Which medication should be avoided in a patient with GERD?

• A. Statin
• B. ACE inhibitor
• C. Beta blocker
• D. Calcium channel blocker

Answer: (D)

Calcium channel blockers are best avoided in GERD because they relax smooth muscle, including the lower esophageal sphincter. When the LES loses tone, the barrier to gastric reflux is weakened, making it easier for stomach contents to reflux into the esophagus and trigger heartburn and other GERD symptoms. That direct effect on LES pressure is the key reason this class worsens GERD.

Statins mainly affect cholesterol synthesis and don’t typically influence LES tone, so they don’t have the same reflux-promoting effect. ACE inhibitors can cause a cough in some patients but do not primarily impact LES relaxation. Beta blockers don’t have a consistent, direct effect on LES pressure, so they’re not as likely to worsen GERD in the same way calcium channel blockers do.