Dr. Roach: This sleep med can weaken stomach valve, worsening reflux

Keith Roach
To Your Health

Dear Dr. Roach: I am an 80-year-old female and have been on 10 mg Elavil for 30 years to help me sleep. I have been having reflux problems from time to time for quite a while. I have been diagnosed with LPR (laryngopharyngeal reflux). I have read that there could be a connection between Elavil and weakened sphincter. If I am able to wean myself off Elavil, could the muscle strengthen, or once it is weakened is the damage done?

— Anon.

Dear Anon.: Laryngopharyngeal reflux is when stomach acid comes all the way up the esophagus into the pharynx. It’s a type of severe gastric reflux, and can damage important structures, including the vocal cords and airway. Treatment is the same as it is for gastro-esophageal reflux disease, including lifestyle modification and antacid drugs.

Dr. Keith Roach

Lifestyle modification is critical and includes not going to bed with anything in the stomach; raising the head of the bed (putting 6-inch blocks under the bedposts); weight loss, if appropriate; and avoiding triggers to symptoms. One frequently used medication treatment for LPR beyond simple antacids and acid-suppressing drugs is sodium alginate, such as Gaviscon Advance, which forms a physical barrier (a “raft” that floats on top of the stomach contents), preventing backflow of the acid and enzymes of the stomach that can cause the damage.

Amitriptyline (Elavil) is an antidepressant that is frequently used to improve sleep or in people with chronic pain. You are absolutely correct that it also relaxes the muscles that comprise the lower esophageal sphincter (LES). The LES is a muscular valve at the bottom of the esophagus where it joins the stomach. It is supposed to keep food and acid in the stomach, where it belongs. Stopping the Elavil, even after decades, could certainly improve the symptoms. You can talk to your doctor about other options for sleep during a trial off the Elavil.

Dear Dr. Roach: My husband and I went to dinner with another couple. Three days later the man called to inform us he tested positive for Covid. The next day my husband developed symptoms, then tested positive as well. Our doctor prescribed Paxlovid. Symptoms were relatively mild, and he recovered quickly.

We both received two vaccines and two boosters. How did I not contract Covid? I was obviously around the same Covid source (I was even closer than my husband) and was in normal closeness to my husband until he tested positive. Do I have natural immunity?

— C.R.

Dear C.R.: “Natural immunity” means that a person has gotten the disease and is protected from getting that disease again. This happens with many viral diseases. For example, very few people who get measles infection will get measles again, even if exposed. (The rare exceptions would include people who develop an immune system disease.)

Vaccine-based immunity is about 97%. Without a vaccine or previous history of the disease, 90% of people exposed to measles would come down with the disease if exposed. The other 10% may have innate immunity, meaning that they didn’t have to get the vaccine or survive the infection to become immune. Since this is rare and there is no way to tell, it’s best to get the vaccine.

In the case of COVID-19, there are probably some people with innate immunity, while others may have some protection due to previous infection from a different coronavirus, of which there are many. Unfortunately, it seems that natural immunity from a previous infection is NOT long-lasting with COVID-19, and a person can get COVID-19 again and again. Until a vaccine is developed that provides long-lasting protection, we are left with periodic vaccination, which dramatically reduces the risk of severe disease.

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