In the mid 1970s, Black et al. electrified the Gastro-enterology world when they introduced the first drug to suppress acid production. Cimetidine was the first H2-receptor antagonist released and was immediately used to treat ulcers. Thanks to this group of drugs and the proton pump inhibitors, surgery is rarely used as an acid reflux treatment. These drugs are used to heal gastric and duodenal ulcers and esophagitis.

Ranitidine was the second H2-receptor antagonist to be released. Newer drugs in this group are nizatidine and famotidine.

These drugs work in three specific areas to reduce acid secretion in the stomach. They inhibit histamine, gastrin and acetylcholine gastric acid stimulation. This results in low level of acid production.

With acid level low in the stomach, pepsin production is reduced because pepsin production is stimulated by the level of acid in the stomach as well as food content.

H2-receptor antagonists can reduce acid secretion by up to 90%. These drugs by reducing acid levels can heal ulcers and esophagitis. This has been proven by many clinical trials.

When these drugs are discontinued in patients with esophagitis, relapse is likely. The acid level will revert to the previous high and potentially reproduce the same results.

These drugs are taken orally but there are intramuscular and intravenous preparations available but they are rarely used.

Ranitidine and cimetidine are taken twice daily. In esophagitis, for healing, acid suppression must be over 24 hours. A drug taken twice a day may result in poor compliance. The newer drugs famotidine and nizatidine are taken once daily.

Ranitidine is available over the counter at a lower dose. It is without doubt that it is a good acid reflux treatment.

Dr. Phil Hariram