Acid reflux in morning
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Morning Acid Reflux: Causes and Treatments
Prevalence and Symptoms of Morning Acid Reflux
Morning acid reflux, often referred to as "Riser's reflux," is a common complaint among patients with gastroesophageal reflux disease (GORD). Many individuals report waking up with a sour or bitter taste in their mouth, which is indicative of acid reflux events occurring just before or immediately after awakening1. This phenomenon is particularly prevalent among GORD patients compared to normal subjects, highlighting the need for targeted interventions to manage these early morning symptoms.
Mechanisms Behind Morning Acid Reflux
Transient Lower Esophageal Sphincter Relaxations (TLESRs)
One of the primary mechanisms behind acid reflux, including morning episodes, is transient lower esophageal sphincter relaxations (TLESRs). These relaxations allow stomach acid to escape into the esophagus, leading to the characteristic symptoms of acid reflux. Research has shown that TLESRs are a significant factor in reflux events, and managing these relaxations can help reduce the frequency and severity of reflux episodes2.
Impact of Proton Pump Inhibitors (PPIs)
Proton pump inhibitors (PPIs) are commonly prescribed to manage acid reflux by reducing stomach acid production. Studies have demonstrated that PPIs significantly decrease the total number of reflux events, including those occurring during sleep3. However, while PPIs are effective in reducing acidic reflux, they may not completely eliminate non-acidic reflux events, which can still cause symptoms in some patients3.
Treatment Options for Morning Acid Reflux
Lesogaberan as an Add-On Treatment
Lesogaberan (AZD3355), a novel gamma-aminobutyric acid type B receptor agonist, has shown promise as an add-on treatment for patients who continue to experience reflux symptoms despite PPI therapy. In clinical trials, lesogaberan significantly reduced the number of reflux events and TLESRs, and increased lower esophageal sphincter (LES) pressure compared to placebo2. These findings suggest that lesogaberan could be a valuable addition to the treatment regimen for patients with persistent symptoms.
Managing Non-Acidic Reflux
While PPIs are effective in reducing acidic reflux, non-acidic reflux events can still occur and contribute to symptoms. Research indicates that non-acidic reflux events are relatively more common during PPI treatment, although the difference is not always statistically significant3. This highlights the importance of comprehensive management strategies that address both acidic and non-acidic reflux to improve patient outcomes.
Conclusion
Morning acid reflux is a significant issue for many GORD patients, often resulting in unpleasant symptoms upon waking. Understanding the mechanisms behind these reflux events, such as TLESRs, and exploring effective treatment options like lesogaberan, can help manage and reduce these symptoms. While PPIs remain a cornerstone of reflux management, addressing non-acidic reflux is also crucial for comprehensive care. Further research and tailored treatment strategies are essential to improve the quality of life for individuals suffering from morning acid reflux.
Sources and full results
Most relevant research papers on this topic
Riser’s reflux – an eye‐opening experience
GORD patients experience more acid reflux events before and after awakening from sleep in the morning compared to normal subjects.
Observational Study
Very Rigorous JournalEffects of lesogaberan on reflux and lower esophageal sphincter function in patients with gastroesophageal reflux disease.
Lesogaberan reduces reflux episodes and increases lower esophageal sphincter pressure in patients with gastroesophageal reflux disease despite proton pump inhibitor treatment.
RCT
Highly CitedAcidic and non-acidic reflux during sleep under conditions of powerful acid suppression.
PPI treatment reduces overall reflux events, but non-acidic reflux events are more likely to occur, potentially explaining why some individuals continue to have symptoms after PPI treatment.
RCTAmbulatory pH monitoring of gastro-oesophageal reflux in "morning dipper" asthmatics.
Morning dipping in asthmatics is not associated with gastro-oesophageal reflux, and a randomized, double-blind trial of ranitidine versus placebo showed no significant difference in peak expiratory flow rates or patient well-being.
RCTHighly CitedEffect of Food and Dosing Regimen on Safety and Efficacy of Proton Pump Inhibitors Therapy—A Literature Review
Proper administration of proton pump inhibitors (PPIs) depends on the drug type and formulation, with morning intake providing better daytime control of gastric acidity.
Systematic Review
Rigorous JournalLifestyle Intervention in Gastroesophageal Reflux Disease.
Weight loss and tobacco smoking cessation can reduce esophageal acid exposure and symptoms in GERD patients, while avoiding late evening meals and using bed elevation can help with nocturnal GERD.
Systematic ReviewHighly CitedSedation and Afternoon Placement of the 48-Hour Wireless Ambulatory pH Capsule Results in More Reflux on the First Day
Afternoon capsule placement is associated with a significantly increased amount of acid reflux on day 1, suggesting that morning capsule placement is ideal for accurate results.
Observational StudyCharacteristics of nighttime reflux assessed using multichannel intraluminal impedance pH monitoring and a portable electroencephalograph.
Nighttime reflux in GERD patients occurs in various phases during sleep, with liquid reflux more common in awakenings and nonrapid eye movements, potentially contributing to sleep disturbances.
Observational Study