I just want my stomach to work right again.
November 18, 2011 8:54 AM   Subscribe

Help me manage my GERD (reflux). Snowflakiness inside.

I’ve always had a sensitive stomach, but this is new. I’ve been having pretty classic GERD symptoms for a few weeks: Bloating and gas, along with some stomach and abdominal cramping; an odd (not exactly painful; never had true ‘heartburn’) burning sensation under the breastbone; feeling like my throat is painfully tight; general nausea and feeling like my gastric system isn’t moving food along properly. My doctor wasn’t available so I saw a nurse practitioner, who prescribed generic Zantac. After a few days of no improvement, I woke up in the middle of the night and [warning: gross] dry-heaved until I produced some vomit which seemed to be very low in acid and full of undigested food. (I hadn’t eaten in 6-8 hours by that point). I stopped the drug, and I’m now on a PPI generic (omeprazole). It’s only been two days but I still feel like I’m being choked, and that whatever I swallow is just hanging out in my throat. I am following all of the dietary rules, I don’t eat 2-3 hours before bed, I sleep propped up, I am not overweight (almost underweight, actually), I’m not pregnant. I am quite stressed but I can’t really fix that (I’m taking care of my mental health in the usual ways, but my life circumstances are unavoidably stressful at the moment).

My problem: I don’t have any real hope that this drug will help me, and that’s causing me distress. I hate the idea of being on it for a long time, and I feel it’s only treating a symptom and not the disease. And, I’m not convinced it will solve my problem; don’t I need stomach acid to digest my food properly? Should I be taking some sort of probiotic or digestive enzymes? I just feel so crappy, and I don’t see how I’ll ever feel better. And knowing that unsolved GERD can lead to cancer isn’t helping my stress any. Any words of experience would be very welcome. Thanks.
posted by chowflap to Health & Fitness (36 answers total) 12 users marked this as a favorite
Okay so I am pretty much a veritable cornucopia of stomach issues, with no underlying cause outside of a vicious circle of GERD and stress. And boy do I have the lab report after lab report for rather invasive exams to prove it.

I can follow all the diet instructions I want and it will only make things a bit easier. The omeprazole is the only thing that actually helps. I've been taking it for years now, and once in a while I will be stupid and fall off the wagon because I am too lazy to pick it up at the pharmacy and everything just goes back to being miserable. I won't bother you with the details, but they're a lot grosser than yours.

You need stomach acid to digest food properly, yes. GERD means you have too much. Your body, for whatever reason, isn't doing something right. It's a condition and sometimes diet changes and so on fix it and sometimes it doesn't. Back in the day, people just lived with it, miserably. Now we have medicine that, yes, you might have to take every day for the rest of your life, but what GERD can eventually due to your stomach, esophagus and general well-being, it's a small price to pay. Taking opeprazole is, in fact, treating the disease. The problem is that GERD is chronic. There's no cure. You do the diet, the pills and so on and you can more-or-less live a regular life. Otherwise, you suffer.

Definitely take probiotics. Acidopholous (you can find it in the drug store) is great, and so is just eating a bunch of yogurt. If you don't like sweet yogurt -- I can't stand the stuff -- get unflavored greek yogurt; it's basically sour cream so you can put it on baked potatoes or rice or whatever.

Finally, if you have insurance, you might want to go for an endoscopy and a colonoscopy with a good gastrointerologist, just in case.
posted by griphus at 9:06 AM on November 18, 2011 [4 favorites]

Oh, and carry antacids everywhere you go and read up on the general acidity of foods. So if you go for Italian or Mexican food or something, take some before and after the meal.
posted by griphus at 9:08 AM on November 18, 2011 [1 favorite]

I know people that take DGL (a form of licorice) for a natural was to manage it. It may be worth a less than $20 effort
posted by ibakecake at 9:08 AM on November 18, 2011

Go back to your doctor and ask for a referral to a gastoenterologist. You don't need to try to manage this on your own. The GI referral may take some time, but you'll feel better once you know you're working on it -- I've been there myself (with somewhat different symptoms), and I know I did.

One thing I wish someone had told me sooner: if you don't go back to the doctor, they won't follow up with you. They'll assume you're doing better. It took me quite a few return visits and referrals and lots of tests, but I'm now at a place where I feel pretty good about how I was diagnosed (all the really serious stuff has been ruled out) and how my problem is being managed.

If your doctor isn't taking your concerns seriously, one thing that really worked for me was being very specific about my problems -- detailing how often, using the phrase "affecting my daily life," that sort of thing. Be very, very specific about the fact that something is wrong and about what's actually going on. It's OK to not feel comfortable accepting "stress" as a diagnosis unless they've explained how everything else has been ruled out first.

