Acid reflux, PPIs, and longer-term health
December 5, 2021 12:29 AM Subscribe
I have a (hopefully) mild case of acid reflux that I'm more or less managing, but want to find a cure. Doctors offered PPIs. I'm skeptical, and would also like some longer term perspective. Help me manage the doctor / patient relationship, decide if I take PPIs, and get better. Details and more specific questions below.
Non-smoker, just sliding into middle age.
I'll come out and clarify that I'm skeptical towards PPIs, but not 100% closed to them.
The skeptical part comes from 10 years ago, I had bad indigestion after overeating, so I took aspirin, and got a pain in my lower right abdomen. The doctor back in the UK precribed PPIs. I took them home and read the leaflet and given the extreme sounding side effects, opted to walk off the indigestion and suffer through the gut pain, which did subside. Yes, I should have gone back to the doc and discussed my misgivings, that was my bad.
The lower right gut pain has come back any time I took aspirin or ibu on an empty stomache, which I learned to avoid. I also should have taken that to a doc. Ouch.
FFWD to now, 1 month ago I got severe nausea, reflux, and gut pain (same exact spot). Circumstances that might be relevant:
- stressful year (2020 I know, but also add work / family changes)
- overindulging in food and alcohol
- overexercising
- at that precise time, eating some leftover food that possibly went bad (eggs)
My GP helped me get through the nausea and extreme reflux symptoms. I don't feel sick/dizzy any more, but the reflux is still there every day, some days worse, some almost like normal. However I'm relying on:
- sleeping at an angle
- minimal diet
- cutting out bread, milk, booze, tea, coffee, and as many of the other usual suspect foods as possible
- OTC antacids (rennies, maalox)
- a spoonful of icecream when the throat really hurts (I know, lactose, right?!)
- daily mild exercise after eating
I also have one parent who suffered reflux with a hernia, PPIs did not improve it for them, so...
A bunch of excreta tests, blood tests, and an ultrasound of my abdomen didn't find anything. I was meant to book an endoscopy but the gastro doctor told me not to bother (this worries me too, why would you not do the test?)... I want to get one anyhow if possible.
Questions:
- if I postpone PPIs for a month or two, do I risk burning my throat / vocal cords out?
- if I start on PPIs now, do I risk getting into a cycle of dependence?
- how to handle the doctors? their attitude seems to be that I'm a bad patient for being concerned about possible side-effects, and they just told (ordered) me to take the pills repeatedly. It doesn't help that we are here in Eastern Europe now, where I guess this is relatively friendly bedside manner.
It worries me a lot that they are not interested in finding a cause of this sudden outbreak, which could then be treated. Is it because they don't care? Or there is no way to find out? I would be happier if they came out and said "hey, no-one really knows, part of getting old, you may have to deal with this long term now, sorry".
I'd love to hear from anyone who's been through something similar and come out the other side. How long did you hold out before dropping the PPIs? Did you try some homespun remedy like mainlining lemon water? Is that mostly a placebo while waiting for the gut to just do its thing? Why are doctors so reticent about talking about the cause?
Non-smoker, just sliding into middle age.
I'll come out and clarify that I'm skeptical towards PPIs, but not 100% closed to them.
The skeptical part comes from 10 years ago, I had bad indigestion after overeating, so I took aspirin, and got a pain in my lower right abdomen. The doctor back in the UK precribed PPIs. I took them home and read the leaflet and given the extreme sounding side effects, opted to walk off the indigestion and suffer through the gut pain, which did subside. Yes, I should have gone back to the doc and discussed my misgivings, that was my bad.
The lower right gut pain has come back any time I took aspirin or ibu on an empty stomache, which I learned to avoid. I also should have taken that to a doc. Ouch.
FFWD to now, 1 month ago I got severe nausea, reflux, and gut pain (same exact spot). Circumstances that might be relevant:
- stressful year (2020 I know, but also add work / family changes)
- overindulging in food and alcohol
- overexercising
- at that precise time, eating some leftover food that possibly went bad (eggs)
My GP helped me get through the nausea and extreme reflux symptoms. I don't feel sick/dizzy any more, but the reflux is still there every day, some days worse, some almost like normal. However I'm relying on:
- sleeping at an angle
- minimal diet
- cutting out bread, milk, booze, tea, coffee, and as many of the other usual suspect foods as possible
- OTC antacids (rennies, maalox)
- a spoonful of icecream when the throat really hurts (I know, lactose, right?!)
