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Doctors' Answers to "Frequently Asked Questions" - Gastro Esophageal Reflux Disease

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 09/28/2000]
Question: I have my gallblader removed about four month ago. After the surgery, I suffered occasional Heart burn mostly at night, I was diagnosed with H. Pylori (thru blood test) and took the Prevacid/Boxin/Amoxi. combination of drugs for over a month. After the drug treatment, I had a mild heart burn and I used my last Pebcid which worked fine. Is Pebcid any better than Prevacid? How do they work and what do they do?

Answer: Do you mean pepcid? Pepcid is an H2 blocker, that is it blocks the H2 receptors on the gastric mucosa decreasing acid production. Prevacid is a proton pump inhibitor, meaning it inhibits the metabolic process inside the cell which is responsible for "pumping" positive protons(acid)into the lumen of the stomach. Prevacid is usually a stronger drug in reducing acid, but if the pepcic works that is sufficient.

[posted 09/20/2000]
Question: I am a 31 yr old male and have had IBS and severe GERD for at least 5 years now. My major symptoms are regurgitation/vomitting, acid stomach upset/pain/cramping, gas & bloating. I have tried many medications from Levsin & similar, SRIs like Paxil, over-the-counter Antacids, and even accupuncture/pressure. The only real relief has come from concurrenmt use of Prevacid & Propulsid. But now Propulsid has been taken off the common market due to possibly fatal cardiac side-effects. The risky side-effects of Reglan scare me as well. Is there any other option to replacing Propulsid? And if I were to opt to only take Prevacid, what dose at what time would you recommend as most effective for my symptoms.

Answer: Reglan is the other drug used, it has some long term neurologic risk to be discussed with your md. There is a drug in Canada called domperidome which is similar to propulsid(probaly the same cardiac risk also). This can be acquired through international web sites with a Rx from your md, or through pharmacies by telcon. 10 mg four times a day is the dosage.

[posted 08/4/1999]
Question: After recovering from pancreatitis 2.5 years ago, I
continuted to have upper abdominal pain
with buring in the center of my stomach. All tests were run
and nothing was found. The drs. conclude the pain was probably
a stress-related IBS, but the only meds that ever worked to
eliminate the pain was Prevacid. I have been taking 30 mg a day
for two years now. Every time I try stop this medicine,
the pain returns within two days. Most recently I've had problems with feeling
like I can't get a good breath along with chest pains. All
tests confirm no heart problems and no lung problems.
One dr. suggested it might be related to the GERD, but I've
never actually been diagnosed with GERD. My basic question:
how can I get off the Prevacid and if I can't, what are the
long term problems I have to worry about? I really don't
like taking meds on a long term basis and I'm worried the Prevacid
might be doing more harm then good in light of my new symptoms. If
it is an acid problem, couldn't I just use something like Tagament?

Answer: Well, it might be worth trying large doses of Tagamet to see if your symptoms resolve-has this been previously done? The only advantage to Tagamet and its cousins, Pepcid, etc is the long term track record. Prevacid and Prilosec seem to have no major long term problems, at least to date. Your problem clearly is acid related, doesn't really matter what one calls it. The only reason to establish if it is GERD is that there are potential surgical approaches to fixing reflux, thus decreasing the medications necessary. This can be established by nocturnal ph testing by a GI specialist.

Acid Reflux [posted 1/4/99]
Question: My 92 year old mother-in-law, who has been a welcome guest in my home for 28 years, started suffering with back pain about two months ago. Prior to back problems she was quite active. She knitted, read, went to the hairdresser, and watched television. While suffering back pain she quit all activities and even watching television was discontinued and refused to eat proper meals or even get out of bed. She now says her back pain is gone but she still will not get out of bed except to walk a few feet to the bathroom and will not eat except for an occasional egg or some cereal. She is still not interested in resuming any of her activities including television, reading, etc., and just lays completely still. She refuses to even consider seeing a doctor and is getting weaker all the time. She now complains of stomach pain, which I believe is caused by not eating. Her weight has dropped considerably ... would estimate it to be now down to less than eighty pounds. She was around 95 pounds when first stricken. I don't know what to do for her stomach ache, but believe if I could stimulate her appetite and get her to eat she will recover for a while. If not I'm afraid I shall lose her in the very near future. I would appreciate some advice.

