may mask symptoms of stomach cancer and so delay a diagnosis. To date, however, there have been no reports of an increased risk of stomach cancer with long-term use of these drugs.
Agents that Protect the Mucus Lining (Sucralfate)
Sucralfate (Carafate) protects the mucus lining in the gastrointestinal tract. It seems to work by sticking to an ulcer crater and protecting it from damage due to stomach acid and pepsin. It may be helpful for maintenance therapy in people with mild to moderate GERD. Other than constipation, which occurs in 2.2% of patients, the drug has few side effects. Sucralfate interacts with a wide variety of drugs, however, including warfarin, phenytoin, and tetracycline.
Anti-Spasm Drugs to Prevent Acid and Non-Acid Reflux
Most drugs used for GERD have no effect on non-acid reflux, such as back-up of bile. Baclofen, known as a gamma-amino butyric acid agonist, is commonly used to reduce muscle spasms. Investigators are now showing that is can reduce both acid and non-acid reflux episodes (as much as 70% in one study) and to increase LES pressure, an important factor for preventing back up.
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