- daily mild exercise after eating
I also have one parent who suffered reflux with a hernia, PPIs did not improve it for them, so...
A bunch of excreta tests, blood tests, and an ultrasound of my abdomen didn't find anything. I was meant to book an endoscopy but the gastro doctor told me not to bother (this worries me too, why would you not do the test?)... I want to get one anyhow if possible.
Questions:
- if I postpone PPIs for a month or two, do I risk burning my throat / vocal cords out?
- if I start on PPIs now, do I risk getting into a cycle of dependence?
- how to handle the doctors? their attitude seems to be that I'm a bad patient for being concerned about possible side-effects, and they just told (ordered) me to take the pills repeatedly. It doesn't help that we are here in Eastern Europe now, where I guess this is relatively friendly bedside manner.
It worries me a lot that they are not interested in finding a cause of this sudden outbreak, which could then be treated. Is it because they don't care? Or there is no way to find out? I would be happier if they came out and said "hey, no-one really knows, part of getting old, you may have to deal with this long term now, sorry".
I'd love to hear from anyone who's been through something similar and come out the other side. How long did you hold out before dropping the PPIs? Did you try some homespun remedy like mainlining lemon water? Is that mostly a placebo while waiting for the gut to just do its thing? Why are doctors so reticent about talking about the cause?
Like Omeprazole? I've been on it coming up for a decade and will be likely for life. My youngest was on it as a baby and is likely to end up going onto it at some point because she inherited my gastro issues. I've never really experienced any side effects from it as a med, and it really does make a difference. The only real advice I've been given about it is that you should take Vit D and calcium as well because it can cause some bone loss over longterm use, so I get a bone scan every 5 years too.
I've also had a gallbladder infection and had it removed - it is the devil's work indeed. That got mistaken initially for gastro, but the pain continued and got significantly worse. It's worth having your gallbladder examined if the pain is continuing, but honestly? Your symptoms sound pretty standard to me for a diagnosis of oh yeah, take a PPI and adjust your diet.
Try the meds for a month.
posted by dorothyisunderwood at 2:42 AM on December 5, 2021 [1 favorite]
I've also had a gallbladder infection and had it removed - it is the devil's work indeed. That got mistaken initially for gastro, but the pain continued and got significantly worse. It's worth having your gallbladder examined if the pain is continuing, but honestly? Your symptoms sound pretty standard to me for a diagnosis of oh yeah, take a PPI and adjust your diet.
Try the meds for a month.
posted by dorothyisunderwood at 2:42 AM on December 5, 2021 [1 favorite]
I am not a doctor, but I feel I have a duty here to give you anecdotal experience. My partner of more than 20 years took PPIs (the generic form of Protonix called pantoprazole) for more than 10 years. He now has a bad case of osteoporosis and he is only 51. Part of this could definitely be due to bad diet after having a few hernia surgeries (he is underweight and probably doesn’t get enough calories) however there are studies out there showing a correlation between long-term use of PPIs and less calcium absorption, which can lead to osteoporosis. He really wishes his doctors over the years had mentioned this or any other side effects but they just didn’t.
posted by SomethinsWrong at 2:44 AM on December 5, 2021 [2 favorites]
posted by SomethinsWrong at 2:44 AM on December 5, 2021 [2 favorites]
You mention cutting out milk but not ice-cream...
Mark Bittman has written about his experience with reflux, PPIs and dairy. tl;dr: Chronic reflux starting in adolescence, PPIs as an adult, then within 24 hours of giving up dairy...no more reflux.
He wrote a follow-up column a couple weeks later.
It's all anecdata; take what you like and discard the rest.
posted by lulu68 at 3:31 AM on December 5, 2021 [1 favorite]
Mark Bittman has written about his experience with reflux, PPIs and dairy. tl;dr: Chronic reflux starting in adolescence, PPIs as an adult, then within 24 hours of giving up dairy...no more reflux.
He wrote a follow-up column a couple weeks later.
It's all anecdata; take what you like and discard the rest.
posted by lulu68 at 3:31 AM on December 5, 2021 [1 favorite]
The only thing that worked for me was Zantac, which is off the market now. But I realized one reason it helped was because of the ‘cooling mint coating,’ which you can get from a menthol cough drop. That’s my one weird trick and it helps a lot- maybe try a menthol cough drop instead of ice cream to soothe and numb.
posted by dianeF at 3:38 AM on December 5, 2021
posted by dianeF at 3:38 AM on December 5, 2021
My acid reflux was confirmed by endoscopy - that could be why the test was originally ordered. If they are sure this is reflux, maybe they feel you don't need it.
