How to manage GERD
May 23, 2018 5:04 PM Subscribe
I believe I have GERD but am reluctant to take Prilosec indefinitely. What are my options here?
I'll try to keep this short, but the backstory is that I went to see my doctor in March after experiencing weeks of sore throat and ear aches without any symptoms of cold or flu but with severe fatigue. He took a look at my ears, nose, throat and said everything looked fine, including tonsils. He said I should try taking Prilosec for a week or two and if it didn't help, he would then refer me to a specialist.
So I did go home and start on some Prilosec, which actually did make all my symptoms go away. I took it on and off until about April, when I decided to stop taking it and do some further experimenting by eating more yogurt and bananas, which seemed to help calm it down. So I've been sort of managing it, but occasionally I will have flare-ups of the sore throat and ear aches, mainly on the left side, as well as the fatigue.
After some googling, I'm now wondering if I have Barrett's esophagus. I actually don't experience any burning sensation in my breastbone or stomach. It's mostly the sore throat in the morning and fatigue throughout the day.
Should I go see the doctor again? Or a specialist to get my esophagus checked out? Go back on the Prilosec? Does anyone here take that long term? Is it okay to take it on an as-needed basis only?
Thank you for any insight.
I'll try to keep this short, but the backstory is that I went to see my doctor in March after experiencing weeks of sore throat and ear aches without any symptoms of cold or flu but with severe fatigue. He took a look at my ears, nose, throat and said everything looked fine, including tonsils. He said I should try taking Prilosec for a week or two and if it didn't help, he would then refer me to a specialist.
So I did go home and start on some Prilosec, which actually did make all my symptoms go away. I took it on and off until about April, when I decided to stop taking it and do some further experimenting by eating more yogurt and bananas, which seemed to help calm it down. So I've been sort of managing it, but occasionally I will have flare-ups of the sore throat and ear aches, mainly on the left side, as well as the fatigue.
After some googling, I'm now wondering if I have Barrett's esophagus. I actually don't experience any burning sensation in my breastbone or stomach. It's mostly the sore throat in the morning and fatigue throughout the day.
Should I go see the doctor again? Or a specialist to get my esophagus checked out? Go back on the Prilosec? Does anyone here take that long term? Is it okay to take it on an as-needed basis only?
Thank you for any insight.
Absolutely talk to a specialist. They can also give you an elimination diet to try. The fact that the prilosec works for you is a good clue to what's going on, but it doesn't answer all of the questions or point to a true diagnosis.
I took prilosec for several years (actually genericized omeprazole, but same difference), and it fixed so many of my GERD issues. However, after taking it daily for so long, if I missed a pill I would get MISERABLE heartburn. My close friend who is a nurse (and all of her nurse friends) were very concerned about me taking omeprazole long term. There have been recent studies that show that it is not good for your heart long term, and it also can deplete magnesium, to my understanding. I went to a new doctor who switched me to famotadine (generic Pepcid), which I take nightly, and is pretty good. I can go longer without it without getting painful heartburn as well.
In addition to that I just got this book, on a fellow GERD suffering co-worker's suggestion. You might try some of the suggestions in the book and see if they help you.
But nthing see a gastroenterologist.
posted by pazazygeek at 5:25 PM on May 23, 2018 [3 favorites]
I took prilosec for several years (actually genericized omeprazole, but same difference), and it fixed so many of my GERD issues. However, after taking it daily for so long, if I missed a pill I would get MISERABLE heartburn. My close friend who is a nurse (and all of her nurse friends) were very concerned about me taking omeprazole long term. There have been recent studies that show that it is not good for your heart long term, and it also can deplete magnesium, to my understanding. I went to a new doctor who switched me to famotadine (generic Pepcid), which I take nightly, and is pretty good. I can go longer without it without getting painful heartburn as well.
In addition to that I just got this book, on a fellow GERD suffering co-worker's suggestion. You might try some of the suggestions in the book and see if they help you.
