Protonix to an OTC

Question:

  My Doc gave me a months supply of free Protonix and my chest pains went away. I quit taking them after three weeks because I wasnt having any symptoms. (stupid I know) Well about a week later I chowed down on some great Mexican food and now my chest pains are back. The Doc gave me a prescrip for Protonix when I first went in but holy hell it’s $100 for a months supply! Im taking my last 7 days of the free protonix now but i cant afford $100 prescription. Do the OTC meds work as well? How about any Generics to these drugs?

Response:

>  My Doc gave me a months supply of free Protonix and my chest pains went >away. I quit taking them after three weeks because I wasnt having any >symptoms. (stupid I know) Well about a week later I chowed down on some >great Mexican food and now my chest pains are back. The Doc gave me a >prescrip for Protonix when I first went in but holy hell it’s $100 for a >months supply! Im taking my last 7 days of the free protonix now but i cant >afford $100 prescription. Do the OTC meds work as well? How about any >Generics to these drugs?

Mind if I ask why you take Protonix?  What your situation is and your symptoms? Im going for a gastric scope here next week… having chest discomfort, pain, etc…. Im afraid I have erosive esophagus and looking for info and advice. Im 46…..non smoker…. but heavy soda drinker….and drank a few beers as well.  What have you had to do to cure your problem?

Response:

 i was having chest pains… MD assumed it was Acid reflux…..plus I was having Panic attacks…I dont know which or if one was causing the other

– Hide quoted text — Show quoted text ->  My Doc gave me a months supply of free Protonix and my chest pains went >away. I quit taking them after three weeks because I wasnt having any >symptoms. (stupid I know) Well about a week later I chowed down on some >great Mexican food and now my chest pains are back. The Doc gave me a >prescrip for Protonix when I first went in but holy hell it’s $100 for a >months supply! Im taking my last 7 days of the free protonix now but i cant >afford $100 prescription. Do the OTC meds work as well? How about any >Generics to these drugs? > Mind if I ask why you take Protonix?  What your situation is and your > symptoms? > Im going for a gastric scope here next week… having chest > discomfort, pain, etc…. Im afraid I have erosive esophagus and > looking for info and advice. > Im 46…..non smoker…. but heavy soda drinker….and drank a few > beers as well.  What have you had to do to cure your problem?

Response:

> i was having chest pains… MD assumed it was Acid reflux…..plus I was >having Panic attacks…I dont know which or if one was causing the other

I see So you really don’t know what is going on for sure?   I mean you have not been gastric scoped to confirm that in fact you have gastric reflux??

Response:

no

– Hide quoted text — Show quoted text -> i was having chest pains… MD assumed it was Acid reflux…..plus I was >having Panic attacks…I dont know which or if one was causing the other > I see > So you really don’t know what is going on for sure? > I mean you have not been gastric scoped to confirm that in fact you > have gastric reflux??

Response:

Google my recent postings on inositol. It may well stop your panic attacks. If you are uninsured consider the OTC Prilosec twice a day which is double the recommended dose per the label but the same as a presciption Prilosec or Nexium dosewise.

– Hide quoted text — Show quoted text -> i was having chest pains… MD assumed it was Acid reflux…..plus I was > having Panic attacks…I dont know which or if one was causing the other > >  My Doc gave me a months supply of free Protonix and my chest pains went > >away. I quit taking them after three weeks because I wasnt having any > >symptoms. (stupid I know) Well about a week later I chowed down on some > >great Mexican food and now my chest pains are back. The Doc gave me a > >prescrip for Protonix when I first went in but holy hell it’s $100 for a > >months supply! Im taking my last 7 days of the free protonix now but i > cant > >afford $100 prescription. Do the OTC meds work as well? How about any > >Generics to these drugs? > Mind if I ask why you take Protonix?  What your situation is and your > symptoms? > Im going for a gastric scope here next week… having chest > discomfort, pain, etc…. Im afraid I have erosive esophagus and > looking for info and advice. > Im 46…..non smoker…. but heavy soda drinker….and drank a few > beers as well.  What have you had to do to cure your problem?

Response:

>If you are uninsured consider >the OTC Prilosec twice a day which is double the >recommended dose per the label but the >same as a presciption Prilosec or Nexium >dosewise.

Is it safe to take two Prilosec a day? Im now only taking one… and that is in the morning right after i get up. If I stick with one Prilosec only… is it best to take right before bed so as to keep acid production at min levels while laying in prone position?  Or is it still best to take one only in the AM after getting up?    Bottom line…. what is bets "timing" for taking only one pill?

Response:

> i was having chest pains… MD assumed it was Acid reflux…..plus I was >having Panic attacks…I dont know which or if one was causing the other > I see > So you really don’t know what is going on for sure? > I mean you have not been gastric scoped to confirm that in fact you > have gastric reflux??