I was on PPIs for a few years - can't remember exactly how long. My acid reflux went away when I switched to a whole foods, vegan diet. I only get symptoms if I fall off the wagon, which for me means adding in a fair amount of white flour, sugar, and/or oil. It's an extreme change, I realize, and I don't know if any element in particular made the difference. I also lost 80 pounds with this change, and reflux does seem to be related to excess weight, but I got better before I lost the weight.
I hope you can get this resolved. As you probably know, PPIs are not recommended for long-term use.
As far as why doctors are reticent about talking about the cause, there could be a lot of reasons. They may not be sure about the cause in your particular case. They may not be interested in dietary changes or might think patients won't change their diets - I started the vegan diet because my doctor was pushing blood pressure medicine, and I thought I could fix that with diet. Turns out I was right. They may be very limited in time they can spend with a patient - I listen to a UK doctor's podcast (Dr. Chatterjee), and he talks about that a lot - it's an issue in the US as well, which is why I switched to an integrative medicine practice - the appointments there are scheduled for half an hour, which is an eternity compared with normal time with docs. I also now consult with a plant-based doctor online through an organization called Plant-Based Telehealth. They primarily work with lifestyle changes, and their site does say they do international consultations, though the page about them is somewhat confusing, since it says to make sure the doc is licensed in your state. If you want to try them, you'd need to pay out of pocket - they don't take insurance.
posted by FencingGal at 4:18 AM on December 5, 2021 [2 favorites]
I was on PPIs for a few years - can't remember exactly how long. My acid reflux went away when I switched to a whole foods, vegan diet. I only get symptoms if I fall off the wagon, which for me means adding in a fair amount of white flour, sugar, and/or oil. It's an extreme change, I realize, and I don't know if any element in particular made the difference. I also lost 80 pounds with this change, and reflux does seem to be related to excess weight, but I got better before I lost the weight.
I hope you can get this resolved. As you probably know, PPIs are not recommended for long-term use.
As far as why doctors are reticent about talking about the cause, there could be a lot of reasons. They may not be sure about the cause in your particular case. They may not be interested in dietary changes or might think patients won't change their diets - I started the vegan diet because my doctor was pushing blood pressure medicine, and I thought I could fix that with diet. Turns out I was right. They may be very limited in time they can spend with a patient - I listen to a UK doctor's podcast (Dr. Chatterjee), and he talks about that a lot - it's an issue in the US as well, which is why I switched to an integrative medicine practice - the appointments there are scheduled for half an hour, which is an eternity compared with normal time with docs. I also now consult with a plant-based doctor online through an organization called Plant-Based Telehealth. They primarily work with lifestyle changes, and their site does say they do international consultations, though the page about them is somewhat confusing, since it says to make sure the doc is licensed in your state. If you want to try them, you'd need to pay out of pocket - they don't take insurance.
posted by FencingGal at 4:18 AM on December 5, 2021 [2 favorites]
Not everyone's guts or reflux are the same. After dietary experimentation I realised that the key to no acid pain was lots of dairy and bread. Removing dairy from my diet actually make things worse. By experimentation I figured out that what really knocked me off was citric acid, which meant foregoing sour citrus and shop-bought salads, plus very sweet things, black coffee and alcohol. After a digestive tract infection knocked off a particularly bad bout with daily pain, PPIs helped everything heal to the point where I could go off them after six months, relying on my management techniques instead.
The actual culprit? Stress. I switched jobs and I barely need my coping mechanisms now. I can sleep on a flat pillow, go eight hours without food, do inversion yoga poses - feels like a completely different gut situation from my twenties.
PPIs are kind of like painkillers - a short-term solution that allows you to function while your body heals. I probably wouldn't go on that six-month course now, but since the adverse reactions are with long-term use and they kick in fast, there's no downside to checking if a week's course will break the cycle of your overactive acid production. If they don't work, you don't have to keep taking them. If they do work, stop them anyway after a week or two and see if the pain comes back.
posted by I claim sanctuary at 5:06 AM on December 5, 2021 [1 favorite]
The actual culprit? Stress. I switched jobs and I barely need my coping mechanisms now. I can sleep on a flat pillow, go eight hours without food, do inversion yoga poses - feels like a completely different gut situation from my twenties.