But nthing see a gastroenterologist.
posted by pazazygeek at 5:25 PM on May 23, 2018 [3 favorites]
PS the generic of Zantac is called ranitadine, which was recommended to me by my concerned nurse friend.
posted by pazazygeek at 5:25 PM on May 23, 2018 [1 favorite]
posted by pazazygeek at 5:25 PM on May 23, 2018 [1 favorite]
Look at the instructions for Prilosec and follow them. You're not supposed to take it "on and off" nor take it for a long period without a doctor's supervision. I've taken the 14 day course a few times and have found that often I would feel better a week or two after the course has ended.
posted by exogenous at 5:28 PM on May 23, 2018 [2 favorites]
posted by exogenous at 5:28 PM on May 23, 2018 [2 favorites]
I had a very similar problem for several months. I believe this is called silent reflux or LPR. PPIs like Omeprazole (Prilosec) were of limited help to me, and I also felt conflicted about taking them long term - studies do show negative effects from long term use. In addition, Prilosec can cause rebound heartburn when you suddenly stop taking it.
Eventually I stumbled on recommendations for Gaviscon Advance in my desperate googling for a solution. It worked with consistent and persistent use over about 4-6 weeks. Apparently LPR can take a long time to resolve - you can find good information online about why. After using Gaviscon Advance religiously (meaning every time I had symptoms - constantly at first), everything settled down. It got better bit by bit until I eventually realized I didn't need the Gaviscon at all anymore.
Not sure where you're located, but you do have to get the Gaviscon Advance from the UK - the US version is different and doesn't work the same. I am in the US but was able to get it on Amazon in both liquid and chewable tablets. It is extremely safe - no long term issues as with Prilosec.
posted by pitseleh at 5:36 PM on May 23, 2018 [2 favorites]
Eventually I stumbled on recommendations for Gaviscon Advance in my desperate googling for a solution. It worked with consistent and persistent use over about 4-6 weeks. Apparently LPR can take a long time to resolve - you can find good information online about why. After using Gaviscon Advance religiously (meaning every time I had symptoms - constantly at first), everything settled down. It got better bit by bit until I eventually realized I didn't need the Gaviscon at all anymore.
Not sure where you're located, but you do have to get the Gaviscon Advance from the UK - the US version is different and doesn't work the same. I am in the US but was able to get it on Amazon in both liquid and chewable tablets. It is extremely safe - no long term issues as with Prilosec.
posted by pitseleh at 5:36 PM on May 23, 2018 [2 favorites]
Excessive acid production can be your body's way of compensating for too-low levels of healthy acidity in your stomach.
Hydrochloric acid supplements provide relief of this condition for many people.
posted by OnefortheLast at 5:38 PM on May 23, 2018
Hydrochloric acid supplements provide relief of this condition for many people.
posted by OnefortheLast at 5:38 PM on May 23, 2018
See a gastroenterologist. Be also sure to get checked for H Pylori bacteria. I personally can't live without 40mg daily Prilosec. The risks are acceptable to me compared to literally being unable to eat or survive. But there are many acid reducing treatments between there and nothing.
In addition to the Prilosec I'm on a low acid diet - find and eliminate foods that bother you. I don't drink caffeine. I sometimes use Zantac and tums and Pepto. I also do peppermint leaf capsules to help my IBS and it has also helped my GERD (I have to take it before I eat or it will cause heartburn.)
posted by Crystalinne at 5:41 PM on May 23, 2018 [1 favorite]
In addition to the Prilosec I'm on a low acid diet - find and eliminate foods that bother you. I don't drink caffeine. I sometimes use Zantac and tums and Pepto. I also do peppermint leaf capsules to help my IBS and it has also helped my GERD (I have to take it before I eat or it will cause heartburn.)
posted by Crystalinne at 5:41 PM on May 23, 2018 [1 favorite]
It’s possible that you have GERD or, more properly, LPR (laryngo-pharyngeal reflux). GERD without retrosternal symptoms of discomfort (not always burning in quality) or swallowing issues can occur but is less common. I was referred many patients who had presented to their ENT with laryngeal and pharyngeal symptoms and in whom laryngoscopic evidence of inflammation was seen and thus were diagnosed with LPR - many of which did not have this condition. Other things can cause a similar symptom complex, including allergies, second hand smoke, or household, industrial or occupational dusts, pollen, spores, fumes, or gases, etc. The omeprazole trial does not have great diagnostic specificity.
EGD is useful - to exclude Barretts as suggested above - and may provide helpful info if, for example, obvious esophagitis is seen (which can be present without much in the way of retrosternal symptoms). The gold standard is 24 hour pH monitoring which nowadays is done with the Bravo capsule or similar technology. So, yes, go see a GI specialist.
