Which drugs can decrease lower esophageal sphincter pressure and contribute to reflux?

Which drugs can decrease lower esophageal sphincter pressure and contribute to reflux?

• A. Prokinetic Agents
• B. Calcium Channel Blockers, NSAIDs, Nitrates, Sedatives, Oral Contraceptives, and Anticholinergics
• C. Proton Pump Inhibitors
• D. Antacids

Answer: (B)

Lower esophageal sphincter (LES) tone is the barrier that keeps stomach contents from refluxing into the esophagus. When drugs relax smooth muscle or dampen neuromuscular control, they can lower LES pressure and make reflux more likely. Calcium channel blockers decrease calcium availability in smooth muscle, which relaxes the LES and reduces its resting pressure. Nitrates, used for angina, also relax smooth muscle via a cGMP-mediated pathway, lowering LES pressure. Sedatives can blunt central and reflex control of muscle tone, which can translate to a lower baseline LES tone. Anticholinergics block acetylcholine, reducing esophageal muscle activity and LES tone, contributing to reflux risk. Hormonal therapies—especially those containing progesterone—promote smooth muscle relaxation, so oral contraceptives can worsen reflux by lowering LES tone. NSAIDs, while primarily irritating the stomach lining, can worsen reflux symptoms and may be associated with changes in the gastric environment that promote reflux, contributing indirectly to lower barrier function. Prokinetic agents, by contrast, increase LES tone and speed gastric emptying, helping reduce reflux. Proton pump inhibitors and antacids address acid and mucosal protection rather than LES pressure, so they don’t directly decrease LES tone.

Lower esophageal sphincter (LES) tone is the barrier that keeps stomach contents from refluxing into the esophagus. When drugs relax smooth muscle or dampen neuromuscular control, they can lower LES pressure and make reflux more likely.

Calcium channel blockers decrease calcium availability in smooth muscle, which relaxes the LES and reduces its resting pressure. Nitrates, used for angina, also relax smooth muscle via a cGMP-mediated pathway, lowering LES pressure. Sedatives can blunt central and reflex control of muscle tone, which can translate to a lower baseline LES tone. Anticholinergics block acetylcholine, reducing esophageal muscle activity and LES tone, contributing to reflux risk. Hormonal therapies—especially those containing progesterone—promote smooth muscle relaxation, so oral contraceptives can worsen reflux by lowering LES tone. NSAIDs, while primarily irritating the stomach lining, can worsen reflux symptoms and may be associated with changes in the gastric environment that promote reflux, contributing indirectly to lower barrier function.

Prokinetic agents, by contrast, increase LES tone and speed gastric emptying, helping reduce reflux. Proton pump inhibitors and antacids address acid and mucosal protection rather than LES pressure, so they don’t directly decrease LES tone.