Why does acid reflux get worse after treatment?

Chronic acid reflux can be annoying and uncomfortable. Many times, when people are struggling with chronic acid reflux their healthcare provider prescribes them with a proton pump inhibitor, a proton pump inhibitor stops gastric acid secretion into the stomach and is commonly taken in combination with a protectant like sucralfate to in case there is damage done to the esophagus tissue or stomach lining (ulcer) which will coat theses part of the body to prevent and heal damage. Short term use of PPIs is the most effect and safe, but many people experience something called “rebound acid hypersecretion" which is an sudden increase in acid reflux and indigestion right after they finishing taking a PPI. It was found that the increase acid production was quicker than before they had taken the PPI and the release enterochromaffin-like cells had begun which also cause more acid production by releasing histamine.

Acid reflux and gastroesophageal reflux disease are very common problems for many people, but I choose to talk about how acid reflux can get worse after the most common treatment, which is PPI use, because I think the acid reflux is a lot more difficult to treat than people realize. When you look up treatments for acid reflux you will see articles saying to try multiple different diets, cleanses, apple cider vinegar, take medication, don’t take medication and it can be confusing how why is the most effective way. The reading I read suggests not abruptly stopping PPI and slowly decrease the amount you take to prevent rebound acid hypersecretion, but I think that more research would be helpful to see ways to treat acid reflux. 

I think this can show a valuable need for change in the experimental planning and publishing. I think when complex conditions and diseases like acid reflux are researched it can lead to a wide array of possible solutions because some treatments can work well on certain people or under certain circumstances. But I noticed that many times when information is published, it can be spread and lead people to misunderstanding how to treat and understand their own disease or condition. The best thing for people to do is to talk to their doctor about their specific illness and symptoms and there be more control over how information is published so that people are encouraged to talk to their doctor before becoming confused. In terms of research, more time should be put into test the effects of abruptly stopping a drug to prevent people from suffering from worsening symptoms. 

Citation: https://www.medsafe.govt.nz/profs/PUArticles/June2019/Proton-pump-inhibitors-and-rebound-acid-hypersecretion.htm

Antidepressants for IBS?

One of the most common gastrointestinal disorders is irritable bowel syndrome, which causes recurrent cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. IBS is related to abnormal motility (too fast causing diarrhea or too slow causing constipation), visceral hypersensitivity which is increased sensitivity in the nerves in the GI tract which leads to discomfort and cramping. Lastly, it also shows poor brain-gut function where the brain is overly responsive to the pain signals coming from the GI tract and is worsened when an individual is experiencing stress. Antidepressants like SSRIs (selective serotonin reuptake inhibitors) and SNRIs (Serotonin-Norepinephrine reuptake inhibitors) have been shown to help with the brain and spinal cord function properly and help reduce visceral hypersensitivity. 

What is not talked about though is that there is a lot of strain on the people who have IBS, not feeling well all the time can make it difficult to not be worried and stressed. Being worried and stressed worsens the symptoms and creates a very difficult cycle for someone to be stuck in. These drugs can help reduce depression and anxiety symptoms and help people feel better. 

 

I wanted to talk about this since I learned that SNRI’s have a been effective in reducing the symptoms of IBS which was interesting, and I wanted to know what the physiology was behind it. I think IBS is an illness that is complex and can be caused by multiple different things, and it seems like every person with IBS has different experiences. I do find it very interesting to see stress has a big role on digestion and a decrease in norepinephrine can lead to improvement in symptoms, which I think shows how dependent all of the different systems in the body are on each other and sometimes the solution to one system starts somewhere else. 

In terms of how this can relate to ethics in science, I think it can show how experimental design can be altered to broaden how we think and measure the human body, for example recently more research is being done on how the microbiome effects the immune system, mental illness, and even likelihood of developing cancer. It is very interesting, and many people may assume that the bacteria in our intestines have very little to do with mental health, but according to new studies that is not true. I think experimental designs in physiology is moving towards being more wholestic when it comes to looking at small part of the body or dieases which I think will lead to more effective and unique research. 

Citation: https://www.med.unc.edu/ibs/wp-content/uploads/sites/450/2017/10/IBS-and-Antidepressants.pdf