Answer: She needs to see a doctor, don't take no for an answer.

Symptomatic Hiatal Hernia [posted 12/04/98]
Question: Hello, I am a concerned daughter, looking out for mom. I'm new at this internet thing ,so please bare with me. My mom has been dx. with a hiatal hernia-reflux, as been using several meds. to relieve pain etc. She has lots of concerns about the long term effects from using propulsid, and is also looking at different ave. re: surgery.. needs information re the laporoscopy repair for her hernia.  Thank you for your help, it is greatly appreciated.

Answer: With a symptomatic hiatal hernia ensure the basics have been done. Elevate the head of the bed 4-8 inches, do not eat after 6pm, lose weight, lose weight, lose weight. If these have been done and there continues reflux, the surgery is a good option in most patients. Opt for the laparascope because the recovery is shorter. I have several patients who have had this surgery usually with very good results. They are not always able to stop the medications;but, the dosage is lower and the symptoms much better. The long term outlook in terms of side effects look very favorable.

  Vocal Cord Lesion & Acid Reflux [posted 11/10/98]
Question: My husband was diagnosed with a vocal cord lesion after sore throats that wouldn't go away. We saw an ENT and he did the scope down the nose and found it. He ordered barium swallow, sinus x-rays and a CT scan of the larynx. All was clear but showed he suffers from reflux. He has been on zantac, then prilosec, then propulcid and previcid and now is currently taking previcid and donnatal which finally seems to be helping the reflux. Although he stays somewhat sleepy, it does seem to have helped. He takes one previcid a day and a donnatal in the morning and at night. He was scoped a second time and said it looked much better and not nearly as inflammed. He still has a lot of sinus drainage and is constantly clearing his throat which the ENT says is worse for the lesion due to the fact that it grinds his vocal cords together. My question is how long does it take for these lesions to clear up and is there any other medication that would be better and if surgery is recommended for the removal of the lesion, would you recommend a second opinion?

Answer: The lesions are probably due to acid coming up his esophagus to his vocal cords. They usually take 3 months to resolve, assuming the acid problem does not reoccur. This often requires constant use of meds or a surgical fix of his reflux.

Longterm Effects of Acid Reflux Treatment [posted 10/20/98]
Question: I am a 25 yr old male who has been diagnosed with a hiatal hernia and suffers from acid reflux. My physician has prescribed me Prevacid for life (15mg once daily). It works great but I am concerned about long term effects. Do you know of any?

Answer: Seems pretty safe currently. But, this drug has only been around a few years. Did your physician discuss surgical corrections? This would be an option for one as young as you.

GERD Diagnosis & Treatment [posted 10/13/98]
Question: I have been diagnosed a small duodenal ulcer after being ascertained through a gastroscopy. I was treated with losec, klacid and fasigyn. I improved for a while but continued to have colic. The doc prescribed librax and meteospasmyl as he suspect a strong element of IBS. Four weeks after I finished the above course of medication, my refluxes and vomitting came back again. I was put on lansoprazole and metoclopramide to stop the vomiting. However, my condition didnt' seem to improve. I developed frequent heartburns, sore throat, cough and continued the vomitting. I have not been able to retain food nor water. Am i put on the right medication? Do i need a biospy to eliminate other possibilities?

Answer: You should have been biopsed or treated for H. Pylori. This is a bacteria thought to be responsible for up to 80 -90% of duodenal ulcers.

Problems Related to GERD? [posted 10/13/98]
Question: I am a GERD patient and have also been diagnosed with H pylori. I was taking prevacid with propulsid, but after I took the medications the symptoms intensified and did not subside for hours. Due to this, the medications were discontinued. What would cause this? Are there any other medications that could calm these symptoms?