It is important to know that an EGD may not diagnose GERD. A normal upper GI endoscopy does NOT mean that the patient is NOT having GERD. It only means that the GERD hasn’t caused enough esophageal damage (stricture, esophagitis, Barrett’s esophagus) to be visible while scoping. The only way to diagnose or rule out GERD with certainty in the face a normal EGD is by ambulatory pH testing. If the endoscopist see stricture, esophagitis, or Barret’s esophagus, then he/she can conclude that the patient has GERD. If the EGD is negative, the patient may still have severe GERD. HMc

Response:

>If you are uninsured consider >the OTC Prilosec twice a day which is double the >recommended dose per the label but the >same as a presciption Prilosec or Nexium >dosewise. > Is it safe to take two Prilosec a day?

OTC (over the counter/nonprescription) strength Prilosec  (20 milligrams) is half the dose of the common acid reflux dose  (40 milligrams) one gets from the physician. Higher dosages are used in patients with hyperacidic stomach conditions. I suspect the OTC form time release method is somewhat inferior to the prescription form. So I suggest since to it takes two to get to the higher prescription level, it would much sense to take the med at twice a day for a total of 40 milligrams. The result is $1.20 compared to several dollars per day for the Prilosec. > Im now only taking one… and that is in the morning right after i get > up.

One what? OTC 20 milligrams or 40 milligram prescription? > If I stick with one Prilosec only… is it best to take right before > bed so as to keep acid production at min levels while laying in prone > position?  Or is it still best to take one only in the AM after > getting up?    Bottom line…. what is bets "timing" for taking only > one pill?

I noted on the Medscape web site a continuing medical education article that some physicains were prescribing an additional H-2 blocker ( Pepcid, Axid) in addition to a full strength proton pump inhibitor drug such as Prilosec to prevent acid break thru. The article claimed PPI meds fail to fully prevent this acid release though they are much more effective drugs for the rest of day than H-2 blockers. At regular time a half hour before a meal or so I understand. Warning I am not a physician. These suggests are just what I’ve read somewhere or I might think I know about. It wouldn’t hurt to ask your Doc. When I retire, I leaving the United States.

Response:

>It is important to know that an EGD may not diagnose GERD. A normal upper GI >endoscopy does NOT mean that the patient is NOT having GERD. It only means >that the GERD hasn’t caused enough esophageal damage (stricture, >esophagitis, Barrett’s esophagus) to be visible while scoping.

Good point Howard. Thanks!

Response:

>I suspect the OTC form time release method >is somewhat inferior to the prescription form. >So I suggest since to it takes two to get to >the higher prescription level, it would much >sense to take the med at twice a day for >a total of 40 milligrams. The result is $1.20 >compared to several dollars per day for the >Prilosec.

Your last sentence above confuses me.  Are you saying that is would be OK to take TWO Prilosec pills a day?  But you are saying that is MORE expensive than Prilosec?  Im not understanding above paragraph at all. It sounded like conflicting advice

Response:

>> Im now only taking one… and that is in the morning right after i get > up. >One what? OTC 20 milligrams or 40 milligram prescription?

Im only taking one Prilosec pill a day for now.  And wondering if taking two is OK Or…. wondering if it bets to take the one Prilosec a day but take it at bed time rather than in morning.

Response:

>I suspect the OTC form time release method >is somewhat inferior to the prescription form. >So I suggest since to it takes two to get to >the higher prescription level, it would much >sense to take the med at twice a day for >a total of 40 milligrams. The result is $1.20 >compared to several dollars per day for the >Prilosec. > Your last sentence above confuses me.  Are you saying that is would be > OK to take TWO Prilosec pills a day?  But you are saying that is MORE > expensive than Prilosec?  Im not understanding above paragraph at all. > It sounded like conflicting advice

I don’t see why. You should be able to infer what I mean. I’ll try again. Think in terms of number of milligrams of the drug per day and not in terms of number of "pills". The use of the term pills, by the way, is somewhat derisive. Two over the counter strength TR (time released) tablets add up to 40 milligrams for a total drug cost of $1.20 per day. One prescription strength TR capsule of 40 milligrams results in a total of 40 milligrams per day at cost of several dollars per day. My estimate of the costs for you are contingent on you not having drug coverage, since with drug coverage the net prescription costs for you may well be lower than the OTC drugs costs.. If you still don’t understand, go talk to your primary care provider as I counseled earlier and see how much time he or she will give you. 20  + 20 = 40 milligrams   60 CENTS + 60 CENTS = $1.20 40 = 40 milligrams     $3.00 = $3.00

Response:

> >> Im now only taking one… and that is in the morning right after i get >> up. >One what? OTC 20 milligrams or 40 milligram prescription? > Im only taking one Prilosec pill a day for now.  And wondering if > taking two is OK > Or…. wondering if it bets to take the one Prilosec a day but take it > at bed time rather than in morning.

