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MarieDay
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Quote MarieDay Replybullet Topic: anti-depressants ...
    Posted: 29 Oct 2018 at 11:04pm
Hello, I was just diagnosed with long segment, nondysplastic BE. I have no risk factors other than I hiatal hernia (I guess that's enough). I've started my PPI 4 days ago, and have had no success in calming my reflux. Could my anxiety and upset over the diagnosis be making it worse?

This diagnosis adds to a truly terrible year and I feel pretty depressed. I guess I have 2 questions:

1) How long should I wait about calling my doctor about my continuing reflux?

2) I took a low dose pill of lorazepam to calm myself, but just read that increases GERD. I then read that many anti-depressants increase GERD. What do people recommend to help get over anxiety/sadness? Are the any meds that won't end up hurting my esophagus more than it already is?

Thanks in advance for any information.

Marie
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chrisrob
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Quote chrisrob Replybullet Posted: 30 Oct 2018 at 9:20am
Hi Marie and welcome to the forum.

Your Barrett's has formed to protect you against the acid refluxing into your oesophagus. The most common reason for the reflux is a hiatus hernia -
as described here.

The pain you feel is from the oesophagitis - inflammation and scarring due to the acid. The PPIs will reduce that acid and let the inflammation heal but that may take a couple of weeks. Think of it like a grazed knee. Washing it with vinegar would aggravate it. It can take a few days before you start seeing the PPI beginning to have an effect.

Barrett's itself has no symptoms and can be thought of a bit like a friend providing armour plating to protect you. The risk of it progressing towards cancer is really very small and nothing to really worry about. Those of us who know we have Barrett's are the lucky ones: we'll be able to take our PPIs, which probably reduce the risk, and have surveillance scopes every few years to check there are no signs of progression (dysplasia) - as described here.
If any signs are ever seen, you'll be able to have the Barrett's segment ablated to minimise that risk.

Acid reflux has two main components: acid and the reflux that carries it into your oesophagus. Whereas PPIs are excellent at reducing acid, they do not reduce reflux ( as shown in this paper).

To reduce reflux, you'll need to observe a few lifestyle modifications: lose weight if necessary, avoid overfilling your stomach (small meals but frequently), avoid tight clothing, keep upright while eating, avoid exercise after food, leave at least 3 hours between your last meal and going to bed, raise the bedhead by 6 - 8 inches on blocks.

You may find the free encyclopaedia, Down with Acid helpful. If you would like a free printed copy, message me, or email me at Chris@ChrisRob.co.uk with a postal address and I'll send you one.

All the best
Chris
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MarieDay
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Quote MarieDay Replybullet Posted: 31 Oct 2018 at 12:58am
I think I replied to you the wrong way (since it didn't appear). First, thank you for responding so quickly. I am not in pain, but I feel bile in my throat, which burns a bit, so not sure about the effectiveness of my PPI. The link you sent said I should feel better in 4 days. It's now day 5, and I might possibly be feeling more reflux. Also, do you know of any anti-anxiety/anti-depressants that do not increase reflux. Thanks again.
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chrisrob
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Quote chrisrob Replybullet Posted: 31 Oct 2018 at 9:19am
Hi again,

I've checked the links I sent but cannot find any reference quoting 4 days to feel better.
It can take a few days for the medication to be most effective and then it could take a few weeks for any abrasions to heal.

Bile by itself is non-acidic and won't burn. "Bile acid" is bile mixed with stomach acid.
If you are tasting bile, it means you are refluxing. PPIs do not sop the reflux, they just make it less erosive.
You need to adhere to the lifestyle advice to control the reflux.

If you think the PPIs aren't working, you may ask your doctor if you can increase the dose for a week or two.
It is quite common to be prescribed at double strength for the first few weeks.
Normal (maintenance dose) is 20mg omeprazole or 30 mg lansoprazole or 40 mg pantoprazole. Many people have to take it at double strength. (I was actually on 80mg omeprazole for a few years prior to an operation to stop the reflux.)

I do not know about anxiety drugs. You would need to discuss this with a pharmacist.
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MarieDay
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Quote MarieDay Replybullet Posted: 31 Oct 2018 at 9:04pm
Thank you. Is there any way that you can tell if there is acid in your reflex? Any tests? I hate that if the PPIs aren't effective, then surgery probably won't be effective. How many days before you think I should call my doctor? Should I give it two weeks or less? I see you as an expert.
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chrisrob
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Quote chrisrob Replybullet Posted: 01 Nov 2018 at 9:41am
Hi Marie,

There are various tests that could be performed: 24hr pH manometry or Bravo tests will measure your acid levels. (You may read my account of the procedure here.)
If you discuss anti reflux surgery with your doctors they'd want you to undertake this test first as it will also reveal whether your reflux problem is due to a malperforming lower oesophageal sphincter, when surgery will help, or weak peristalsis, when surgery could make things worse.

Another test is the Peptest which doesn't check for acid but the presence of pepsin in your saliva. Since pepsin is only normally found in the stomach, its presence in the throat proves you have reflux. (But Peptest is unlikely under NHS, you have to order, and pay for, a home test kit and return it to the labs after use. Its findings would just confirm what you already know.

But your endoscopy will have shown signs of acid refluxing anyway: oesophagitis and the Barrett's which has formed.
If you're still getting the burning, you coud try supplementing with some OTC ranitidine (eg Zantac). Take your PPI in the morning half an hour before breakfast and your ranitidine in the evening to see if it helps.
If you are seeing no relief from the burning in a day or two call your doctor and ask if you can double your dose of PPI for a couple of weeks.
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steveb8189
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Quote steveb8189 Replybullet Posted: 01 Nov 2018 at 9:49am
Hi Marie
When do you feel your heartburn? Day time, night time, before or after eating etc? Have you tried smaller meals or cutting out certain foods? How soon before bed do you eat? You may find that lifestyle changes can have a significant impact on your reflux.

Remember, the PPIs cut out the acid but don't help the reflux. Certain lifestyle changes can help with both.

Thanks, Steve
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MarieDay
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Quote MarieDay Replybullet Posted: 01 Nov 2018 at 10:28am
The bizarre thing for me is that it feels like my reflux has increased since beginning the PPI (40 mg). I will call my doctor tomorrow, because then it will have been a week on the meds. I just don't want to be annoying. He gave me an appointment for December for follow up, so I didn't know if I should wait that long to talk to him about my continued/increased reflux. Thanks for helping.
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MarieDay
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Quote MarieDay Replybullet Posted: 01 Nov 2018 at 10:32am
At this point, I feel reflux pretty constantly. Heartburn usually at night. I've done the following lifestyle changes: raised the head of my bed, cut out wheat, dairy and sugar, am eating smaller meals, take a slow 15 minute walk after dinner, and go to bed at least 3 hours after this meal. I don't know how much anxiety is playing into this (lots of tough things going on in my life currently), but my doctor says anxiety didn't cause my BE. If you have any suggestions, I would love to hear them. Thank you.
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MarieDay
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Quote MarieDay Replybullet Posted: 01 Nov 2018 at 10:37am
Also, is there any treatment for weak peristalsis? Sorry to have so many questions, but this is all so new to me.
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