PPIs are kind of like painkillers - a short-term solution that allows you to function while your body heals. I probably wouldn't go on that six-month course now, but since the adverse reactions are with long-term use and they kick in fast, there's no downside to checking if a week's course will break the cycle of your overactive acid production. If they don't work, you don't have to keep taking them. If they do work, stop them anyway after a week or two and see if the pain comes back.
posted by I claim sanctuary at 5:06 AM on December 5, 2021 [1 favorite]
Chronic heartburn/ reflux can damage the esophagus; this is something to avoid. I damaged my esophagus by taking medication without adequate water. I was on a med that thickened the esophagus for 6 months and it took longer to really heal. Why are you taking aspirin? Seems like a bad choice for now.
I'm unable to eat dairy at all, it 's a pain, but give it a try. Do all the things - get lots of fiber, elevate the head of the bed, don't eat for several hours before sleep.
posted by theora55 at 5:09 AM on December 5, 2021
I'm unable to eat dairy at all, it 's a pain, but give it a try. Do all the things - get lots of fiber, elevate the head of the bed, don't eat for several hours before sleep.
posted by theora55 at 5:09 AM on December 5, 2021
I take otc h2 blockers as needed (Zantac, Pepcid), and maybe once or twice a year do a 2-week course of omeprazole when my reflux gets particularly bad - PPIs can be helpful without being long term.
posted by songs about trains at 5:48 AM on December 5, 2021 [3 favorites]
posted by songs about trains at 5:48 AM on December 5, 2021 [3 favorites]
If you’re uncomfortable with PPIs, try some dietary changes first. But don’t leave reflux untreated—it goes beyond burning your vocal cords and can eventually lead to esophageal or laryngeal cancer. Sorry you’re dealing with indifferent doctors. It’s really frustrating when they don’t seem to be interested in determining a cause.
posted by corey flood at 6:27 AM on December 5, 2021 [1 favorite]
posted by corey flood at 6:27 AM on December 5, 2021 [1 favorite]
I was soooooo uncomfortable with the thought of PPIs for the reasons noted above. I eventually gave in & tried them a few years ago when nothing else was working (probable ulcer & bad reflux). It made a huge difference. I stayed on them for only 8 weeks & then tapered off- I had no problems doing that and they really helped everything heal. So I would recommend highly based on my experience but definitely understand the concerns with being on them long term.
posted by DTMFA at 7:14 AM on December 5, 2021 [2 favorites]
posted by DTMFA at 7:14 AM on December 5, 2021 [2 favorites]
My mom tried to power through her reflux and ended up diagnosed with Barrett’s esophagus. If your reflux responds to changes in diet, then by all means change your diet. I personally have a few trigger foods that I know will cause problems, but overall I was unable to stop my own reflux with dietary changes. I took an H2 blocker for years but eventually my gastroenterologist switched me to a PPI and I’ve been on that for several years now. Every now and then I’ll try not taking it, but I’m lucky to make it a week without needing it again.
I take a multivitamin but don’t otherwise supplement my calcium and haven’t had any skeletal side effects.
posted by fedward at 7:42 AM on December 5, 2021
I take a multivitamin but don’t otherwise supplement my calcium and haven’t had any skeletal side effects.
posted by fedward at 7:42 AM on December 5, 2021
To add to the anecdata and the general idea of "everyone is different". I have had gastritis for a long time, but it got quite bad early this year.
I had just about all the tests and scopes to confirm it's gastritis.
I cut out all dairy and all gluten... And it got worse. I also cut out a bunch of other things like garlic, night shades etc... No change. Pain every day.
I went on a Ppi for a month and while it did make a difference, it wasn't dramatic. It's only now that I started taking a SSRI and my anxiety levels are lower, that I finally seem to be improving. It's early days yet but for me the root cause for my pain seems to be stress and anxiety, and I could not fix it by changing my diet. (That said, my diet is pretty healthy, pescatarian, no caffeine or alcohol, nor much sugar)
Just to underline that everyone is different.
My experience has been that even the better doctors don't want to get into the complex reasons of what might be the cause, especially allergy hormones, or diet related things because there are just too many variables. That's my job to figure out as best I can.
posted by Zumbador at 7:45 AM on December 5, 2021 [1 favorite]
I had just about all the tests and scopes to confirm it's gastritis.
I cut out all dairy and all gluten... And it got worse. I also cut out a bunch of other things like garlic, night shades etc... No change. Pain every day.