Be the squeaky wheel! I hope you're feeling better soon.
posted by pie ninja at 9:08 AM on November 18, 2011 [3 favorites]

This seems to be a classic example of a "go see a doctor" question. You exhibited symptoms of GERDS and took two drugs which are usually quite good at treating it. But -- (1) they did not work, and (2) you have additional symptoms (dry-heaving) that seem less typical (at least I guess -- I'm not a doctor nor an expert, but have battled with low-level GERDS at times). So you need to see a doctor who can try other meds (maybe dry-heaving is a common side effect) and/or can look to see if there is something else going on. Your other concerns come into play after you find out what's going on.
posted by rtimmel at 9:10 AM on November 18, 2011

My recurring but relatively low-level GERD symptoms were alleviated when I cut out gluten. Obviously ymmv.
posted by monju_bosatsu at 9:10 AM on November 18, 2011

Seconding monju_bosatsu. Actually this is what killed it dead for me, but it hasn't come back despite adding a bunch of stuff back in to my diet.
posted by restless_nomad at 9:13 AM on November 18, 2011 [1 favorite]

My recurring but relatively low-level GERD symptoms were alleviated when I cut out gluten.

Yeah, my symptoms went way the hell down when I cut out lactose. A lot of people are gluten/lactose intolerant and have no idea. So you might want to try to cut out lactose for a little while as well and see what happens.
posted by griphus at 9:14 AM on November 18, 2011 [1 favorite]

Seconding pie ninja. I came down with GERD-like symptoms a couple of months ago and saw my GP, who immediately put me on Prilosec. It didn't work that well.

I let the GP know about this, and, after he tried prescribing another PPI that didn't seem to work that well initially (it's OK now) the GP recommended that I see a GI. The GI is tapering me off the PPI (he'll hear about the extremely mixed results at the end of that regime) and wants to do a scope eventually. I'm not happy about that but them's the breaks.

Fortunately for me, I wouldn't have needed a referral to see a GI guy initially, even if my GP hadn't referred me.

You don't want to mess around with this condition - untreated, it can lead to esophageal cancer.

Anything with caffeine (it's not the acid in the coffee/tea so much as the caffeine, which specifically lowers the pressure on the esophageal sphincter) is a problem for me. So is pure chocolate (the theobromine in the chocolate is the culprit) and, apparently, cheese. :-( Others have mentioned acidophilus yogurt as a good thing; I concur.
posted by Currer Belfry at 9:18 AM on November 18, 2011

Your doctor wasn't available, so you saw a nurse-practicionist, and now you're asking the internet about what to do because the drug you were prescribed isn't working? For gastric issues, one of the most difficult areas to diagnose?

Go back to your GP, if you need referrals, or a gastro doctor if you don't. If that doesn't fix anything, go to an allergist. And an endocrinologist. And...well, whatever. One visit to the substitute for your doctor who seemed to give you the most obvious panacea for the most obvious symptom doesn't mean that it's time to think you'll never feel better.

It may take a lot of time (my stomach issues are still recurring, but I've gotten some symptom relief), but it sounds like you're cutting out the best hope for getting a real diagnosis and/or real symptom relief.
posted by xingcat at 9:19 AM on November 18, 2011

Go to another doctor, but also everything griphus said.

I've had GERD for years and after cutting dairy out of my diet completely (my baby can't digest it)...lo and behold, my GERD became ten times better. Turns out I'm allergic to dairy! Not just lactose intolerant. So please consider allergy testing as well.
posted by the young rope-rider at 9:30 AM on November 18, 2011

The chocking issue sounds like me a few years ago. GERD can inflame the intestines. The only way to know for sure is an endoscopy, in which they take a look around and clean out while they are in there. It's literally a 5 minute procedure, although you'll be in the hospital 1/2 day by the time it's all said and done. GERD is positively linked with esophageal cancer - so don't screw around. Go see a Gastro.
posted by COD at 9:33 AM on November 18, 2011

Thank you all. I definitely want to see my actual doctor, or just skip straight to a GI doc. But what I'm trying to manage is the next week or two. It sounds like I just need to deal. Should I not be expecting relief (via the PPI) so early?
posted by chowflap at 9:33 AM on November 18, 2011

The alternative hypothesis about GERD is that your stomach is producing too little acid or it lowers the acid level too soon after a meal. Taking HCL with pepsin controls my GERD. Yes, more acid. Don't ignore this because it doesn't fit your mental model. You can try this too:

posted by zeek321 at 9:36 AM on November 18, 2011 [2 favorites]

Just a note, I had an experience with the drug sertraline (Zoloft) wherein I was taking it for about a month with no apparent side effect, then all of a sudden for no apparent reason it began causing heartburn worse than I've ever had in my life. I've never had heartburn so bad that it made me throw up. It's unusual for there to be a delay in the appearance of this kind of side effect, I guess, but I experimented with which time of day I took it and the drug was definitely the cause of the problem.
posted by XMLicious at 9:36 AM on November 18, 2011

It sounds like I just need to deal.