For what it is worth, I have been taking Protonix  for about 2 years now.  It does work and as you know very expensive.  After the first year I noticed it being less effective.  So I stopped taking it but continued buying it as long as I am insured.  I recently started using Prilosec OTC.  I have kept a log of when I take it (before dinner), what I eat and how well I slept that night.  I found that Prilosic OTC has me sleeping much better at night.  I now use it for 14 days at a time and am currently trying to learn if there are health reasons that will prevent me from using EVERY day.  They say use it for 14 days but why not more than that?

Response:

– Hide quoted text — Show quoted text -> >> Im now only taking one… and that is in the morning right after i get > >> up. > >One what? OTC 20 milligrams or 40 milligram prescription? > Im only taking one Prilosec pill a day for now.  And wondering if > taking two is OK > Or…. wondering if it bets to take the one Prilosec a day but take it > at bed time rather than in morning. > For what it is worth, > I have been taking Protonix  for about 2 years now.  It does work and > as you know very expensive.  After the first year I noticed it being > less effective.  So I stopped taking it but continued buying it as > long as I am insured.  I recently started using Prilosec OTC.  I have > kept a log of when I take it (before dinner), what I eat and how well > I slept that night.  I found that Prilosic OTC has me sleeping much > better at night.  I now use it for 14 days at a time and am currently > trying to learn if there are health reasons that will prevent me from > using EVERY day.  They say use it for 14 days but why not more than > that?

Protonix/pantoprazole and Prilosec/omeprazole or Aciphix/rabeprezole are all proton pump inhibitors. The list of adverse effects listed for each are rather similar. Prilosec/omeprazole is approved by the FDA for treatment of acid reflux disease. Many people take it a daily basis and per physicians orders take continuously. Prilosec and Nexium are quite similar. Nexium contains only the best stereoisomer found in Prilosec which contains more than one stereoisomer. What research I’ve seen indicated that it isn’t a big improvement over the older Prilosec and Aciphex is still the most effective of the PPI meds. Does this mean, I think Aciphex is best? Not exactly. I suspect that it the best drug to get healing but it may have a little higher risk of side effects. This is because the marketing departments of the drug companies don’t provide enough different dose possibilities to patients and physicians. Being that the FDA is in part a creature responsive to the drug companies and a creature given to blind bias and inertia , this will not change. Ideally compounding pharmacies would be provided with the time release granules so that physicians could titrate the drug dose so that the maintenance dose would be less likely to result in adverse effects, IMHO. Though it pretty clear most physicians couldn’t bothered at least currently with such titration of medication scheme. But with a little research from the drug companies and with some promotion I think this would be feasible. Yes, I know, this will never happen. Getting back to OTC Prilosec, understand the OTC Prilosec contains half the dose of the drug as it is commonly prescribed. Further, I suspect that timed released feature of the OTC form is inferior (if indeed it has it) to the prescription forms. So if you double dose with OTC form to reach the prescription level the drug, I’d suggest taking the tablets every 12 hours, rather than together. Understand this is against the directions on the packaging, but I say "so what". Use the money you save, to have your esophagus scoped every several years. The other nice thing about OTC form over the prescription form is that the patient can dail the dose up or down. Three times a day if they get in trouble or once a day to lessen adverse effects such as dizziness, dry mucous membranes, and abdomen pains. Now this is an idea that will upset some orthodox quacks/physicians IMHO:-) Warning I am not a physician!!

Response:

I have taken prilosec for seven years with no side effects.  20mg. once a day has been the standard dosage  prescribed by doctors. For me through trial and error anything stronger than 20mg adds no additional relief and anything less than 20mg a day has no effect. All proton pump inhibitors are timed release so you may take it any time of the day. Prilosec over the  counter $17.00 per month from Walmart. Prilosec by prescription for me previously if I did not  have insurance, $110.00 per month retail.  Nexium was developed by the drug company so they could still have a high price prescription drug It is no more effective than over the counter prilosec

Response:

>I have taken prilosec for seven years with no side effects.  20mg. once >a day has been the standard dosage  prescribed by doctors. For me >through trial and error anything stronger than 20mg adds no additional >relief and anything less than 20mg a day has no effect. All proton pump >inhibitors are timed release so you may take it any time of the day. >Prilosec over the  counter $17.00 per month from Walmart. Prilosec by >prescription for me previously if I did not  have insurance, $110.00 per >month retail.  Nexium was developed by the drug company so they could >still have a high price prescription drug It is no more effective than >over the counter prilosec

OK…. well its good to hear that one can take Prilosec long term like you have.  I really didn’t know if it was considered a long term choice or not. Im sorry you had to pay so many months back when it was still prescription only and cost so much more!