I went on a Ppi for a month and while it did make a difference, it wasn't dramatic. It's only now that I started taking a SSRI and my anxiety levels are lower, that I finally seem to be improving. It's early days yet but for me the root cause for my pain seems to be stress and anxiety, and I could not fix it by changing my diet. (That said, my diet is pretty healthy, pescatarian, no caffeine or alcohol, nor much sugar)
Just to underline that everyone is different.
My experience has been that even the better doctors don't want to get into the complex reasons of what might be the cause, especially allergy hormones, or diet related things because there are just too many variables. That's my job to figure out as best I can.
posted by Zumbador at 7:45 AM on December 5, 2021 [1 favorite]
I take otc h2 blockers as needed (Zantac, Pepcid), and maybe once or twice a year do a 2-week course of omeprazole when my reflux gets particularly bad
Same here. For me, the PPI is the only thing that stops the burning ball of pain feeling I get in my throat from reflux. I can't sleep at an angle and dietary changes make no difference. My reflux symptoms, like all of my other stomach issues, are very clearly tied to my anxiety. Sometimes instead of taking the H2 blocker I'll drink hot water and apple cider vinegar and/or ginger.
posted by sm1tten at 11:00 AM on December 5, 2021
Same here. For me, the PPI is the only thing that stops the burning ball of pain feeling I get in my throat from reflux. I can't sleep at an angle and dietary changes make no difference. My reflux symptoms, like all of my other stomach issues, are very clearly tied to my anxiety. Sometimes instead of taking the H2 blocker I'll drink hot water and apple cider vinegar and/or ginger.
posted by sm1tten at 11:00 AM on December 5, 2021
I was diagnosed via endoscopy with a defective esophageal valve (I don't know if that's the technical term) many years ago, which allows acid to enter the esophagus. I was pre-cancerous at the time it was diagnosed, and now I'm clear of that. I've been on a low dose of omeprazole (20mg daily) since then with no discernible side effects. The only cure for my condition is surgery, but my doctor has been quite upfront with me about why she feels my continued use of omeprazole is the better choice in my case.
I can go a day, at most two, without medication before I notice it. Nothing about diet really helped before my diagnosis.
posted by lhauser at 11:06 AM on December 5, 2021
I can go a day, at most two, without medication before I notice it. Nothing about diet really helped before my diagnosis.
posted by lhauser at 11:06 AM on December 5, 2021
Alcohol, overeating and overweight are all reflux triggers, as are a number of specific foods, like tomato sauce, spicy food, carbonated drinks and others you can easily research. If you are able to reduce your weight and cut out or greatly reduce your alcohol consumption you may find your reflux symptoms diminish greatly without any medication. Propping up the head of your bed with bricks can help with night-time reflux. Some people with night reflux take a PPI only at bedtime. Do you have chronic cough? This can be due to chronic reflux, which can cause minute amounts of gastric acid to be aspirated into the lungs, not an extremely well-known (or common) complication but one which does exist.
I suggest visiting a GI doctor and being tested for h.pylori, a bacteria that can live in the stomach. It is a cause of ulcers, but can usually be eliminated with medication, typically an antibiotic and a couple of other medication taken for a few weeks. Since stomach pain can be a sign of ulcers, this would be a good move, at least to rule h.pylori out.
There are some problems with long-term PPI use, including osteoporosis, but limited-time use is usually not problematic. lhouser above describes having a precancerous condition because of long-term acid reflux. This is called Barrett's esophagus, and generally means long-term surveillance with endoscopy and long-term measures to reduce reflux, which usually include PPIs. You definitely do not want esophageal cancer, a miserable and life-threatening condition.
These are the kind of issues and questions you should discuss with a qualified doctor, preferably a gastroenterologist. Although medications often have side effects, the benefits can outweigh the negatives. And if you have abdominal pain with aspirin it's best to avoid it as well as NSAIDs like ibuprofen, as both these medication can themselves cause ulcers with long-term use. Good luck getting to the bottom of your situation.
posted by citygirl at 11:34 AM on December 5, 2021 [3 favorites]
I suggest visiting a GI doctor and being tested for h.pylori, a bacteria that can live in the stomach. It is a cause of ulcers, but can usually be eliminated with medication, typically an antibiotic and a couple of other medication taken for a few weeks. Since stomach pain can be a sign of ulcers, this would be a good move, at least to rule h.pylori out.
There are some problems with long-term PPI use, including osteoporosis, but limited-time use is usually not problematic. lhouser above describes having a precancerous condition because of long-term acid reflux. This is called Barrett's esophagus, and generally means long-term surveillance with endoscopy and long-term measures to reduce reflux, which usually include PPIs. You definitely do not want esophageal cancer, a miserable and life-threatening condition.
