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How they work: Zinc Oxide and Bismuth Salts are mild astringents and antiseptics that soothe and protect raw, irritated areas

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Mechanism for Extraesophageal Symptoms The mechanism for extraesophageal manifestations of GERD, such as wheeze or cough, may not always be direct aspiration or damage of mucosa in the respiratory tract but a vagally mediated reflex triggered by acidification of the distal esophageal mucosa

Pre-existing inborn errors of sulfur-amino-acid metabolism (e.g., homocystinuria) represent an absolute contraindication because parenteral methionine can exacerbate elevated homocysteine concentrations and associated thrombotic risk

These can range from mild redness and transient discomfort to more pronounced inflammation with knot formation lasting several days