From the Guidelines
Management of esophageal acid hypersensitivity should prioritize a multi-faceted approach, including lifestyle modifications and medications, with a focus on reducing acid exposure and modulating pain perception pathways, as evidenced by the most recent study 1.
Key Components of Management
- Lifestyle modifications are crucial and include:
- Avoiding trigger foods (spicy, acidic, fatty)
- Eating smaller meals
- Not lying down for 2-3 hours after eating
- Elevating the head of the bed
- Weight loss if appropriate, as supported by studies such as 1 which showed a dose-dependent association between weight loss and reduction of GORD symptoms
- Medications:
- Proton pump inhibitors (PPIs) such as omeprazole 20-40 mg daily, esomeprazole 20-40 mg daily, or pantoprazole 40 mg daily for 8-12 weeks, as recommended in 1 and 1
- Neuromodulators, including low-dose tricyclic antidepressants, selective serotonin reuptake inhibitors, or serotonin-norepinephrine reuptake inhibitors, for patients with persistent symptoms despite PPI therapy, as suggested in 1
- Pain modulators such as gabapentin or pregabalin may also help reduce hypersensitivity, as mentioned in 1
Psychological Interventions
- Cognitive behavioral therapy can address anxiety and hypervigilance that often accompany and exacerbate symptoms
- Relaxation training and abdominal breathing exercises may also be beneficial, as reported in 1
Individualized Treatment
- Treatment should be tailored to each patient, with regular follow-up to assess response and adjust therapy as needed, emphasizing the importance of a personalized approach as outlined in 1
From the Research
Management of Esophageal Acid Hypersensitivity
- Esophageal acid hypersensitivity can be managed with proton pump inhibitors (PPIs), which have been shown to be effective in healing and maintaining erosive or worse esophagitis 2.
- PPIs such as omeprazole and lansoprazole are highly effective and safe in acute healing of erosive esophagitis and are significantly better than H2 receptor antagonists 2.
- However, PPIs can also cause hypersensitive reactions, which can range from mild symptoms to life-threatening disorders 3, 4.
- The management of esophageal (noncardiac) chest pain, which can be related to esophageal acid hypersensitivity, can be challenging, but PPIs, antidepressants, theophylline, and cognitive behavioral therapy appear to be useful treatments 5.
- In cases where PPIs are not effective or cause hypersensitive reactions, alternative treatments such as new drugs that increase the defensive properties of the esophageal mucosa may be considered 6.
Treatment Options
- Proton pump inhibitors (PPIs) such as omeprazole and lansoprazole are commonly used to treat esophageal acid hypersensitivity 2, 5.
- Antidepressants such as sertraline, trazodone, and venlafaxine may also be effective in treating esophageal (noncardiac) chest pain 5.
- Theophylline and cognitive behavioral therapy may also be useful in treating esophageal (noncardiac) chest pain 5.
- New drugs that increase the defensive properties of the esophageal mucosa may be considered in cases where PPIs are not effective or cause hypersensitive reactions 6.
Hypersensitive Reactions to PPIs
- Hypersensitive reactions to PPIs can range from mild symptoms to life-threatening disorders 3, 4.
- Cases of urticaria, angioedema, anaphylaxis, and other autoimmune reactions have been described 4.
- A high level of clinical suspicion is critical in the diagnosis of PPI-induced hypersensitive reactions 4.
- Physicians should be aware of the possible hypersensitive reactions due to PPIs and routine/empirical prescription for PPI should only be used when clinically indicated 4.