The omeprazole should kick in pretty fast from my experiences. Are you feeling any relief at all from the way you felt two days ago?
posted by griphus at 9:38 AM on November 18, 2011

(By "pretty fast" I mean a day or two, not immediately.)
posted by griphus at 9:39 AM on November 18, 2011 [1 favorite]

Dysphagia (the discomfort with swallowing and that feeling that food is stuck in your throat) can definitely last more than a couple of days after starting on the PPI. Acid has actually damaged your throat a little and it doesn't heal up overnight. Obviously you will need to see medical specialists (though, be warned, this is one of those areas where medical knowledge is still pretty primitive--one thing I like about my GI is that he's very upfront about the unstable state of current medical thinking around these issues), but I can tell you from personal experience that the dysphagia lasting a few days after starting the PPIs doesn't mean they're not working.
posted by yoink at 9:51 AM on November 18, 2011 [1 favorite]

Yeah, I still feel totally unsettled. It might just be the throat thing which hasn't had time to heal, but I also have no appetite at all. I feel full from the yogurt and granola I ate 3 hours ago. I know, you are NMD...
posted by chowflap at 10:25 AM on November 18, 2011

yogurt is actually pretty acidic. It can take a while for the drugs to reach their full effect. You might need a different, Rx drug. My partner was on one for a year or two and then with the damage healed he switched to something over the counter that maintained the healing.
posted by the young rope-rider at 10:41 AM on November 18, 2011

My SO other cut out coffee (we still drink white tea in the mornings) and completely eliminated the terrible indigestion he was experiencing at night, all night. I don't know if it was the acids in the coffee or the oils and caffeine, but eliminating coffee really made a huge difference. The pills they give you to suppress stomach acid also interfere with the absorption of calcium (and maybe other things) from your food. I think that, long term, they are a bad idea. Cut out coffee and see what happens. What you really want is to eliminate the problem, not just cope with it.
posted by Jenna Brown at 10:50 AM on November 18, 2011

I have pretty special snowflake food restrictions that help my acid reflux. I take medication given to me by my doctor that make my life livable and I restrict food based on advice given to me by a naturopathic doctor that makes me actually feel healthy and happy! Just wanted to add to the chorus that you should go to a doctor, or GI for more treatment - it could be your gall bladder. After seeing your doctor - please look into the possibility that food is causing you problems. Food sensitivities can be very individual, so don't give up!
posted by Gor-ella at 10:50 AM on November 18, 2011

Aside from the dry-heaving, I thought this post was written by me. I, too, saw a nurse practitioner who put me on Zantac last week. It didn't help with the throat problems, despite the fact that I started cutting out carbs, dairy, caffeine, alcohols, etc. I switched myself to Prilosec on Wednesday and stopped using my asthma inhaler, and I can tell that my throat is healing. I still can feel the lump, like something is stuck there, but it has lessened. I also don't feel like I have to burp all the time. We'll see if things are ok after I finish the 14 days of Prilosec, but I thought I'd chime in to say that maybe the Zantac just isn't working for you. Good luck!!!
posted by Maarika at 11:19 AM on November 18, 2011

PS, I also started taking a probiotic more regularly. This is also the only thing that has ever gotten me to stop eating dairy and gluten, and I am shocked at how much better the rest of my body feels.
posted by Maarika at 11:25 AM on November 18, 2011

I have GERD, and had a flareup of it caused by Dexedrine, which I was taking for ADHD.

Seconding the Endoscopy here, along with seeing a GI. It was a pain, but I felt much better knowing that I didn't have any damage. I've been taking Prilosec, and it makes me feel better. One other thing that I've been doing is sleeping on a wedge pillow at night. I don't have this exact model, but I have found it helpful.
posted by spinifex23 at 11:27 AM on November 18, 2011 [1 favorite]

I took one of the OTC purple pills, double dose, 6 weeks with no improvement. Took about a month of protonix, with lots of diet changes before mine went away.

Stress is definitely a contributor.