Response:

excruciating heartburn / esophagitis

Question:

Developed after 10 days on Doxycycline as treatment for prostatitis. My gastroenterologist suspects the doxycycline is the cause.  I would tend to agree, but I always took it with a full meal, so can’t quite see how it could have worked its evil on my esophagus.  Anyway, assuming I have doxy induced esophagitis, my doc put me on 30mg prevacid 1x/day, and sucralfate 4x/day.  So far, after only 1 day’s treatment, I am still in agony.  I have slept virtually not at all the past two nights because of the pain, which is still excruciating even when fully upright.  Food or lack of it does little to affect the pain.  Tylenol seems to do nothing as well. Is there any medication I can take to relieve the pain so that I can sleep and let the other medicines do their work?  I’ve heard of a "GI cocktail" that has lidocain in it that is used in ERs.  Is there something similar OTC? TIA for any and all ideas — John.

Response:

In article <95556f1e.0402110805.5b5cc475 > Developed after 10 days on Doxycycline as treatment for prostatitis. > My gastroenterologist suspects the doxycycline is the cause.  I would > tend to agree, but I always took it with a full meal, so can’t quite > see how it could have worked its evil on my esophagus.  Anyway, > assuming I have doxy induced esophagitis, my doc put me on 30mg > prevacid 1x/day, and sucralfate 4x/day.  So far, after only 1 day’s > treatment, I am still in agony.  I have slept virtually not at all the > past two nights because of the pain, which is still excruciating even > when fully upright.  Food or lack of it does little to affect the > pain.  Tylenol seems to do nothing as well. Is there any medication I > can take to relieve the pain so that I can sleep and let the other > medicines do their work?  I’ve heard of a "GI cocktail" that has > lidocain in it that is used in ERs.  Is there something similar OTC? > TIA for any and all ideas — John.

First of all, one can take prevacid 30 mg twice a day.  It is a large dose, but not that infrequently done (I’m doing it for the last month and it’s helped a lot with acid burning my throat till I could barely talk).  If you’re in the US, and using our wonderful insurance plans…..your doctor will have to get special permission for the large dose, but it can be done and it will make a big difference. Also, OTC Gaviscon is different from other antacids in that it creates a barrier of foam so the acid has a harder time refluxing.  If you take too much, the magnesium in it might give you some diahrrea – but again, for a little while, no harm done. In the health food camp:  1 tsp of aloe vera juice (pure) a few times a day.  DGL (deglycerized licorice) tablets chewed 15 minutes before meals. Put some kind of blocks under the head of your bed so that it is at an angle – they usually recommend 6 to 8 inches.   DO NOT USE EXTRA PILLOWS – you need the blocks under the top of the boxspring to create the proper angle. There are other things, such as medicines available in other countries, but not here, but those will take weeks for you to get and you’ll probably be better by then. Hope this helps and that you’re feeling better soon. Louise

Response:

How much insulation to add to refrigerator ?

Question:

> A plywood chimney sounds like it wont pass code and will be dangerous > Yes insulate 1-4 inches  use the R 7.2 foamboard. refrigerators come wth > apx R 10 to 15 R , but your ceiling should have R35 in zone 5 ?  More > will help.

I guess my description was not very good. The chimney is really just a drafting aid for the exhaust gases. The unit is rated for zero clearance on all sides. The sheet metal lining is a good idea. I will have upper and lower louvered vents through the back wall to allow for intake and exhaust. The installation manual says that the vents will allow for enough room for cleaning etc. The refrigerator seals with foam strips to the front of the cabinet to isolate the cabin interior. I have carefully caulked and sealed the cabinet and draft chimney. I will add the foam board to the sides as suggested. Thanks for the feedback. Offgridman

Response:

Sounds like a winning design. – Hide quoted text — Show quoted text -> I have the same frig in my cabin.  Your suggested installation does not > appear to lend itself to easy inspection / repair.  And if your cabin is > like mine – critters get inside and do all sorts of nasty stuff…. Like or > crap on the burner.  Under certain conditions soot can build up around the > burner and needs to be cleaned. > I insulated top, bottom and sides with 1 1/2" polyisocyanurate and covered > the exposed insulation with concrete board [I figured drywall might get > pretty dinged up over time].  It uses about 4 lbs of propane a week – which > is a little less than a gallon.  I think this is pretty good effeciency all > things considered.  And cold beer IS important. > I riveted additional sheet metal to increase the chimney height to a few > inches above the frig and insulation – and placed it at counter height on a > shelf with heavy duty roller bearing draw glides [the double slide, full > extension type] – it’s kinda like the upper half of a broom closet.  The gas > connection is flexible stainless steel – so the unit can roll out without > kinking the gas line – and I can get a look-see whenever I want without any > heartburn. > It’s on an outside wall.  In the ceiling I installed a short piece of metal > dryer duct venting into the roof overhang.  I finished both terminations > with soffit louvre vents.  The distance between the top of the unit chimney > and the ceiling is about 18" and not directly connected.  This allows a > little air to come in and a little exhaust to go out.  I did some CO tests > after installation and never got a positive reading.  I’ve never had a flame > out due to insufficient oxygen.

