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Pyrrhonist
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Quote Pyrrhonist Replybullet Topic: Alternatives to PPIs
    Posted: 22áJulá2014 at 11:49am
http://www.homeopathicmd.com/2011/05/gastroesophageal-reflux-disease/
is interesting.

I don't believe in homeopathy - except that the placebo effect can be extremely strong. But the author (Dr Ronal D Whitmont) talks a lot of general sense.

As it happens his advise about diet and general management is almost exactly what I have done to control my reflux: a regime that has worked excellently for me.

So others may be interested. Good luck.
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: 22áJulá2014 at 12:20pm
Thanks for the article.
I have only had time to skim it.

I agree that lifestyle and dietary changes can considerably reduce and possibly control normal acid reflux and that should be encouraged.

I would personally, however, caution most patients who have Barrett's Oesophagus not to drop their PPIs without discussing it with their doctor. There have been many studies that have shown PPIs have a chemo-protective effect in preventing possible progression of Barrett's to adenocarcinoma and even possible regression from LGD to N-DBO.

PPIs have come in for a bad press, principally in the US where too many people are using them at too high a dose and too frequently without medical supervision due to their ready availability over-the-counter and aggressive advertising.
If taken at correct dosage with proper monitoring, they are the best treatment for those at risks due to persistent acid reflux.
During Questions and Answers at Barrett's Wessex recent AGM, in answer to a question about dangers of PPIs, our consultant gastroenterologist answered that millions of people worldwide have been taking them for 25 years. Only a comparatively small percentage have had cause to complain about possible "side effects" making them statistically one of the safest drugs on the market.

Cheers
Chris
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Pyrrhonist
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Quote Pyrrhonist Replybullet Posted: 22áJulá2014 at 12:59pm
I cannot disagree with Chris: PPIs, statistically speaking, are very safe. But the vast majority of PPI users take them only short term. To properly state statistics - they should be quoted for long-term PPI takers only. Of course that's not possible.

The main difference between Chris and I is that he speaks from experience: experience that PPIs did not work for him so he had a fundo (which failed so he had it redone) and no longer takes PPIs.

I speak from a similar experience: PPIs did not completely work for me. So I stopped taking them. My symptoms actually reduced after I stopped taking PPIs. I also know, from experience, that the reason PPIs did not do well for me was that they caused, in me, bile reflux. I was also fortunate enough to be able to differentiate between bile and acid reflux. Something which it seems few people can do.

I am now off medications entirely and have no symptoms of reflux.

Chris is now also off medication - with a hopefully successful second fundoplication. It seems easy for him to preach the benefit of a medication that did not work for him.
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: 22áJulá2014 at 1:52pm
Au contraire Richard, PPIs DID work for me.

I was on PPIs for 14 years before my first fundo.
Back in the 1990's, my heartburn was like a blow torch down my throat. PPIs stopped the acid.
However, PPIs do not stop reflux. My problem was Non_erosive Reflux which promoted naso-bronchial complications, principally the reflux cough that caused blackout fits two or three times a day.

In a study, only 20% said PPIs helped with NERD symptoms. And why should they?

THAT is why I had that first fundo.
Without reflux, I didn't need to suppress the acid.
The year between the fundo failure and the revision surgery I was on high dose Acid Suppressant Medication. It was my choice I used H2RAs as ASM rather than PPIs but if I had had to wait any longer, I'd have had to switch to PPIs as the H2RAs, even with alginate supplementation, was insufficient at times - and yes, I was following very strict rules about lifestyle and avoiding my particular trigger foods.
(I actually posted the photos of everything I ate in a typical day on a FB forum and someone asked how I survived on that (mainly fruit and salad).)
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MrJealousy
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Quote MrJealousy Replybullet Posted: 22áJulá2014 at 7:24pm
I really enjoy these little sparring matches between you 2 chris and richard...hehe
I agree with both of you on alot of things.
I believe that PPIs are very important but they do have side effects, some serious.
Ive been taking omeprazole / esomeprazole since 1992. To start off with the side effects weren't noticeable but as time went on they became more troublesome. My confirmed side effects are fatigue, somnolence, flatulence, bloating, diarrhoea, paraesthesia and bradycardia. These have all gone since I stopped taking esomeprazole 85 days ago. Unconfirmed side effects are joint pain, gallbladder disease, mild kidney disease and most worrying for me atrial tachycardic arrhythmia all of which have not resolved (as yet ).
I think as time goes on and more and more people have been on PPIs for as long as me, the side effects will become more apparent and become a major issue for everyone taking them and the drug companies.

Edited by MrJealousy - 23áJulá2014 at 6:50am
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jcombs99
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Quote jcombs99 Replybullet Posted: 22áJulá2014 at 7:40pm
Mr. j
    How about me don't I count ?
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Jeannie
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Quote Jeannie Replybullet Posted: 24áJulá2014 at 3:27pm
Can someone explain to me the difference between bile and acid reflux? I never knew there was a difference and thought they were one and the same.
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chrisrob
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Quote chrisrob Replybullet Posted: 24áJulá2014 at 3:38pm
Hi Jeannie,

Acid is produced by cells lining the stomach walls. It's concentrated hydrochloric acid and helps leach minerals from food and kill off bad bacteria.
If it refluxes, it burns and is usually felt as heartburn. It can cause serious scarring but cannot cause Barrett's by itself. (High acid is low pH.)

Bile is produced by the liver and stored in the gall bladder. It is usually deployed in the duodenum to help break down proteins from animal products.
Bile is a yellow green colour and has a horrible bitter taste.
However, because acid cannot dissolve animal fats, occasionally some bile is permitted to backflow from the duodenum into the stomach, via the pyloric sphincter.
If it refluxes into the oesophagus, it can start dissolving any flesh exposed by acid scarring.

It requires a combination of acid and bile refluxing to cause Barrett's Oesophagus. Bile acid at low pH reduces squamous differentiation and activates EGFR signaling in esophageal squamous cells in 3-D culture.
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Jeannie
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Quote Jeannie Replybullet Posted: 24áJulá2014 at 4:03pm
Thanks Chris - sounds horrible. I tend to not get much in the way of any problems during the day but any problems I did/do have has nearly always been at night. Intermittently, I have woke up choking with an awful burning and even going into the lungs occasionally.

Is there anything we can take to keep the bile down then if the PPI's do not do this?

Have asked you a query on another post as well so apologies for keeping you busy!

Jeannie
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jcombs99
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Quote jcombs99 Replybullet Posted: 24áJulá2014 at 4:12pm
J
   If your bed is raised they also make foam casts that keep you more up right . My buddy uses one and got it online BETTER then drugs ..
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