The H2RAs (famotidine, ranitidine) are not as effective as the PPIs (omeprazole, lansoprazole, etc.). Long-term use of PPIs may be associated with increased risk of kidney disease, osteoporosis, and other conditions, but the evidence for this is not definitive. Nevertheless, continuous use of any medication is not recommended without careful evaluation.
posted by sudogeek at 5:44 PM on May 23, 2018 [3 favorites]
EGD is useful - to exclude Barretts as suggested above - and may provide helpful info if, for example, obvious esophagitis is seen (which can be present without much in the way of retrosternal symptoms). The gold standard is 24 hour pH monitoring which nowadays is done with the Bravo capsule or similar technology. So, yes, go see a GI specialist.
The H2RAs (famotidine, ranitidine) are not as effective as the PPIs (omeprazole, lansoprazole, etc.). Long-term use of PPIs may be associated with increased risk of kidney disease, osteoporosis, and other conditions, but the evidence for this is not definitive. Nevertheless, continuous use of any medication is not recommended without careful evaluation.
posted by sudogeek at 5:44 PM on May 23, 2018 [3 favorites]
IME Barret's Esophagus is more unpleasant than what you've described experiencing; for me the pain was severe, constant, and came with a few other related issues that are similarly unpleasant and doctor-worthy. Mine has been closely monitored for 5 years now and remains nondysplasic and, however rightly or wrongly, I attribute this to my daily single prilosec and 2x of pepcid. The main issue I've had is repeated b12 deficiencies, so I now take a whole lot of daily b12.
I do know that obviously everyone's body behaves differently so I definitely agree with suggestions above to see a gastro doc and get an endoscopy. It's a lot better than the alternative, and a lot less horrifying both before and after than a colonoscopy.
posted by poffin boffin at 5:51 PM on May 23, 2018
I do know that obviously everyone's body behaves differently so I definitely agree with suggestions above to see a gastro doc and get an endoscopy. It's a lot better than the alternative, and a lot less horrifying both before and after than a colonoscopy.
posted by poffin boffin at 5:51 PM on May 23, 2018
I have GERD and I had an Upper GI back in 2008. I've taken Prilosec daily every since. My doctor says there is no conclusive evidence that daily Prilosec has any serious long term issues but plenty of evidence that uncontrolled GERD can lead to esophageal cancer.
posted by COD at 6:04 PM on May 23, 2018 [3 favorites]
posted by COD at 6:04 PM on May 23, 2018 [3 favorites]
Regarding the comment above about the body producing too much acid in order to compensate for too little acid production, that doesn’t even make sense. Is it too much or too little? If you produce too little, how can you at the same time produce too much? The concept is bogus, leaving aside the many studies showing that most GERD sufferers have normal acid production. (However, we could get into a discussion about the uncommon conditions of non-acid reflux and alkaline reflux but maybe another time.)
In any case, the problem with GERD is not too much acid (although esophagitis can be a symptom of excessive acid production as in Zollinger-Ellison syndrome). The problem is acid in the wrong place. The defect is abnormal function of the muscular sphincter in the lower esophagus, allowing acid from the stomach to reflux into the esophagus. For some, the LES is totally non-functional; for most, the defect are so-called TILSRs - transient inappropriate lower esophageal sphincter relaxations.
As an aside, some acid reflux is normal. In 24 hr pH monitoring, normal is considered a pH below 4 for less than ~4% of the time. When there is little or no acid in the esophagus- as in long-term or high-dose PPI use - Candida and other organisms can overgrow in the esophagus potentially causing symptoms which can be mistaken for inadequately treated GERD, leading to more meds. So, see an expert, get a scope, and be monitored closely.
posted by sudogeek at 6:19 PM on May 23, 2018 [3 favorites]
In any case, the problem with GERD is not too much acid (although esophagitis can be a symptom of excessive acid production as in Zollinger-Ellison syndrome). The problem is acid in the wrong place. The defect is abnormal function of the muscular sphincter in the lower esophagus, allowing acid from the stomach to reflux into the esophagus. For some, the LES is totally non-functional; for most, the defect are so-called TILSRs - transient inappropriate lower esophageal sphincter relaxations.
