Treating stubborn reflux

treating stubborn reflux

H2 receptor antagonists and proton pump inhibitors (PPI’s)

Last week I discussed causes of reflux and how to treat mild infrequent symptoms.  If symptoms are becoming more frequent and/or are not relieved with the use of antacids the next step is to take a medicine called a histamine 2 receptor antagonist.  If a medicine from this group is not effective then the next step is to take a proton pump inhibitor (PPI).

These are available over the counter and on prescription so it is best to speak with your Doctor or Pharmacist to discuss the use of these and your symptoms.

These medicines should not be taken by women who are pregnant or breastfeeding.  Antacids can be used instead.


How do H2 receptor antagonists work?

These medicines work because they significantly decrease the amount of acid made in the stomach.  This means the burning caused by acid travelling upwards from the stomach does not occur.  H2 antagonists do not work as quickly as antacids but they can give relief for up to 12 hours.

Taking H2 receptor antagonists

These medicines can be used to treat as well as prevent reflux symptoms.

H2 antagonists should not be used for more than 2 weeks without a Doctor being consulted.

Ranitidine (Zantac) is the most commonly used medicine of this type and is available over the counter and on prescription.  If these medicines are to be taken once daily they are best taken at night and twice daily dosing is best taken morning and night.


How do PPI’s work?

PPI’s stop acid production in the stomach.  They are the strongest medicines available for reflux.  People who suffer with symptoms on a daily basis usually benefit from these medicines the most and the effects last for 24 hours.

Taking PPI’s

These medicines have recently become available over the counter as well as on prescription.

A Doctor should be consulted if these medicines are used for more than 2 weeks whether they are effective or not.

Esomeprazole (Nexium) is the most commonly used over the counter and prescription PPI.


Lifestyle changes are also important even if these medications are being used.

These include; limiting tea, coffee and alcohol, limiting spicy and fatty foods, eating smaller meals and not eating too close to bedtime, elevating the head of the bed can also be helpful for those who suffer during the night.


As with all medications there are potential interactions with other medicines and potential adverse effects possible with H2 antagonists and PPI’s.  It is wise to speak with you Doctor or Pharmacist about your use of these.


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