These are the kind of issues and questions you should discuss with a qualified doctor, preferably a gastroenterologist. Although medications often have side effects, the benefits can outweigh the negatives. And if you have abdominal pain with aspirin it's best to avoid it as well as NSAIDs like ibuprofen, as both these medication can themselves cause ulcers with long-term use. Good luck getting to the bottom of your situation.
posted by citygirl at 11:34 AM on December 5, 2021 [3 favorites]
IANAD/IANYD, but if we're just talking about a 2 week course of a PPI at standard dosage (like 20 mg of omeprazole), I wouldn't hesitate to do that. It's better than risking damage to your upper GI tract.
But I would do everything possible to avoid long term PPI treatment if you can. By long term, I mean 6+ months.
I say this as someone who has been on it for years. I was aware of the osteoporosis risk, but I didn't realize about the rebound reflux and how difficult it would be to get off of omeprazole. I am now doing a glacially slow taper to see if I can get off PPIs and get by just with H2 blockers and diet changes.
The only OTC pain med I use is tylenol. NSAIDs are a huge no for me. One regular strength advil is enough to cause serious reflux and all sorts of other GI symptoms. SInce it sounds like aleve can trigger symptoms, I'd consider cutting that out as well.
I think some doctors are a little too cavalier about doing long term PPI treatment, or at least they used to be (in the US). I know my GI docs preference is to do high dose H2 blockers instead of PPI for long term maintenance therapy if possible. Obviously there will be some cases where PPIs are the only way to long term control symptoms, but I would try everything else first before resorting to that personally. But a 2 week course, I wouldn't hesitate to do.
YMMV, etc.
posted by litera scripta manet at 12:25 PM on December 5, 2021 [2 favorites]
But I would do everything possible to avoid long term PPI treatment if you can. By long term, I mean 6+ months.
I say this as someone who has been on it for years. I was aware of the osteoporosis risk, but I didn't realize about the rebound reflux and how difficult it would be to get off of omeprazole. I am now doing a glacially slow taper to see if I can get off PPIs and get by just with H2 blockers and diet changes.
The only OTC pain med I use is tylenol. NSAIDs are a huge no for me. One regular strength advil is enough to cause serious reflux and all sorts of other GI symptoms. SInce it sounds like aleve can trigger symptoms, I'd consider cutting that out as well.
I think some doctors are a little too cavalier about doing long term PPI treatment, or at least they used to be (in the US). I know my GI docs preference is to do high dose H2 blockers instead of PPI for long term maintenance therapy if possible. Obviously there will be some cases where PPIs are the only way to long term control symptoms, but I would try everything else first before resorting to that personally. But a 2 week course, I wouldn't hesitate to do.
YMMV, etc.
posted by litera scripta manet at 12:25 PM on December 5, 2021 [2 favorites]
To my small anecdote: I started on a vitamin supplement as advised by my doctor. Thinking myself clever, I took the vitamins at bedtime, to maximize their uptake. I had acid reflux until I moved the pills to the morning, after which the reflux stopped. From what I've read, even the simple act of taking a pill, regardless of content, can trigger your esophagus to open. I've been taking my pills in the morning and, to date, no reflux.
posted by SPrintF at 2:09 PM on December 5, 2021
posted by SPrintF at 2:09 PM on December 5, 2021
Deglycyrrhizinated licorice (DGL) took care of my reflux problems, such that I'm no longer taking it regularly and rarely have any issues in spite of not modifying my diet. Occasionally something acidic causes some issues and I chew some licorice tablets and everything is fine again. Obviously YMMV.
posted by oneirodynia at 3:39 PM on December 5, 2021
posted by oneirodynia at 3:39 PM on December 5, 2021
PPIs are literally a miracle medicine for those who really need them, but they are massively overprescribed - something like 80% of people on them don't need to be.
- If you can get by with an H2 blocker instead, or just OTC antacids, or a combination of H2 blocker and OTC antacids, that is definitely better than being on a PPI. H2 blockers include cimetidine, famotidine, nizatidine and ranitidine (generic names). The most easily available in the U.S. right now is famotidine (brand name Pepcid).
- Some people swear by antacids that include sodium alginate that makes a sort of "raft" in the top of your stomach, stopping acid from going back up into the esophagus (in theory). The U.S. version of Gaviscon extra strength has a little alginate (you could buy alginate powder from Amazon and supplement it) and the U.K. version Gaviscon Advance has a lot more.
