Antacids Alginic acid

Antacids work locally to increase the pH of the reflux-ate, neutralizing the acid. The increase in pH-causes pepsin to become inactive, and may also prevent the

Table 6. GERD therapy in the elderly

Medication

Advantages

Disadvantages

Antacids/Alginic acid

- Relief of mild/moderate symptoms (20%)

- Over the counter

- Rapid effect

- Do not heal mucosal disease

- Diarrhea/Constipation

- Impaired drug absorption

- Must be upright for effect (alginic acid)

Prokinetic agents

- Effectively relieve symptoms

- Heal mucosal erosions

- Useful for dyspeptic symptoms - nausea, gas, bloating

- As effective as H2B's

- Fatal arrhythmias (Cisapride)

- Poor side effect profile - crosses blood-brain barrier (CNS toxicity)

- Anti-cholinergic effects (Bethenechol)

Mucosal protective

- Provides symptom relief and esophageal healing

- Dosing four times a day

- Affects drug absorption

- Drug-drug interactions

Histamine2 receptor blockers

- Blocks acid production secondary to multiple stimuli

- Incomplete acid suppression

- Tolerance development

- Not as effective for erosive esophagitis

- May require increased dosing for full effect

- Dosage adjustment in renal failure

- Short duration of action

Proton pump inhibitors

- Blocks final common pathway of acid secretion

- Symptom relief and mucosal healing in up to 95%

- Effective in severe disease

- Once daily dosing

- Effective for maintenance therapy

- No dosage adjustments in renal or hepatic failure

- Increased gastrin production

- Possible alteration of gastritis pattern in H. Pylori positive patients

- Drug-drug interactions are possible

- Decreased vitamin B12 levels

injurious effects of certain bile acids [71]. They may increase LES pressure, decreasing the amount of gastroesophageal reflux. Alginic acid forms a foamy barrier on top of the refluxate to protect the esophagus from acid-induced damage. These agents have been shown to be more effective than placebo in providing relief of mild to moderate reflux symptoms [20]. Relief of symptoms can be expected in up to 20% of patients. Antacids and alginic acid are not likely to promote healing of the esophageal mucosa, or any other complications of chronic GERD [2]. There are some adverse effects, which may be of particular concern in the elderly, including constipation with aluminum containing preparations and diarrhea with magnesium containing products. Combination products may lessen these effects. Aluminum containing antacids can cause dialysis encephalopathy and osteomalacia, and should be used with caution in those with renal impairment. Antacids may promote salt overload, induce hypercalcemia, and affect absorption of other drugs, especially antibiotics [10]. In addition, alginic acid requires a patient to be in the upright position to be efficacious, which may be an issue in an elderly population. Antacids should not be use for more than 2 weeks, as this may hide a more severe diagnosis requiring endoscopic evaluation, and more aggressive medical management [72].

Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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