Prokinetics are a less commonly discussed category of reflux medication that work through an entirely different mechanism than PPIs or H2 blockers — rather than reducing acid, they aim to speed up stomach emptying and improve the strength of digestive muscle contractions.
Why this approach helps some people
For people whose reflux is driven significantly by slow stomach emptying (delayed gastric emptying, sometimes called gastroparesis) rather than primarily by a weak LES, reducing acid alone doesn't fully address the underlying issue. Prokinetics target that motility problem more directly, which can reduce the volume and pressure contributing to reflux.
Who typically considers this option
This category is generally considered for people whose reflux hasn't responded adequately to standard acid-suppressing medication, or for whom testing has specifically identified a motility issue, rather than as a first-line treatment for typical GERD.
A note on availability and side effects
Prokinetics have historically had a more limited range of options compared to acid-suppressing medications, partly due to side effect profiles in some earlier drugs in this class. This makes them a more specialized conversation to have with a gastroenterologist rather than a general first-choice medication.