As an aside, some acid reflux is normal. In 24 hr pH monitoring, normal is considered a pH below 4 for less than ~4% of the time. When there is little or no acid in the esophagus- as in long-term or high-dose PPI use - Candida and other organisms can overgrow in the esophagus potentially causing symptoms which can be mistaken for inadequately treated GERD, leading to more meds. So, see an expert, get a scope, and be monitored closely.
posted by sudogeek at 6:19 PM on May 23, 2018 [3 favorites]
Seconding to see a specialist and read the Acid Watcher Diet. The author explains exactly what is happening with GERD, how potentially dangerous it is, and how to treat it. Don't think about Barrett's esophagus until you see a specialist.
Cut out coffee, tea, or carbonated drinks and don't eat large amounts in one sitting.
It sounds like you may have Laryngopharyngeal reflux.
If you start getting acid reflux into the throat is could be LPR. https://www.everydayhealth.com/gerd/understanding-silent-gerd.aspx
posted by loveandhappiness at 6:32 PM on May 23, 2018
Cut out coffee, tea, or carbonated drinks and don't eat large amounts in one sitting.
It sounds like you may have Laryngopharyngeal reflux.
If you start getting acid reflux into the throat is could be LPR. https://www.everydayhealth.com/gerd/understanding-silent-gerd.aspx
posted by loveandhappiness at 6:32 PM on May 23, 2018
For me it's all about diet and eliminating triggers. Mine are things like coffee, citrus, and chocolate, but yours are probably different. I also try not to take ppis and find that pepcid works well for occasional flare ups.
posted by ch1x0r at 6:39 PM on May 23, 2018
posted by ch1x0r at 6:39 PM on May 23, 2018
Raising the head of your bed, or for me, putting a wedge pillow under the mattress, can make a giant difference and allow you to cut back a lot on the medication.
posted by velveeta underground at 6:48 PM on May 23, 2018 [2 favorites]
posted by velveeta underground at 6:48 PM on May 23, 2018 [2 favorites]
I take omeprazole (Prilosec) every day and have for years. I don't even take the little breaks like they tell you too; that's just because the maximum course of treatment for any OTC drug is 14 days.
I've read all the warnings, and it seems like when I'm super old I might stop absorbing magnesium as well (a side effect which discontinues as soon as you stop taking it) and if I get C. Diff or another infection, I might not be able to fight it off (or reoccurrences) as well.
Well, I'm just going to deal with that when I'm old af and my magnesium levels are off, or when I get C. Diff. It's not worth changing my entire diet, and it's certainly not worth feeling sick and in pain all the time. My doctor just ran liver testing and a full bloodwork panel on me and I'm fine.
I'm a recovering bulimic (doing great thanks!) and my stomach makes too much acid because of all the stuff I put my body through. I take a pill once a day, along with some vitamins and probiotics because I'm a healthy bitch, that tells my stomach not to bother making so much acid. I almost never get reflux anymore.
I just ate manicotti for dinner. Do you know how many years I couldn't eat red sauce?
I believe in everyone doing what feels right for them, and if you (or anyone in this thread) has decided the risks of omeprazole are too great, that's fine. But I do encourage anyone who is slowly having their life ruined with heartburn and is scared by how many people avoid PPIs to look into the actual risks of the drug and make their own decision.
You, too, could be eating manicotti right now.
posted by Juliet Banana at 8:11 PM on May 23, 2018 [3 favorites]
I've read all the warnings, and it seems like when I'm super old I might stop absorbing magnesium as well (a side effect which discontinues as soon as you stop taking it) and if I get C. Diff or another infection, I might not be able to fight it off (or reoccurrences) as well.
Well, I'm just going to deal with that when I'm old af and my magnesium levels are off, or when I get C. Diff. It's not worth changing my entire diet, and it's certainly not worth feeling sick and in pain all the time. My doctor just ran liver testing and a full bloodwork panel on me and I'm fine.
I'm a recovering bulimic (doing great thanks!) and my stomach makes too much acid because of all the stuff I put my body through. I take a pill once a day, along with some vitamins and probiotics because I'm a healthy bitch, that tells my stomach not to bother making so much acid. I almost never get reflux anymore.
I just ate manicotti for dinner. Do you know how many years I couldn't eat red sauce?