- Be very, very aware of the PPI rebound effect that is inevitable if you are on a PPI for more than about 2-3 weeks. This is the reason so many people stay on a PPI for months and years after they should quit it.
What happens is: They quit the PPI, within a few days to a couple of weeks they experience the most horrible heartburn they ever have, they jump to the conclusion that their GERD has gotten much, much worse since starting the PPI and only the PPI has kept them from experiencing this excruciating pain every day of their lives, they get back on the PPI, the pain goes away, and so they are convinced they really do need it.
So pretty much every phrase in the paragraph above is incorrect:
- You should NEVER EVER EVER EVER STOP A PPI COLD TURKEY. Taper off slowly, so slowly, so very slowly. Much, much, much more slowly than you would ever imagine.
When I tapered off it took my around 4 months. But guess what? I had literally zero PPI rebound. If you stop your PPI and feel heartburn and pain, you're doing it wrong. (Or maybe you really are one of the 10-20% who really do need it long term. But you'll only find that out if you really taper off slowly, slowly, slowly and still have the heartburn pop up again.)
- When you taper off, you replace each missed PPI dosage with an H2 blocker. So you don't taper to nothing - you taper from PPI to H2 blocker.
- Also, use OTC antacids etc as needed.
Once you are entirely off the PPI and stable there, if you want to go down to nothing - or try to! - you can then reduce or entirely quit the H2 blocker. H2 blockers don't have the same kind of rebound effect that PPIs do. So you can just cut the dose in half or 3/4s, quit them, or take only as needed, whatever you want to try, and see how it goes.
- Brief description of PPI taper plan (look for post by flug32)
- Detailed explanation of PPI taper plan with reasons, how-tos, and detailed taper schedule.
- How long a PPI takes to phase in and phase out, why it takes a long while before the PPI is completely effective, and why you need to taper off when you quit the PPI.
- More about how PPIs work, why it takes a long time for them to reach full effectiveness, when is the best time to take a PPI and why.
- In general I would recommend the GERD subreddit as a good place to ask questions and get decent answers.
FWIW, I believe the information about PPI rebound and how to successfully quit a PPI is information that should be branded in giant golden letters on every bottle of PPI sold. No one should start using a PPI within a full understanding of what they are going to have to do when it is time to stop it.
But, that info is not included in the drug facts on any bottle of PPI I have ever seen, and it is also rarely mentioned by the doctor who recommends starting a PPI.
Or - even worse! - by the doctor who recommends stopping the PPI.
Also, some doctors understand the need to taper off a PPI but their taper plans are far, far, FAR too fast and their idea of how long rebound GERD will last is generally far, far too short.
Just for example, here is a doctor who says "10-14 days." He doesn't really have a taper plan at all - just 40mg, then 20mg, then hunker down and just take the pain for 10-14 days. And - he is one of the more enlightened ones.
FWIW actual research plus basic biology says PPI rebound is going to last more like six weeks, though some of that period might be experienced more as mild to moderate discomfort rather than extreme discomfort. And there is literally no reason to experience rebound GERD from a PPI at all - if you taper slowly enough. But tapering from 20mg down to zero might take more like 1, 2, or 3 months instead of one day.
posted by flug at 6:33 PM on December 5, 2021 [6 favorites]
- If you can get by with an H2 blocker instead, or just OTC antacids, or a combination of H2 blocker and OTC antacids, that is definitely better than being on a PPI. H2 blockers include cimetidine, famotidine, nizatidine and ranitidine (generic names). The most easily available in the U.S. right now is famotidine (brand name Pepcid).
- Some people swear by antacids that include sodium alginate that makes a sort of "raft" in the top of your stomach, stopping acid from going back up into the esophagus (in theory). The U.S. version of Gaviscon extra strength has a little alginate (you could buy alginate powder from Amazon and supplement it) and the U.K. version Gaviscon Advance has a lot more.
- Be very, very aware of the PPI rebound effect that is inevitable if you are on a PPI for more than about 2-3 weeks. This is the reason so many people stay on a PPI for months and years after they should quit it.
What happens is: They quit the PPI, within a few days to a couple of weeks they experience the most horrible heartburn they ever have, they jump to the conclusion that their GERD has gotten much, much worse since starting the PPI and only the PPI has kept them from experiencing this excruciating pain every day of their lives, they get back on the PPI, the pain goes away, and so they are convinced they really do need it.
