Which medicine is most likely to provoke symptoms of gastro-oesophageal reflux disease (GORD)?

Which medicine is most likely to provoke symptoms of gastro-oesophageal reflux disease (GORD)?

• A. Metformin
• B. Alendronic acid
• C. Omeprazole
• D. Simvastatin

Answer: (B)

Gastro-oesophageal reflux symptoms are most likely triggered by a medication that can irritate and inflame the esophagus itself when it sits there for a moment before moving into the stomach. Alendronic acid (a bisphosphonate) is well known for causing local irritation of the esophagus if the tablet doesn’t travel down properly. This irritation can manifest as heartburn, retrosternal discomfort, and other reflux-like symptoms, especially if the tablet is taken without enough water or if the patient lies down soon after swallowing. To minimize this risk, alendronic acid should be taken with a full glass of water and the patient should remain upright for about 30 minutes after taking it, avoiding lying down or taking it right before bed. If someone develops persistent heartburn or odynophagia after starting it, the clinician would reassess the regimen. Metformin can cause nausea and Gastrointestinal upset in general but is not particularly known for provoking reflux symptoms specifically. Omeprazole is a proton pump inhibitor used to treat GERD, not to provoke it. Simvastatin can cause GI upset too, but again, it’s not characteristically associated with triggering GORD like a bisphosphonate is.

Gastro-oesophageal reflux symptoms are most likely triggered by a medication that can irritate and inflame the esophagus itself when it sits there for a moment before moving into the stomach. Alendronic acid (a bisphosphonate) is well known for causing local irritation of the esophagus if the tablet doesn’t travel down properly. This irritation can manifest as heartburn, retrosternal discomfort, and other reflux-like symptoms, especially if the tablet is taken without enough water or if the patient lies down soon after swallowing.

To minimize this risk, alendronic acid should be taken with a full glass of water and the patient should remain upright for about 30 minutes after taking it, avoiding lying down or taking it right before bed. If someone develops persistent heartburn or odynophagia after starting it, the clinician would reassess the regimen.

Metformin can cause nausea and Gastrointestinal upset in general but is not particularly known for provoking reflux symptoms specifically. Omeprazole is a proton pump inhibitor used to treat GERD, not to provoke it. Simvastatin can cause GI upset too, but again, it’s not characteristically associated with triggering GORD like a bisphosphonate is.