Excess Stomach Acid: Causes and Treatment Options - Gastroenterology and Hepatology

Q: Excess Stomach Acid: Causes and Treatment Options

Response： Hello, 1. I have not heard that these two medications affect the contraction of the lower esophageal sphincter, leading to gastroesophageal reflux. 2. There is indeed a difference; gastric acid secretion increases after meals, and it also tends to in

Excess stomach acid (Gastroesophageal reflux disease?)

Dr.
Chen: Hello, I have been experiencing excessive gastric acid and heartburn after meals since mid-August 2004.
Currently, I am taking (1) Domperidone, (2) Famotidine, and (3) MGO (all before each meal), but I have not been able to resolve the issue.
Prior to this, starting in June 2003, I had symptoms of abdominal bloating and loss of appetite due to autonomic nervous system dysfunction.
I underwent colonoscopy and gastroscopy in May and August of last year, both of which were normal.
I was prescribed the following psychiatric medications once daily.
After the symptoms of bloating and loss of appetite improved, I gradually reduced the medication until I completely stopped in July of last year.
However, after the gastroenterologist mentioned that excessive gastric acid is closely related to mental health, I resumed taking the following psychiatric medications once daily: (1) Foan 10mg (Oxazepam), (2) Homagyl 50mg, and (3) Diazepam 2mg, which is an anticonvulsant used for muscle rigidity.
Diazepam is highly lipophilic.

1.
Could Diazepam and Homagyl cause relaxation of the lower esophageal sphincter, leading to gastroesophageal reflux?
2.
I find that my excessive gastric acid issue is more severe after Chinese meals.
Does gastric acid secretion vary at different times?
Best regards.

Johnson, 40~49 year old female. Ask Date: 2005/01/27

Dr. Chen Zhiping reply Gastroenterology and Hepatology

Response: Hello,
1.
I have not heard that these two medications affect the contraction of the lower esophageal sphincter, leading to gastroesophageal reflux.

2.
There is indeed a difference; gastric acid secretion increases after meals, and it also tends to increase during sleep.
Currently, the medications used to treat gastroesophageal reflux disease (GERD) are long-acting and should help control symptoms over a 24-hour period.

Sincerely, Dr.
Chen Zhi-Ping, Internal Medicine.

Reply Date: 2005/01/27

More Info

Excess stomach acid, also known as hyperacidity, can lead to a range of uncomfortable symptoms, including heartburn, acid reflux, and indigestion. Understanding the causes and treatment options for this condition is crucial for effective management.

Causes of Excess Stomach Acid
1. Dietary Factors: Certain foods and beverages can stimulate the production of stomach acid. Spicy foods, citrus fruits, tomatoes, chocolate, caffeine, and alcohol are common culprits. Eating large meals or lying down immediately after eating can also exacerbate symptoms.

2. Stress and Anxiety: Emotional factors such as stress, anxiety, and depression can significantly impact digestive health. The autonomic nervous system, which regulates bodily functions, can influence gastric acid secretion. Stress can lead to increased acid production and exacerbate symptoms of gastroesophageal reflux disease (GERD).

3. Medications: Some medications, including certain antidepressants and anti-anxiety drugs, can relax the lower esophageal sphincter (LES), leading to acid reflux. For instance, Diazepam (Valium) and other benzodiazepines may contribute to this issue by relaxing the muscles of the esophagus.

4. Underlying Conditions: Conditions such as gastritis, peptic ulcers, and gastroesophageal reflux disease can lead to increased acid production or impaired acid clearance.

Treatment Options
1. Medications:
- Proton Pump Inhibitors (PPIs): Medications like Omeprazole and Esomeprazole reduce stomach acid production and are commonly prescribed for conditions like GERD.

- H2 Receptor Antagonists: Drugs such as Famotidine decrease acid production and can provide relief from symptoms.

- Prokinetics: Medications like Domperidone help improve gastric motility and can reduce symptoms of bloating and discomfort.

2. Lifestyle Modifications:
- Dietary Changes: Avoiding trigger foods and eating smaller, more frequent meals can help manage symptoms. Keeping a food diary may assist in identifying specific triggers.

- Weight Management: Maintaining a healthy weight can reduce pressure on the stomach and lower the risk of acid reflux.

- Stress Management: Techniques such as mindfulness, yoga, and cognitive-behavioral therapy can help manage stress and its impact on digestion.

3. Surgical Options: In severe cases where medications and lifestyle changes do not provide relief, surgical interventions such as fundoplication may be considered to strengthen the LES and prevent acid reflux.

Addressing Your Specific Concerns
Regarding your questions about Diazepam and Homagyl, both medications can potentially relax the LES, which may contribute to acid reflux. If you suspect that these medications are exacerbating your symptoms, it is essential to discuss this with your healthcare provider. They may consider adjusting your medication regimen or exploring alternative treatments.

As for the timing of acid secretion, it is indeed possible for stomach acid production to vary throughout the day. Factors such as meal timing, type of food consumed, and individual metabolic rates can influence acid secretion. For instance, acid production may be higher after meals, particularly if the meal is large or rich in fat.

In conclusion, managing excess stomach acid involves a multifaceted approach that includes medication, lifestyle changes, and addressing underlying psychological factors. It is crucial to work closely with your healthcare provider to tailor a treatment plan that best suits your individual needs and to monitor any changes in your symptoms. Regular follow-ups and open communication about your treatment progress will help ensure effective management of your condition.

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