This sleep medication can weaken stomach valve, worsening reflux

I am an 80-yearold 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 READER » 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.

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.