Answer Offhand couldn't tell you. Pretty uncommon. Maybe related to the closure pressure of your lower esophageal sphincter.

Acid Reflux [posted 10/6/98]
Question: I've been taking Pepsid or Zantac occasionally over the last year for mild heartburn and indigestion. Now I can enjoy foods that were previously off limits because they upset my stomach, e.g. ribs, deep fried fish, and ice cream. However, I'm concerned about potential side effects. Recently, I read where Zantac and Pepcid can contribute to hair loss. Is this true? In recent months, I've noticed a receding hairline, which naturally has started to alarm me. Few men of my age can boast of a full head of hair. Is this coincidence given that I'm in my fortieth year or could these acid controllers be at the "root" of my minor hair loss? If this is a side effect, what do you recommend as an alternative? Some natural health food stores recommend liquid aloe vera to facilitate digestion. Would this work?

Answer: Tagamet can cause hair loss, the other H2 blockers don't seem to have much of an effect. However, it is mentioned on each of their listings in the PDR, so I can't say it won't. Rogaine is available OTC and is effective in 30% of men-especially if the loss is on the crown and not at the edges. Other prescription drugs are available, try Rogaine first. Lastly, there are acid suppressors from different classes-Prilosec, Prevacid etc. which don't have hair loss as a problem.

Acid Reflux [posted 10/1/98]
Question: My HMO has directed me to change from prilosec to prevacid. The prilosec relieves the heartburn very well for 24 hrs. At a time. The propusid evacuates the stomach and prevents the regurgitation when lying down. I only take the propulsid as needed, perhaps on average three times a week. My question to you is two fold: isthere any negative trade off using prevacid in lieu of prilosec? I'm especially concerned for long term use. And would anti-reflux surgery be a viable alternative to taking both of the above drugs? My physician thinks not. But if anti-reflux surgery works, it seems as though this would be better than taking the above drugs for the rest of my life.

Answer: These are generally seen as equivalent drugs for acid and or reflux. Whether or not to get the surgery would depend a lot on your age. I recommend a lot of young people for the surgery, older patients less so. Also, have you tried losing weight, elevating the head of your bed and the mechanical things we try to prevent reflux? The surgery is fairly simple and completely effective about 50% of the time partially effective about 25% of the time, so you might wind up taking the drugs post op anyway.

Gastro Esophageal Reflux Disease (GERD)
Question: I take 10 mg Prozac in the morning and 0.25 mg of Klonopin in the evening for Fibromyalgia. The Prozac was recently discontinued as it had done its job and was no longer needed. Nightly nausea continuing through 9:00 - 10:00 AM caused a trial of 15 mg Prevacid in the morning with questionable results. 30 mg of Prevacid in the morning eliminated all nausea. Upper GI showed hiatal hernia and GERD. Propulsid 2 times daily has been prescribed in addition to the Prevacid. Klonopin has also been discontinued for last 3 weeks. Does Prevacid and/or Propulsid "cure" the problem after a time? How long a period does one usually have to take these medications? Is there a limit to how long a period one should be on these medications? Can they safely be take the rest of your life on a daily basis?

Answer: GERD refers to gastro-esophageal reflux disease. It is the reflux of acid up the esophagus from the stomach causing "heart burn" symptoms, as well as occasional aspiration pneumonias. Medications such as prevacid, act to decrease the acidity of the stomach contents. They usually do not decrease the reflux, but merely the acidity. GERD will usually persist if one has a hiatal hernia as long as the hernia is present. This can usually only be accomplished by losing weight or occasional surgical repairs. Consequently, as long as you are having reflux these drugs will be necessary to minimize the damage and symptoms from unopposed acid in the esophagus. Other treatments which help reflux are to elevate the head of your bed 4-8 inches, eat several hours before going to bed, and avoid nicotine and caffeine.

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