Response:

> I am building cabinets for my kitchen and have a RV propane/120volt > Dometic 7732 refrigerator that will fit inside an 3/4 pine BC plywood > cabinet (top/sides and bottom/ I have fashoned an airtight plywood > chimney at the rear for venting to the outside. Should I add additonal > insulation to the sides and bottom of the cabinet or not? The cabin is > empty and gets quite hot during the summer months when we are not there. > Or should I just allow the cabin to vent by leaving a high window open > and installing a floor vent for intake of cooler air from under the > cabin? The cabin is 8ft off the ground on pilings. > Whats do you think? I plan on leaving the frig going 24/7/365. > I was thinking of building a cover of some type to install over the door > when we leave. > Thanks for any and all feed back. > Offgridman

I have the same frig in my cabin.  Your suggested installation does not appear to lend itself to easy inspection / repair.  And if your cabin is like mine – critters get inside and do all sorts of nasty stuff…. Like crap on the burner.  Under certain conditions soot can build up around the burner and needs to be cleaned. I insulated top, bottom and sides with 1 1/2" polyisocyanurate and covered the exposed insulation with concrete board [I figured drywall might get pretty dinged up over time].  It uses about 4 lbs of propane a week – which is a little less than a gallon.  I think this is pretty good effeciency all things considered.  And cold beer IS important. I riveted additional sheet metal to increase the chimney height to a few inches above the frig and insulation – and placed it at counter height on a shelf with heavy duty roller bearing draw glides [the double slide, full extension type] – it’s kinda like the upper half of a broom closet.  The gas connection is flexible stainless steel – so the unit can roll out without kinking the gas line – and I can get a look-see whenever I want without any heartburn. It’s on an outside wall.  In the ceiling I installed a short piece of metal dryer duct venting into the roof overhang.  I finished both terminations with soffit louvre vents.  The distance between the top of the unit chimney and the ceiling is about 18" and not directly connected.  This allows a little air to come in and a little exhaust to go out.  I did some CO tests after installation and never got a positive reading.  I’ve never had a flame out due to insufficient oxygen.

Response:

A plywood chimney sounds like it wont pass code and will be dangerous Yes insulate 1-4 inches  use the R 7.2 foamboard. refrigerators come wth apx R 10 to 15 R , but your ceiling should have R35 in zone 5 ?  More will help.

Response:

I would  consider 1" of rigid polyicocyanurate (sp?) around the fridge. It has a higher "R" factor, and is much less combustable than styrofoam. I would "not" use stryofoam because it is highly combustable. Make provisions in your design for backside access for periodic cleaning and maintenance. We had an old Servel in our camp that ran 24/7/365. Kitchen grease combined with dust and cobwebs accumulated behind the unit, and caused a smoldeing fire. Fortunately, the fire was confined to the area just behind the fridge, and did not spread to the rest of the house, but the smoke damage was considerable. What a mess! It took months until the smell was gone. It might have been a whole lot more of a problem if there had been combustables (like styrofoam) nearby. I’d also line your plywood chimney completely with sheet metal. I think I’d also consider an inlet at the back of the fridge (floor) instead of depending upon an open window. Make it squirrel and rodent proof with some 1/4" heavy wire mesh. A rodent nest could be another source of fuel for a fire. I wouldn’t bother with a door panel. my $.02

– Hide quoted text — Show quoted text -> I am building cabinets for my kitchen and have a RV propane/120volt > Dometic 7732 refrigerator that will fit inside an 3/4 pine BC plywood > cabinet (top/sides and bottom/ I have fashoned an airtight plywood > chimney at the rear for venting to the outside. Should I add additonal > insulation to the sides and bottom of the cabinet or not? The cabin is > empty and gets quite hot during the summer months when we are not there. > Or should I just allow the cabin to vent by leaving a high window open > and installing a floor vent for intake of cooler air from under the > cabin? The cabin is 8ft off the ground on pilings. > Whats do you think? I plan on leaving the frig going 24/7/365. > I was thinking of building a cover of some type to install over the door > when we leave. > Thanks for any and all feed back. > Offgridman

Response:

I am building cabinets for my kitchen and have a RV propane/120volt Dometic 7732 refrigerator that will fit inside an 3/4 pine BC plywood cabinet (top/sides and bottom/ I have fashoned an airtight plywood chimney at the rear for venting to the outside. Should I add additonal insulation to the sides and bottom of the cabinet or not? The cabin is empty and gets quite hot during the summer months when we are not there. Or should I just allow the cabin to vent by leaving a high window open and installing a floor vent for intake of cooler air from under the cabin? The cabin is 8ft off the ground on pilings. Whats do you think? I plan on leaving the frig going 24/7/365. I was thinking of building a cover of some type to install over the door when we leave. Thanks for any and all feed back. Offgridman

Response:

> I am building cabinets for my kitchen and have a RV propane/120volt > Dometic 7732 refrigerator that will fit inside an 3/4 pine BC plywood > cabinet (top/sides and bottom/ I have fashoned an airtight plywood > chimney at the rear for venting to the outside. Should I add additonal > insulation to the sides and bottom of the cabinet or not? The cabin is > empty and gets quite hot during the summer months when we are not there. > Or should I just allow the cabin to vent by leaving a high window open > and installing a floor vent for intake of cooler air from under the > cabin? The cabin is 8ft off the ground on pilings. > Whats do you think? I plan on leaving the frig going 24/7/365. > I was thinking of building a cover of some type to install over the door > when we leave. > Thanks for any and all feed back. > Offgridman

Go for it.