After that, find your food triggers. Mine match what's been said above: coffee, chocolate, tomato (sauce in pasta, usually), garlic, and over-eating. You might need to redefine what "over-eating" means, as I had to.

So, yeah, find the drug that works (which may be trial/error, even though the whole time feels like there's a toothpick in your throat), and find what foods trigger an episode.
posted by k5.user at 11:45 AM on November 18, 2011

We are all special snowflakes on this bus.

> I don’t eat 2-3 hours before bed

The only thing which got my digestive system back to health was no liquid 2.5 hours before bed and no solid food 5-6 hours before bed. My doctor prescribed PPI didn't really produce a noticeable effect for me. If I wake up in the middle of the night to pee or something (around half the time) I will eat a couple of Tums but I no longer take the PPI. The propping up and staying on your back or on your left side is also beneficial. I am a big proponent of constantly experimenting with diet variations and I am always popping something into or out of my diet.
posted by bukvich at 12:06 PM on November 18, 2011

I also ride the snowflake bus.

Zantac works for me reasonably well, but PPIs (I've tried 3) have never worked. So they just might not be your drug.

My triggers include dairy (oh, sweet, cruel dairy) and orange juice. I get hearburn if I SMELL orange juice. The greatest trigger, however, is NOT eating. If I go too long between meals, I get a flare up, regardless of the drug I'm taking.

Oh, and belly fat. Before I even notice my pants are too tied, my esophagus will let me know when I've put on a few pounds.

If you're just looking at finding some comfort for the next week or so until you can see your GP or a GI, you should just be trying to give your esophagus a break until you see someone with a better idea. Don't worry about finding a cure yourself.

Stick with small, bland meals. Elevate the head of your bed. DGL (deglycyrrhizinated Licorice) has helped me. A handful of raw almonds will also calm things down--but, paradoxically, make things worse if my throat is already sore. I find Gaviscon is the best when I need quick relief from a flare up.
posted by looli at 12:24 PM on November 18, 2011

I'm going away on Sunday for a full week of vacation, so I'll have to be giving myself a break from any new changes or tests. (Maybe the break will help my stress levels...) I hate the taste licorice but have heard from others as well that it's good for this. I have been taking ginger candy (the all-natural "chews") which does help me feel a bit better. Anyway -- thank you all, it's comforting to know I'm not alone in this frickin' annoying condition. Bodies, you can't live with 'em, can't be a corporal being without 'em.
posted by chowflap at 1:14 PM on November 18, 2011

Advice I give to people with laryngopharyngeal reflux (so GERD that comes up into their throat) includes:
* Take a liquid alginate like Gaviscon Advance (I don't think you can get that in the US but you probably have equivalents) after every meal and last thing at night. Don't eat or drink anything not even water after the last one.
* Avoid: dairy, high fat foods (pastry, salad dressing), chocolate, all caffeine, spicy foods, acidic foods (no tomato, no citrus fruits)
* No tight clothes around your abdomen
* Put bricks under the head of your bed rather than using extra pillows
* Never eat within 3 hours of bedtime
* Sit upright at a table to eat and drink and stay upright for at least 30 minutes afterwards
* Make sure you take your PPIs at an appropriate time (ask your pharmacist). They are much less effective if taken at the wrong time
* Eat smaller meals more frequently (though if you're taking an alginate you shouldn't eat or drink between your three main meals)

Symptoms like heartburn and feeling full should subside pretty quickly but we tell our clients with throat symptoms (hoarse voice, lump in throat) that it takes between 4 and 12 weeks for them to heal.

The problem with taking PPIs is that reflux can still happen, it's just less acidic. The delicate tissues in your throat have little protection against proteases and bile and partially digested food even if it's not acidic.

Good luck!
posted by kadia_a at 1:16 PM on November 18, 2011 [5 favorites]

Sure sounds like GERD. The omeprazole may just not have had time to kick in yet, but here are a few things from my personal experience:

1. Omeprazole should be taken on an empty stomach, and you should avoid eating for 30 minutes to an hour after you take it as well. (You may already be doing this, but my doctor didn't mention this to me and I would not have known if I had not specifically asked the pharmacist if I needed to take it with food.)

2. Even if you take it exactly as directed, some people are just genetically destined to be extensive metabolizers of omeprazole (and many other drugs metabolized by CYP2C19). If you have this genotype, omeprazole will not work as well for you as it does for other people. Your doctor could have you start taking 20mg omeprazole twice a day instead of once, but that gets to be a hassle with the whole no-eating thing.

