Reflux Disease

Medications for reflux and how they work

There are different treatments for gastroesophageal reflux (GER) and gastroesophageal reflux (GERD), which may be considered if symptoms persist:

Thickening milk

Sometimes a doctor may recommend that formula milk be thickened to help the baby to keep it down. A commercial thickener may be prescribed or your doctor may simply suggest using baby rice or oatmeal.

Hypoallergenic infant formulas

It is possible your doctor may consider changing the infant formulas that you are using if bottle feeding, to feeds that thicken on contact with the stomach or a hypoallergenic infant formula. Hypoallergenic infant formula's are allergy free. As reflux and allergies are often linked this can help to reduce the symptoms. Furthermore many of these are easier to digest and are absorbed faster once in the stomach, leaving less time for the formula to be refluxed back. The infant should thrive much better.

Gaviscon

Often the first medication prescribed for reflux in babies and children. This drug performs three functions. First it thickens the milk making it easier for the baby to cope with, secondly it coats the esophagus all the way down to the stomach. Finally when in the stomach it forms a raft over the stomach contents, helping to stop the contents of the stomach from escaping back up the esophagus.

Histamine-2-receptor antagonists(H2-blockers):

H2-blockers are drugs that block or prevent the production of gastric (stomach) acid. A pump in the stomach releases hydrochloric acid when stimulated by histamine. H2 blocks prevent histamine from stimulating this pump, thereby reducing to amount of acid released into the stomach.

H2-blockers don´t completely neutralise the gastric acid. They are effective for about 50% patients.

Here are a list of some of the more common H2-blockers:

• Cimetidine (Tagamet)
• famotidine (Pepcid)
• nizatidine (Axid)
• ranitidine (Zantac).

Side affects can be dizziness, headache, gynecomastia, malaise

Proton pump inhibitors (PPI):

PPI´s are the most effective way of reducing acid secretion, as they stop acid secretions at the source of acid production. They work by shutting down a system with in the stomach known as proton pumps.

They are usually most effective when given in a single dose before the first meal of the day. Timing of the dose it critical to the success of PPI's and incorrect administration can often be a reason why the treatment fails. Although there are circumstances were an additional dose may be required in the evening.

Some of the more common PPI`s are:

• Omeprazole
• Lansoprazole
• Esomeprazole
• Pantoprazole
• Rabeprazole

Side affects can include headaches, diarrhea, abdominal pain, asthenia (weakness), flatulence (wind), dry mouth

Prokinetic agents (motility drugs):

These medications speed up the emptying of the stomach. Some of them also help to close the sphincter muscle at the opening of the stomach.

Some common Prokinetic agents include:

• Metoclopramide,
• Domperidone, (is one of the most common and should be given 1/2hr to 20 minutes before food)
• Erythromycin

Side affects include Drowsiness, restlessness, diarrhea, nervous system side affects, nausea

Vitamin and mineral supplement

If the patient isn't getting enough vitamins and minerals in their diet, they may be advised to take supplements as poor nutrition can lead to further complications.

Dosage of these medications is weight dependent. If the medication is no longer proving effective, you should check with a member of the medical profession.

Often medications that are prescribed for reflux are not registered for children under the age of 12 years old. This is quite normal and is a question we are frequently asked about.

Written by Tracey (Chairman)