Response:

errosive esophagitis and Barret's

Nexium is a medication used to treat gestational acid reflux disease (GERD). Buy cheap Nexium and feel better today!

Question:

I just had an endosopy (piece of cake BTW) for mild heartburn but it wasn’t that mild. Erosive esophagitis grade 2 with ulceration that bleed like a stuck pig when biopsies, stomach filled with blood. I could have hemorrhaged and died  if I was out drinking.Anyway my concern is Barrett’s which I don’t have. I read a study on PUBMED that states GERD causes non-erosive, erosive and Barrett’s esophagitis but there is no correlation that if you have erosive you will probably progress to Barrett’s syndrome. However once you get Barrett’s you have a good chance of it becoming carcinogenic. any Doc’s out there?

Response:

> I just had an endosopy (piece of cake BTW) for mild heartburn but it wasn’t > that mild. Erosive esophagitis grade 2 with ulceration that bleed like a > stuck pig when biopsies, stomach filled with blood. I could have hemorrhaged > and died  if I was out drinking.Anyway my concern is Barrett’s which I don’t > have. I read a study on PUBMED that states GERD causes non-erosive, erosive > and Barrett’s esophagitis but there is no correlation that if you have > erosive you will probably progress to Barrett’s syndrome. However once you > get Barrett’s you have a good chance of it becoming carcinogenic. > any Doc’s out there?

If you have GERD, you should be having periodic EGDs as surveillance for the development of Barrett’s esophagus. As you noted, the presence of  severe GERD as indicated by your erosive esophagitis does put you at higher risk for Barrett’s esophagus, which in turn increases your risk of esophageal cancer. HMc – Hide quoted text — Show quoted text –

Response:

I never really had GERD symptoms. I always ate the spiciest foods, I would pour on hot sause on eveything. I’ve never had any real pain, just some minor heatburn once in a while. Go figure. However I would go out usually on Saturday night have about3 or  4 maybe 5 scotches, stuff my face with food, then fall asleep for 4 hours, wake up take two excederin eat again and fall asleep. Maybe this did it!???

– Hide quoted text — Show quoted text -> I just had an endosopy (piece of cake BTW) for mild heartburn but it > wasn’t > that mild. Erosive esophagitis grade 2 with ulceration that bleed like a > stuck pig when biopsies, stomach filled with blood. I could have > hemorrhaged > and died  if I was out drinking.Anyway my concern is Barrett’s which I > don’t > have. I read a study on PUBMED that states GERD causes non-erosive, > erosive > and Barrett’s esophagitis but there is no correlation that if you have > erosive you will probably progress to Barrett’s syndrome. However once you > get Barrett’s you have a good chance of it becoming carcinogenic. > any Doc’s out there? > If you have GERD, you should be having periodic EGDs as surveillance for the > development of Barrett’s esophagus. As you noted, the presence of  severe > GERD as indicated by your erosive esophagitis does put you at higher risk > for Barrett’s esophagus, which in turn increases your risk of esophageal > cancer. > HMc

Response:

Howard, Thanks for your reply. I’m assuming you’re the resident DOC here I’m just a little anxious right now, I wasn’t expecting these results from my EGD. My Doctor was also surprised since I had such mild heartburn. Nothing I ate ever gave me heartburn. Lately however come to think of it Margarhitas have caused me some moderate pain.Lately  I was also taking  some diet pills with Efedra to lose weight, maybe I was my own worst enemy. So scotch,excedrin, diet pills, and eating heavy right before I went to bed caused acid reflux to slowly eat away my esophogus? Do you feel some needed lifestyle changes is all I would need after I get off the meds like Previcid?

– Hide quoted text — Show quoted text -> I just had an endosopy (piece of cake BTW) for mild heartburn but it > wasn’t > that mild. Erosive esophagitis grade 2 with ulceration that bleed like a > stuck pig when biopsies, stomach filled with blood. I could have > hemorrhaged > and died  if I was out drinking.Anyway my concern is Barrett’s which I > don’t > have. I read a study on PUBMED that states GERD causes non-erosive, > erosive > and Barrett’s esophagitis but there is no correlation that if you have > erosive you will probably progress to Barrett’s syndrome. However once you > get Barrett’s you have a good chance of it becoming carcinogenic. > any Doc’s out there? > If you have GERD, you should be having periodic EGDs as surveillance for the > development of Barrett’s esophagus. As you noted, the presence of  severe > GERD as indicated by your erosive esophagitis does put you at higher risk > for Barrett’s esophagus, which in turn increases your risk of esophageal > cancer. > HMc

Response:

Alkaline reflux?

