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AH1970
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Quote AH1970 Replybullet Topic: Questions re commencing PPI
    Posted: 03†Nov†2012 at 6:13pm

Hello,

I had a follow-up with the gastro specialist this week. He wants me to go on omeprazole and, to clear h.pylori, antibiotics. However, I cannot go on antibiotics yet as Iím waiting to see the allergy clinic because Iíve various antibiotics have given me a rash previously. (I had various allergy tests a couple of years ago and everything was negative Ė then I took penicillin again and had a rash again Ė I donít know how that could be but now I steer clear of all drugs that have previously caused me rashes.)

So my questions are:

1) I understand that PPIs prevent protein from being digested Ė surely this is a problem for the diet? I have seen horror stories about taking them on the net. Could I not just reduce acid by taking a Rennie after meals, taking slippery elm an hour before bed, not drinking water with meals, raising the head of my bed and eliminating coffee, milk, fried food and spices from my diet?

2) is it better to wait till I get antibiotics for the h.pylori and take the PPI at the same time, as I heard they may not clear h.pylori separately and I donít want to take PPI any longer than necessary?

Thank you and best wishes,

Andrew
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bobgil
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Quote bobgil Replybullet Posted: 03†Nov†2012 at 7:54pm

Is it correct to say that you have not been diagnosed with Barrett's, but have acid reflux? Regarding the PPI's, the maintenance dose is 40mg daily, this is to control the acid reflux. They are certainly more effective than rennie etc. and work in a completely different way. It is only if you are on a really high dose for a prolonged period (80mg etc), that you may experience problems absorbing vitamins etc. I personally woundn't take too much notice of internet horror stories, as the most important thing is keeping the acid reflux under control, to stop it developing into Barrett's. Personally, I would start taking the PPI's and then find a suitable antibiotic later, if it were me.

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chrisrob
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Quote chrisrob Replybullet Posted: 03†Nov†2012 at 11:26pm
Hi Andrew,

H Pylori is quite common and should be cleared up with a course of suitable antibiotics. I note your concern. My mother was extremely allergic to all anti biotics and would swell up at the merest whiff of one. I hope you doctors find something suitable for you.

As regards PPIs. They stop the stomach producing too much acid. Rennie and other calcium based antacids will neutralise some of the acid once it has been produced - but it is better not to have it in the first place.

Some years ago, I passed a kidney stone(s) - very painful. On investigation, it was determined it was because I had been taking too many Rennie - the calcium builds up in the kidneys producing stones.

With reduced acid occasioned by high dose PPIs over long periods, the major side effect is hypochlorhydria. This manifests itself in the inability to process essential minerals. Although they are absorbed in the intestines, acid starts to dissolve them out of the food in the stomach. PPIs do not, however, prevent absorption of protein which is digested in the intestines with the help of bile.

If you are producing too much acid, it needs to be controlled or it can damage the epithelium lining of the oesophagus producing oesophagitis, Barrett's Oesophagus and, in some cases, cancer of the oesophagus.

Although PPIs can produce undesirable side effects - they're better than the possible alternative.

All the best

Chris
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AH1970
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Quote AH1970 Replybullet Posted: 21†Nov†2012 at 11:15pm
Hello,

Many thanks for your replies. I have been diagnosed with Barrett's and hiatus hernia.

How long should I take the PPI for? The specialist has prescribed it long term and said I should have another gastroscopy two years after the first. Will I have take PPI for that period?

Best wishes,
Andrew
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chrisrob
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Quote chrisrob Replybullet Posted: 22†Nov†2012 at 5:49am
Hi again, Andrew,

I'm guessing you may originally have been put on 40mg omeprazole for a couple of weeks or so and then, assuming all's well, put on a maintenance dose of 20mg?

It's probable you'll be expected to stay on the maintenance dose for life, I'm afraid. But at that level, it's unlikely you'll be aware of any side effects. (I was actually on 80mg for a few years before my fundoplication operation - but that's not usually an option for consideration without good reason.)

All the best

Chris
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AH1970
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Quote AH1970 Replybullet Posted: 29†Nov†2012 at 7:15pm
Hi Chris,

The piece of paper that the specialist gave me says to have 40mg and not to be reduced.

The more pressing thing for me now is that I have had a sore throat for over a week, it didn't do anything for five days, then turned into a mild cough & cold but with the throat painful to swallow (be it saliva, food or drink) and painful to cough. However, the last 2 days, the throat pain has eased during the day then gone back to be painful after being abed for a few hours.

My GP looked in my throat yesterday and said it didn't look like an infection-caused problem, so continue treating the symptoms as a cold.

Can painful to swallow throats be connected with acid or is this just a long-lasting cold?

Best wishes,
Andrew
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Sandra W
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Quote Sandra W Replybullet Posted: 01†Dec†2012 at 11:43am
Hi Andrew,
 
Yes, reflux can cause a very sore throat; this is called laryngopharyngeal reflux (LPR), and a very interesting case about this problem can be read at this link:  http://www.gastrosource.com/Patient-Cases/Guest-Authors/1384988?itemId=1384988 .  Unfortunately, although PPIs reduce acid they do not stop reflux, so the sore throat problems can continue even with medication.  The throat area is especially sensitive to reflux, so problems can arise very easily even if acidity is reduced by drugs.
 
Despite taking PPIs, I have had chronic sore throat and painful swallowing since 2007.  When I had HALO treatment in March this year, the doctor also discovered an inlet patch right at the top of the oesophagus.  Inlet patches consist of stomach cells; if they contain parietal cells, they can produce acid and cause problems. 
 
Unfortunately, these patches often get overlooked by endoscopists who take the scope out quickly without having a good look at the throat area.  In my case, my doctor thinks my inlet patch might be producing acid, and I am now awaiting a further scope and biopsies to investigate this.  The doctor has said that if my patch contains the acid-producing cells, he will remove it with HALO.
 
You mention that the throat problem is worse at night; this is because reflux is more likely to happen when you are lying down.  If you don't already do these things, avoid eating or drinking shortly before going to bed and try using blocks to raise the the top end of the bed (about 6 - 8 inches is usually enough).
 
Although I have not tried these myself, some people find anti-sickness (sometimes called "pro-kinetic") drugs like Domperidone or Metoclopramide helpful for reducing reflux.  While these are available "over the counter," as you are taking other medication it would be wise to ask your doctor first.
 
If you have been advised to stay on your current 40mg per day, it would be best to do this.  If you are having problems with your PPI, you could ask if you can try another one. 
 
Otherwise, these are a number of surgical options available, although the results of these these are not guaranteed and they are not suitable for everyone.  As well as fundoplication (open, laparoscopic, or (TIF) transoral incisionless), there is also LINX magnetic band, although I understand that this is not currently recommended for Barrett's patients, and a very new technique called EndoStim; the charity FORT is currently looking for patients to take part in a trial on this. 
 
You might like to google for further information about these options; then, if you would like to be considered for surgery, you need to ask your doctor about this so that you can be referred for assessments (pH and manometry tests) to see if you are suitable for surgery and, if so, which type would be best in your case.
 
Whatever you decide, hope you make good progress soon.  Good Luck.
 
All the best,
 
Sandra.


Edited by Sandra W - 01†Dec†2012 at 11:48am
E-mail: swilliams888@hotmail.co.uk
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