Managing GERD Treatment: Should You Stop Medication Due to Constipation?

If a patient diagnosed with gastroesophageal reflux disease (GERD) experiences severe constipation after starting medication, should the medication be discontinued?

Hello Dr.
Chen, I was diagnosed with grade 2 gastroesophageal reflux disease (GERD) this year after undergoing an endoscopy.
I have been taking Tegoprazan orally disintegrating tablets for 3 months, and I have just completed 2 months of treatment (along with a super strict diet that promotes good digestion).
The discomfort in my throat, the strong peristalsis in my stomach, and the feeling of wanting to vomit before bed have all disappeared.
However, I still experience occasional burping while eating, bloating after meals, and burping when I drink a lot of water at once.
I initially planned to continue taking the medication for the remaining month, but since starting the medication, my stools have become dry and hard, making bowel movements very difficult, and I experience anal pain (I am worried about worsening hemorrhoids; I already have hemorrhoid symptoms, but before the medication, I never experienced prolonged constipation for many days).
During my follow-up visit, the doctor prescribed Bisacodyl enteric-coated tablets to take alongside the medication (which I haven't started yet).
I am very concerned that taking this along with the gastric medication might cause side effects.
I would like to ask the doctor if I stop taking Tegoprazan, will the treatment for GERD be interrupted and will I lose the progress I've made? Will my symptoms immediately return to the severity they were before? Can I take Bisacodyl continuously for a month? The daily experience of hard stools is truly painful and has severely affected my daily life.
Thank you for your response.

Mou xiaojie, 30~39 year old female. Ask Date: 2021/10/15

Dr. Chen Shidian reply Gastroenterology and Hepatology

Discontinuing medication can lead to relapse, so it is advisable to reduce the dosage for better control.
If constipation persists despite increasing water intake, consuming more fruits and vegetables, and increasing physical activity, it may be necessary to use laxatives or stool softeners.

Reply Date: 2021/10/15

More Info

Managing gastroesophageal reflux disease (GERD) can be challenging, especially when side effects from medications, such as constipation, arise. It’s understandable to be concerned about the impact of stopping your medication, especially after experiencing significant symptom relief. Let’s break down your situation and explore the best course of action.

Firstly, it’s important to recognize that the medication you are currently taking, likely a proton pump inhibitor (PPI) like the one you mentioned (泰克胃通口溶錠), is effective in reducing stomach acid production, which helps alleviate GERD symptoms. The fact that you have experienced a reduction in throat discomfort, gastric motility sensations, and pre-vomiting feelings indicates that the medication is working as intended. However, the emergence of constipation and associated discomfort is a common side effect of many medications, including PPIs.

Constipation can indeed be a distressing side effect, especially if it leads to pain during bowel movements or exacerbates existing conditions like hemorrhoids. It’s crucial to address this issue, as chronic constipation can lead to further complications. The introduction of a stool softener or laxative, such as the one your doctor prescribed (變通樂膜衣錠), can help alleviate these symptoms. These medications work by increasing the water content in the stool, making it easier to pass. It’s generally safe to use these medications alongside PPIs, but it’s always best to consult with your healthcare provider regarding potential interactions or side effects.

Now, regarding your concern about stopping the PPI: abruptly discontinuing your medication may lead to a rebound effect, where your GERD symptoms could return, potentially even worse than before. This is particularly true if you have been on the medication for an extended period. The body can become accustomed to the reduced acid levels, and stopping the medication suddenly can lead to increased acid production, resulting in a resurgence of symptoms.

If you are considering stopping the PPI due to constipation, I would recommend discussing this with your healthcare provider. They may suggest a gradual tapering of the medication rather than an abrupt stop, which can help mitigate rebound symptoms. Additionally, they might recommend dietary changes, increased fiber intake, and hydration to help manage constipation without having to stop the GERD treatment.

In terms of the stool softener, it is generally safe to take it for a month, especially if it helps alleviate your symptoms. However, it’s important to monitor your bowel habits and any side effects you may experience. If you find that the stool softener is not effective or if you experience any adverse effects, you should reach out to your healthcare provider for further evaluation.

In summary, do not stop your GERD medication without consulting your doctor, as this could lead to a return of your symptoms. Instead, consider using the stool softener as prescribed and discuss any ongoing concerns with your healthcare provider. They can help you find a balance between managing your GERD effectively while also addressing the constipation issue. Remember, your health and comfort are paramount, and there are often multiple strategies to manage these conditions effectively.

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You can discuss this further with your outpatient physician.