Aciphex is a medication used to treat gestational acid reflux disease (GERD) and ulcers. buy aciphex and feel better today!

Question:

– Hide quoted text — Show quoted text -> I was diagnosed with LPR a few weeks ago. I know I’ve had it off and > on for years. Also have irritable bowel and hiatal hernia. But all has > been under control, through a lot of natural means, until the past few > months. So ENT put scope down my nose to throat and confirmed that it > was LPR (no heartburn, just pain, chronic throat clearing and > coughing). > He wanted me on Zantac. But my internist said no and I should use a > PPI. Well, I’ve tried Nexium, Prevacid, and finally Aciphex. And they > don’t help. In fact, tonight, after taking an Aciphex this morning and > last night, I have that drawing hungry gnawing in my gut. > I even tried DGL licorice for about three days, and no help as well. > Even though I’ve read that H2 blockers are not as good, I’m trying > that. > It’s so bizarre that the meds seem to increase the acidity instead of > decrease it. Same thing happens when I take natural enzymes. > Now, I have been reading and see there is an alkaline reflux. I’m > wondering if that’s what I have, so that’s why digestive enzymes and > PPIs make things worse. Anyone have any experience with this and can > suggest what someone with this can do to heal it?

The next step is a complete diagnostic workup. Technically, the ENT can’t diagnose LPR since reflux, its character and extent, hasn’t been diagnosed yet. There are other things that can cause such laryngitis/pharyngitis. I agree that given your symptoms, it’s a reasonable presumption, but you need to have your upper GI tract evaluated. You need to have EGD, ambulatory pH testing, esophageal manometry. Your internist should be quite willing to get a consultation from a surgeon or gastroenterologist. Acid reflux, if that is indeed what you have, that does not respond to PPIs will usually require anti-reflux surgery. The only other thing you might try is a prokinetic agent, metaclopromide (Reglan) in hopes that it will aid in esophageal clearing and gastric emptying enough to control your symptoms. In the meantime, diet, weight loss, eating habits etc as detailed by many previous poster here on this newsgroup. HMc

Response:

I was diagnosed with LPR a few weeks ago. I know I’ve had it off and on for years. Also have irritable bowel and hiatal hernia. But all has been under control, through a lot of natural means, until the past few months. So ENT put scope down my nose to throat and confirmed that it was LPR (no heartburn, just pain, chronic throat clearing and coughing). He wanted me on Zantac. But my internist said no and I should use a PPI. Well, I’ve tried Nexium, Prevacid, and finally Aciphex. And they don’t help. In fact, tonight, after taking an Aciphex this morning and last night, I have that drawing hungry gnawing in my gut. I even tried DGL licorice for about three days, and no help as well. Even though I’ve read that H2 blockers are not as good, I’m trying that. It’s so bizarre that the meds seem to increase the acidity instead of decrease it. Same thing happens when I take natural enzymes. Now, I have been reading and see there is an alkaline reflux. I’m wondering if that’s what I have, so that’s why digestive enzymes and PPIs make things worse. Anyone have any experience with this and can suggest what someone with this can do to heal it? Thanks, Susan

Response:

Alkaline reflux?

Question:

– Hide quoted text — Show quoted text -> I was diagnosed with LPR a few weeks ago. I know I’ve had it off and > on for years. Also have irritable bowel and hiatal hernia. But all has > been under control, through a lot of natural means, until the past few > months. So ENT put scope down my nose to throat and confirmed that it > was LPR (no heartburn, just pain, chronic throat clearing and > coughing). > He wanted me on Zantac. But my internist said no and I should use a > PPI. Well, I’ve tried Nexium, Prevacid, and finally Aciphex. And they > don’t help. In fact, tonight, after taking an Aciphex this morning and > last night, I have that drawing hungry gnawing in my gut. > I even tried DGL licorice for about three days, and no help as well. > Even though I’ve read that H2 blockers are not as good, I’m trying > that. > It’s so bizarre that the meds seem to increase the acidity instead of > decrease it. Same thing happens when I take natural enzymes. > Now, I have been reading and see there is an alkaline reflux. I’m > wondering if that’s what I have, so that’s why digestive enzymes and > PPIs make things worse. Anyone have any experience with this and can > suggest what someone with this can do to heal it?

