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MrJealousy
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Quote MrJealousy Replybullet Posted: 21 May 2014 at 1:41pm
Hello all, I've only recently heard of bile reflux. Ive been on PPi for 22 years and they control my symptons really well, so I doubt if bile reflux is my problem. I had a scope this morning no barretts but 3cm Hiatus hernia.
I had my gallbladder out in 2004 after 6 years of pain and no diagnosis. 13 stones and a shriveled no functioning gallbladder.
The research I've done suggests that PPI use may cause gallstones and the mechanism behind this is reduced gallbladder motility and that when the gallbladder concentrates the bile, to stop the bile salts from precipitating out of solution the cells lining the the gall bladder secrete H+ ions using the H+ pump. PPIs could therefore be a mechanism behind the formation of my gallstones if I had the predisposition to favour H+ /K+ atpase expression over Na+ / H+

Ive recently come off PPIs because of side effects, one is arrhythmia which could be caused by a similar method. Apparently there are many other H+ pumps in the body including the kidneys and intestines. All of which could be effected by PPIs.
my advice would be if you have gallstones is have the bladder out. If you have chronic reflux have surgery, LINX probably the best as my fundopelcation lasted less than 2 years and I had painfull sideffects that lasted 5 years. dont stay on PPIs unless there is no other option and then the most minimal dose.

Edited by MrJealousy - 22 May 2014 at 4:01pm
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Pyrrhonist
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Quote Pyrrhonist Replybullet Posted: 22 May 2014 at 9:00am
That's interesting. But please excuse my doubt. Searching for "gall bladder proton pump" shows nothing other than the Cahan paper (at least in the early hits). Can you point me to the source of your information?

According to Wikipedia, the main constituents of gall stones are cholesterol and bilirubin, with sometimes calcium carbonate and other minor ingredients. H+ ions would then have little effect on the two main ingredients. So the presence of Proton pumps in the gall bladder seems unlikely.

Nor have I found reference to proton pumps elsewhere than in the stomach. So I'm interested to expand my knowkedge.

I think if there were other pumps - the side effects of PPIs would be far more severe than they seem to be. Most of the listed side effects seem to be due to malasorbtion of minerals, or possibly cholestasis.
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.
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chrisrob
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Quote chrisrob Replybullet Posted: 22 May 2014 at 10:47am
Richard.

I haven't time to do my own searches at present.
Can you send me links to any research you have on bile reflux as a rebound from stopping PPIs and on PPIs causing cholestasis.

Cheers
Chris
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MrJealousy
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Quote MrJealousy Replybullet Posted: 22 May 2014 at 10:50am
Heres the first http://www.innovationsincrm.com/cardiac-rhythm-management/2010/december/29-proton-pump-inhibitors-focal-arrhythmias.
can seem to find the others that metioned that pumps are found else where. When I refind it I'll post it.
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Pyrrhonist
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Quote Pyrrhonist Replybullet Posted: 22 May 2014 at 11:57am
Interesting. I have searched for such links to see if H+/K+-ATPase is present elswhere than in the parietal cells of the stomach and had found nothing.

So there appears to be a link between PPI use and heart arrhythmias.

Thanks for this!
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.
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Pyrrhonist
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Quote Pyrrhonist Replybullet Posted: 22 May 2014 at 12:10pm
Just found

http://www.pharmacorama.com/en/Sections/H-pump-HK-ATPase.php

The second page says that H+/K+-ATPase is present in colon and kidneys. It's quite an interesting read on the way acid secretion and PPIs works.
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.
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Pyrrhonist
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Quote Pyrrhonist Replybullet Posted: 22 May 2014 at 12:24pm
> Can you send me links to any research you have on bile reflux as> a rebound from stopping PPIs and on PPIs causing cholestasis.

No I cannot! Wish I could.

When I was experimenting on dosage, first I would experience a tickly cough. Then I would taste bile in the refluxate, only later would it become acid. This was very consistent.

When I went to 5mG and again when I completely stopped PPIs, I experienced bouts of very severe bile relux. I found the Cahan paper when searching for explanations for these two findings.

Either my physiology is extremely odd (which I find exceedingly unlikely) or I'm normal. If so - such bile reflux could explain many otherwise inexplicable findings:
1: Why are PPIs ineffective long term for so many (exact numbers are hard to find)
2: Why is oesophageal cancer still on the increase - despite the universal use of the "wonder drug" PPIs? Again, exact figures are elusive!

I have now been off PPIs for over two years and my gut is normal again and my reflux symptoms very minimal: if I didn't know had a hernia I would not even notice the reflux most of the time! But I'm sensitised and can take regular antacids at the forst indicatons. I don't get through a lot - though I do take sodium bicarbonate at bed times. There is no mechanism in the stomach for neutralising acid, but once neutralised, acid production overnight seems low so I sleep well.

Edited by Pyrrhonist - 22 May 2014 at 12:58pm
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.
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MrJealousy
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Quote MrJealousy Replybullet Posted: 22 May 2014 at 3:49pm
Well you got me doubting what I said and it seems that I have got my Na+ and K + mixed up. The bile is acidified by the gallbladder but by na h atpase. Saying that whos to know that my gallbladder cells didnt express k+h+ atpase more than na+ h+atpase and thus the reason for my gallstones was the inhibition of the proton pumps by PPIs.
Anyway here are afew links to reasearch / info on pumps in other organs and bile acidification

http://www.pubfacts.com/detail/21753033/Western-blot-confirmation-of-the-H+/K+-ATPase-proton-pump-in-the-human-larynx-and-submandibular-gland
http://www.ncbi.nlm.nih.gov/pubmed/14603049
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2806118/
http://www.pharmacorama.com/en/Sections/H-pump-HK-ATPase-1.php
http://books.google.co.uk/books?id=ZfJN6NS0ZY4C&pg=PA105&lpg=PA105&dq=ph+of+bile+in+gallbladder&source=bl&ots=VGaTtdcb1c&sig=WNdxVRq55f2GlDrurDpg6eSs1hg&hl=en&sa=X&ei=dtF9U4ygK8GV7AaHpYDoAw&ved=0CDAQ6AEwAjge




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MrJealousy
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Quote MrJealousy Replybullet Posted: 28 May 2014 at 11:50am
Heres another... on reading this there could be a link between H+/K+ ATPASE inhibition and Na+/K+ atpase inhibition.Which could explain gallbladder acidification problems, that I described earlier.
http://www.innovationsincrm.com/cardiac-rhythm-management/2010/december/29-proton-pump-inhibitors-focal-arrhythmias
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Pyrrhonist
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Quote Pyrrhonist Replybullet Posted: 28 May 2014 at 2:02pm
> H+/K+ ATPASE inhibition and Na+/K+ atpase inhibition

It's a long time since I did Chemistry A level - it may have been my best subject but it wasn't my favourite!

H+/K+ and Na+/K+ may sound very similar, but electrochemically they are wildly different. Sodium ions have a similar energy to potassium ions and exchanging one for the other is not much work.

H+ ions however are much more energetic and swapping a K+ to an H+ requires much more energy.

The sodium - potassium (Na - K) balance in the body is quite critical and certainly if the balance is wrong it can affect the heart. But I don't think it's relevant to PPIs!

I couldn't spot the reference to Na+/K+ atpase - except in the footnotes!
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.
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