Can Muscle Relaxants Affect the Esophageal Sphincter in GERD?

Q: Can Muscle Relaxants Affect the Esophageal Sphincter in GERD?

Hello： Muscle relaxants primarily act on skeletal muscles, while the lower esophageal sphincter is composed of smooth muscle, so theoretically, the impact should be minimal. <br>However, if there are concerns about potential effects, you can try stopping the medication for three

I would like to inquire about medications for gastroesophageal reflux disease (GERD)?

Hello, doctor.
Recently, I was diagnosed with possible gastroesophageal reflux disease (GERD).
Since then, I have made some changes to my lifestyle, and I no longer feel the constant sensation of phlegm in my throat as I did before.
I also haven't experienced left-sided chest pain again.
However, recently at night, especially after eating a full meal, I have started to feel chest tightness and my breathing isn't very smooth.
I even experience slight palpitations.
I suspect that GERD might be acting up again.
Initially, the doctor only listened to my description and suggested that I might have GERD, but did not perform an endoscopy or X-ray, nor did they prescribe any medication.
Recently, I have been experiencing insomnia, and the doctor prescribed "Ambien" for me to take before bed to help me sleep.
However, I noticed that this medication has muscle relaxant properties.
Could medications with such effects influence the lower esophageal sphincter? Since I take a long time to fall asleep, I am unable to avoid eating for three hours before bed.
I usually eat some fruit one to two hours before sleeping, which leaves me feeling somewhat full; otherwise, I feel quite hungry before falling asleep, which is bothersome.
So, doctor, do muscle relaxant medications affect the lower esophageal sphincter?

Zhang, 20~29 year old female. Ask Date: 2016/10/28

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: Muscle relaxants primarily act on skeletal muscles, while the lower esophageal sphincter is composed of smooth muscle, so theoretically, the impact should be minimal.
However, if there are concerns about potential effects, you can try stopping the medication for three days to see if there is any improvement; if there is improvement, it indicates that there may be an effect.
If issues persist, you may want to consult a gastroenterologist.
Additionally, if you experience discomfort immediately after eating, it is advisable to eat until you are about 70-80% full and avoid sitting or lying down right after a meal.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2016/10/28

More Info

Muscle relaxants can indeed have an impact on the esophageal sphincter, particularly in the context of gastroesophageal reflux disease (GERD). The esophageal sphincter, specifically the lower esophageal sphincter (LES), plays a crucial role in preventing the backflow of stomach contents into the esophagus. When this sphincter is functioning properly, it remains tightly closed to keep stomach acid and other contents from refluxing. However, if the LES is weakened or relaxed, it can lead to symptoms of GERD, such as heartburn, chest discomfort, and regurgitation.

Muscle relaxants, such as the one you mentioned (Ambien, or zolpidem), are primarily used to treat insomnia and can have muscle-relaxing properties. While their primary action is on the central nervous system to promote sleep, they can also lead to a decrease in muscle tone throughout the body, including the smooth muscles of the gastrointestinal tract. This relaxation can potentially affect the LES, leading to a higher likelihood of reflux, especially if taken close to mealtime or bedtime.

In your case, the timing of your meals and the consumption of food close to bedtime can exacerbate GERD symptoms. Eating just before lying down can increase the pressure on the LES and make it more difficult for it to remain closed, especially if muscle relaxants are also in play. This could explain the feelings of chest tightness and difficulty breathing that you are experiencing, particularly after meals.

It's also important to consider that lifestyle modifications are crucial in managing GERD. These include avoiding large meals, not lying down immediately after eating, and steering clear of trigger foods and beverages (such as spicy foods, caffeine, and alcohol). Additionally, maintaining a healthy weight and elevating the head of the bed can help reduce nighttime symptoms.

If you are experiencing persistent symptoms, it may be beneficial to consult with a gastroenterologist for further evaluation. While your doctor may have initially diagnosed you based on your symptoms, additional diagnostic tests such as an upper endoscopy or pH monitoring can provide more insight into the condition of your esophagus and the function of the LES.
In summary, while muscle relaxants can potentially affect the function of the esophageal sphincter, it is essential to consider the overall context of your eating habits and lifestyle. If you continue to experience symptoms, a thorough evaluation and possibly a tailored treatment plan may be necessary to manage your GERD effectively.

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