If you are still not feeling any better in a few more days, you could ask to try a different PPI that isn't as affected by the liver enzyme thing. Pantoprazole (Protonix) works a lot better than omeprazole for me, doesn't have to be taken on an empty stomach, and is available as a generic. I think rabeprazole (Aciphex) isn't acted on at all by CYP2C19, but there's no generic for it.
posted by slenderloris at 2:46 PM on November 18, 2011

Definitely take probiotics. Acidopholous (you can find it in the drug store) is great, and so is just eating a bunch of yogurt. If you don't like sweet yogurt -- I can't stand the stuff -- get unflavored greek yogurt; it's basically sour cream so you can put it on baked potatoes or rice or whatever.

I've taken probiotics for a couple reasons over the years: reflux flare ups, antibiotic-related diarrhea. I've tried yogurt, kefir, capsule supplements, whatever. I had no idea whether the stuff was working or not. I was just following medical advice.

A few weeks ago I made my own sourdough starter and kept it going. After the third day I started tasting it: eating just a spoonful to see if the yeast and bacilli colonies were stable.

And now I know what probiotics are supposed to do for you.

Even if you don't care about baking I recommend having the starter around, just for this. Eat a couple of tablespoons a day, preferably after meals. If you can't get starter from a bakery it's simple and cheap to make your own.
posted by clarknova at 4:46 PM on November 18, 2011 [1 favorite]

It's odds to me that Zantac was overkill and you switched to a PPI, which I have always understood to be much stronger. At least for me, Prilosec destroyed my appetite and made me stomach feel really weird all the time, so I stopped taking it. So... if you don't feel like it's helping, it may be because it's overkill. Just a thought; but you probably do want to keep talking to a Doctor as everyone else said!
posted by flaterik at 5:29 PM on November 18, 2011

I think your symptoms definitely put you on the "see a good GI doc" bus. There's nothing better than a specialist who can really understand the symptoms you're describing. And if they want to do an endoscopy, I would do it. I've had it from, uh, both directions, and it was no sweat either time. Nicely sedated, woke up when it was all over, a friend drove me home. I rested for the remainder of the day to let the sedation wear off.
posted by exphysicist345 at 6:27 PM on November 18, 2011

Omeprazole didn't work for me, even though doctors kept insisting I try it a little longer, but esomeprazole (nexium) works wonders! I've been fighting this for years and there are a few things that have worked for me to make the GERD a relatively minor problem anymore:

Change your milk to a lactose-free milk. The problem is so common that now they sell the lactose-free milk right alongside the regular 2%, fat-free, and whole milk. The lactose-free tastes exactly the same, is fine for cooking, drinking, cereal, etc. An no more bloating/belching, pressure, etc.

Either eat a LOT of yogurt or buy a bottle of acidophilus capsules (the kind that need to be kept in the refrigerator - live culture) and take one or two every day. The acidophilus/probiotics will keep all the bacteria in your gut in proper balance, and that will make a huge difference.

Raise the head of your bed, don't eat or drink much of anything within two hours before you got to bed, etc., and I'd recommend you try not to become dependent on Gaviscon/Maalox/Mylanta/TUMS etc. I was drinking Mylanta by the bottle and found myself uineasy at the idea of doing without it - a kind of psychological dependence, I guess.

I take Nexium a few times a month when I have some trouble with the GERD, but I don't need to take it every day, so I don't. If I take it for two or three days here and there it will straighten up the problem and I can then do without it for another couple of weeks. It's expensive, but if you've tried the Prilosec and Zantac and they don't work, the pharmaceutical company that makes Nexium may be able to set you up on a reduced-price program if your income qualifies you for that - that's the way I was getting it until I became eligible for Medicare's Drug Plan.

Most importantly, though - get a thorough medical workup. I don't know how old you are, but be aware that heart problems can masquerade as stomach trouble/heartburn, so you need to be sure your stomach is the part that needs treatment.
posted by aryma at 1:04 AM on November 19, 2011

Some things that have worked for me included elevating the head of my bed (not just sleeping propped up) 3-6 inches higher than the foot. I also don't take vitamins or pills on an empty stomach unless specifically directed to do so.

Other things that work for me included cutting out bread and other wheat for a time (I just don't seem to digest it well), and using DGL before meals for a period of time (and occasionally licorice tea). Dairy didn't seem to affect me, but grains definitely did.

If you're feeling that choking feeling, you could actually have an erosion. Using the omeprazole or esomeprazole for a few weeks (or a month) religiously could help, but be sure you're following the instructions exactly. From what I recall, they had pretty specific instructions that drastically impacted their effectiveness.

If you think stress is a problem, I've found yoga to be effective for stress and for assisting with digesting.
posted by answergrape at 5:14 PM on November 19, 2011

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