I believe in everyone doing what feels right for them, and if you (or anyone in this thread) has decided the risks of omeprazole are too great, that's fine. But I do encourage anyone who is slowly having their life ruined with heartburn and is scared by how many people avoid PPIs to look into the actual risks of the drug and make their own decision.
You, too, could be eating manicotti right now.
posted by Juliet Banana at 8:11 PM on May 23, 2018 [3 favorites]
I'm on omezaprole for life and my doc added vit-d supplements and runs occasional tests for the long term side effects. It's a case of bad stuff from untreated internal bleeds vs bad stuff from omezaprole - which is worse?
GERD longterm is not great on your system and you need to talk to a specialist to see how bad your symptoms are and if they're worth treating. Omezaprole is a relatively easy longterm med and you can mitigate some of the possible risks.
You can't self-diagnose this, you need someone looking into your throat with like a scope and actual tests.
posted by dorothyisunderwood at 9:31 PM on May 23, 2018 [1 favorite]
GERD longterm is not great on your system and you need to talk to a specialist to see how bad your symptoms are and if they're worth treating. Omezaprole is a relatively easy longterm med and you can mitigate some of the possible risks.
You can't self-diagnose this, you need someone looking into your throat with like a scope and actual tests.
posted by dorothyisunderwood at 9:31 PM on May 23, 2018 [1 favorite]
I have severe GERD with LPR, and that also causes bad asthma problems with me. The only thing that keeps it under control is a restricted diet, Pantoprazole, and mattress wedges.
I got this mattress wedge set last month, and it has been a game changer. I like it for a couple of different reasons: I'm not going to roll off of it, like a regular wedge pillow, and it also isn't going to get compressed with use. I had a wedge pillow for about 8 years, and towards the end, it was really flattened. It may cost quite a bit, but it's worth it not to have a burning throat and mouth every morning, when you wake up.
I also try my best to wait a full 3 hours after eating before I go to bed, so I'm going to bed on a completely empty stomach. That also seems to help. Nthing probiotics as well.
posted by spinifex23 at 11:23 PM on May 23, 2018 [1 favorite]
I got this mattress wedge set last month, and it has been a game changer. I like it for a couple of different reasons: I'm not going to roll off of it, like a regular wedge pillow, and it also isn't going to get compressed with use. I had a wedge pillow for about 8 years, and towards the end, it was really flattened. It may cost quite a bit, but it's worth it not to have a burning throat and mouth every morning, when you wake up.
I also try my best to wait a full 3 hours after eating before I go to bed, so I'm going to bed on a completely empty stomach. That also seems to help. Nthing probiotics as well.
posted by spinifex23 at 11:23 PM on May 23, 2018 [1 favorite]
Diagnosed with GERD, given PPI. Weaned off with Ranitidine. Behavior had a big effect. Five small meals a day. Dinner is usually done by 5:30, 5 hours before my usual bed time. I chew THOROUGHLY. Chew until it's mush. Of course I eliminated triggering foods. Weird thing is years later some stopped being triggers. I now take 1/2 of the smallest dose available of Ranitidine (150mg) twice a day. Gaviscon puts out the occasional flare ups.
posted by Homer42 at 3:17 AM on May 24, 2018 [2 favorites]
posted by Homer42 at 3:17 AM on May 24, 2018 [2 favorites]
I have GERD and I take Prevacid. It's a miracle. I'm not sure about the long-term effects or whether they are the same as Prilosec, though. If I were you, I'd see a specialist and ask about other medication options if it turns out it's GERD.
Generally I don't like to take medications unless necessary, but untreated GERD can lead to cancer so I make an exception for Prevacid.
posted by onecircleaday at 12:57 PM on May 24, 2018
Generally I don't like to take medications unless necessary, but untreated GERD can lead to cancer so I make an exception for Prevacid.
posted by onecircleaday at 12:57 PM on May 24, 2018
Another cause of acid reflux is sleep apnea. Your doctor can screen you.
posted by Kalatraz at 2:05 PM on May 24, 2018
posted by Kalatraz at 2:05 PM on May 24, 2018
This thread is closed to new comments.
Prilosec isn't too, too bad for short term use. I use Costco's Acid Reducer* daily (due to a rare disease) and my gastroenterologist says it's better than acid causing other long term problems.
*I believe it's a generic of Zantac
posted by getawaysticks at 5:20 PM on May 23, 2018 [1 favorite]