So pretty much every phrase in the paragraph above is incorrect:
- You should NEVER EVER EVER EVER STOP A PPI COLD TURKEY. Taper off slowly, so slowly, so very slowly. Much, much, much more slowly than you would ever imagine.
When I tapered off it took my around 4 months. But guess what? I had literally zero PPI rebound. If you stop your PPI and feel heartburn and pain, you're doing it wrong. (Or maybe you really are one of the 10-20% who really do need it long term. But you'll only find that out if you really taper off slowly, slowly, slowly and still have the heartburn pop up again.)
- When you taper off, you replace each missed PPI dosage with an H2 blocker. So you don't taper to nothing - you taper from PPI to H2 blocker.
- Also, use OTC antacids etc as needed.
Once you are entirely off the PPI and stable there, if you want to go down to nothing - or try to! - you can then reduce or entirely quit the H2 blocker. H2 blockers don't have the same kind of rebound effect that PPIs do. So you can just cut the dose in half or 3/4s, quit them, or take only as needed, whatever you want to try, and see how it goes.
- Brief description of PPI taper plan (look for post by flug32)
- Detailed explanation of PPI taper plan with reasons, how-tos, and detailed taper schedule.
- How long a PPI takes to phase in and phase out, why it takes a long while before the PPI is completely effective, and why you need to taper off when you quit the PPI.
- More about how PPIs work, why it takes a long time for them to reach full effectiveness, when is the best time to take a PPI and why.
- In general I would recommend the GERD subreddit as a good place to ask questions and get decent answers.
FWIW, I believe the information about PPI rebound and how to successfully quit a PPI is information that should be branded in giant golden letters on every bottle of PPI sold. No one should start using a PPI within a full understanding of what they are going to have to do when it is time to stop it.
But, that info is not included in the drug facts on any bottle of PPI I have ever seen, and it is also rarely mentioned by the doctor who recommends starting a PPI.
Or - even worse! - by the doctor who recommends stopping the PPI.
Also, some doctors understand the need to taper off a PPI but their taper plans are far, far, FAR too fast and their idea of how long rebound GERD will last is generally far, far too short.
Just for example, here is a doctor who says "10-14 days." He doesn't really have a taper plan at all - just 40mg, then 20mg, then hunker down and just take the pain for 10-14 days. And - he is one of the more enlightened ones.
FWIW actual research plus basic biology says PPI rebound is going to last more like six weeks, though some of that period might be experienced more as mild to moderate discomfort rather than extreme discomfort. And there is literally no reason to experience rebound GERD from a PPI at all - if you taper slowly enough. But tapering from 20mg down to zero might take more like 1, 2, or 3 months instead of one day.
posted by flug at 6:33 PM on December 5, 2021 [6 favorites]
Reflux and sleep apnea are often co-morbidities, and treating one often helps the other. You might consider doing a sleep study.
posted by burntflowers at 11:29 AM on December 6, 2021
posted by burntflowers at 11:29 AM on December 6, 2021
PPIs can cause or worsen anemia, if you're on them long enough.
Ask me how I know.
I've had intermittent anemia for a long time, but the one time it got bad enough for a blood transfusion, rather than iron infusions, well, I can lay that straight at the feet of PPIs that I didn't need at the time, but doctors were telling me I had to take because I took so many NSAIDS on a regular basis. Why? Because anyone who looks at anopiod must become an addict, in popular parlance. Far better to risk destroying your stomach and end up having a blood transfusion for medication to stop the (entirely theorized at the time) stomach problems.
I mean. When I finally did end up with stomach problems 15 years later I wasn't taking anything OTC regularly.
Don't take a doctor's word for anything without researching the shit out of it.
posted by liminal_shadows at 5:36 PM on December 6, 2021 [1 favorite]
Ask me how I know.
I've had intermittent anemia for a long time, but the one time it got bad enough for a blood transfusion, rather than iron infusions, well, I can lay that straight at the feet of PPIs that I didn't need at the time, but doctors were telling me I had to take because I took so many NSAIDS on a regular basis. Why? Because anyone who looks at anopiod must become an addict, in popular parlance. Far better to risk destroying your stomach and end up having a blood transfusion for medication to stop the (entirely theorized at the time) stomach problems.
I mean. When I finally did end up with stomach problems 15 years later I wasn't taking anything OTC regularly.
Don't take a doctor's word for anything without researching the shit out of it.
posted by liminal_shadows at 5:36 PM on December 6, 2021 [1 favorite]
This thread is closed to new comments.
posted by Crystalinne at 1:49 AM on December 5, 2021 [1 favorite]