Topic: Irritable Bowel Syndrome (IBS), June 2000

Dr. Lee:
A viewer suffers from nausea and stomach burning every night after supper. The only thing that relieves the symptoms is a medication called Gravol. He has tried Prilosec and Pepcid AC without symptom relief. What do you think?

Dr. Marks:
Gravol is an antihistamine, diphenhydramine, to be exact, and I don't know why it would be effective in acid reflux or GERD. It is not one of the mainstays of treatment.

The symptoms of GERD usually respond to optimal treatment with medications such as Prilosec and Pepcid. In fact doctors sometimes use acid-suppressing medications as a diagnostic test. If the symptoms go away the problem is likely have been due to acid reflux.

If symptoms do not go away with acid suppressing medications such as Prilosec or other PPI drugs, there are two possible explanations. First, the symptoms may be due to something else other than GERD. Second, the medications are not adequately shutting off the production of stomach acid. This can occur in as many as 1 out of every 5 or 10 patients.

Esophageal pH monitoring can be used to determine why acid suppressing medications are not working. If the pH monitoring study performed while the patient takes his or her medication for reflux shows abnormal amounts of reflux, then treatment is inadequate and needs to be changed (either using another medication or higher doses of the same medication).