The next step is a complete diagnostic workup. Technically, the ENT can’t diagnose LPR since reflux, its character and extent, hasn’t been diagnosed yet. There are other things that can cause such laryngitis/pharyngitis. I agree that given your symptoms, it’s a reasonable presumption, but you need to have your upper GI tract evaluated. You need to have EGD, ambulatory pH testing, esophageal manometry. Your internist should be quite willing to get a consultation from a surgeon or gastroenterologist. Acid reflux, if that is indeed what you have, that does not respond to PPIs will usually require anti-reflux surgery. The only other thing you might try is a prokinetic agent, metaclopromide (Reglan) in hopes that it will aid in esophageal clearing and gastric emptying enough to control your symptoms. In the meantime, diet, weight loss, eating habits etc as detailed by many previous poster here on this newsgroup. HMc

Response:

I was diagnosed with LPR a few weeks ago. I know I’ve had it off and on for years. Also have irritable bowel and hiatal hernia. But all has been under control, through a lot of natural means, until the past few months. So ENT put scope down my nose to throat and confirmed that it was LPR (no heartburn, just pain, chronic throat clearing and coughing). He wanted me on Zantac. But my internist said no and I should use a PPI. Well, I’ve tried Nexium, Prevacid, and finally Aciphex. And they don’t help. In fact, tonight, after taking an Aciphex this morning and last night, I have that drawing hungry gnawing in my gut. I even tried DGL licorice for about three days, and no help as well. Even though I’ve read that H2 blockers are not as good, I’m trying that. It’s so bizarre that the meds seem to increase the acidity instead of decrease it. Same thing happens when I take natural enzymes. Now, I have been reading and see there is an alkaline reflux. I’m wondering if that’s what I have, so that’s why digestive enzymes and PPIs make things worse. Anyone have any experience with this and can suggest what someone with this can do to heal it? Thanks, Susan

Response:

flare up because of SPLENDA?

Question:

I have had heartburn incidences periodically for over 15 years. Starting at the end of September, I had the flare up from hell. Nonstop pain.  Last weekend I had no pain.  Oddly enough, I was out of town.  I kept thinking to myself what was different.  I realized that I had not brought my Splenda (sugar substitute with me) and was using Equal and regular sugar.  Since I have been home, I have used only real sugar and still no pain. Coincidence?  Maybe.  But it was in September that I started using Splenda.  Anyone else ever have problems with this?  I know it is not the cause of my original problem, but it seems that it heightened the pain intensity and amount.

Response:

In article <350bd14.0312161924.63812e87 > I have had heartburn incidences periodically for over 15 years. > Starting at the end of September, I had the flare up from hell. > Nonstop pain.  Last weekend I had no pain.  Oddly enough, I was out of > town.  I kept thinking to myself what was different.  I realized that > I had not brought my Splenda (sugar substitute with me) and was using > Equal and regular sugar.  Since I have been home, I have used only > real sugar and still no pain. Coincidence?  Maybe.  But it was in > September that I started using Splenda.  Anyone else ever have > problems with this?  I know it is not the cause of my original > problem, but it seems that it heightened the pain intensity and > amount.

YES!   I have been increasingly sick for over a year and recently discovered that all the non-absorbable sugars tend to cause excessive gas.  I was using Splenda almost exclusively during this time but never put the two together. In my case the increased gas definitely has been connected to increased reflux.  I have stopped all artificial sweeteners and I’m not all better, but I’m noticeably improved. I’ve been trying xylitol (Miracle Sweet) which comes from Finland and is, I believe a natural and absorbable sugar.   I think it’s ok but I’m so flared that it’s hard to tell. My gastro (AFTER I found out about the artificial sweeteners), also told me that some people have trouble with the sugars in milk products as well. Keep us posted as to how you’re doing and what you’ve found.   Louise

Response:

- Hide quoted text — Show quoted text – > In article <350bd14.0312161924.63812e87 > I have had heartburn incidences periodically for over 15 years. > Starting at the end of September, I had the flare up from hell. > Nonstop pain.  Last weekend I had no pain.  Oddly enough, I was out of > town.  I kept thinking to myself what was different.  I realized that > I had not brought my Splenda (sugar substitute with me) and was using > Equal and regular sugar.  Since I have been home, I have used only > real sugar and still no pain. Coincidence?  Maybe.  But it was in > September that I started using Splenda.  Anyone else ever have > problems with this?  I know it is not the cause of my original > problem, but it seems that it heightened the pain intensity and > amount. > YES!   > I have been increasingly sick for over a year and recently > discovered that all the non-absorbable sugars tend to cause > excessive gas.  I was using Splenda almost exclusively > during this time but never put the two together. > In my case the increased gas definitely has been connected > to increased reflux.  I have stopped all artificial > sweeteners and I’m not all better, but I’m noticeably > improved. > I’ve been trying xylitol (Miracle Sweet) which comes from > Finland and is, I believe a natural and absorbable sugar.   > I think it’s ok but I’m so flared that it’s hard to tell. > My gastro (AFTER I found out about the artificial > sweeteners), also told me that some people have trouble > with the sugars in milk products as well. > Keep us posted as to how you’re doing and what you’ve > found.   > Louise

hi louise! thanks for your input.  10 days splenda free and there is a major difference.  like i said, it wasn’t what caused years of reflux, but what has amazed me is how i have controlled my diet so well and still had horrible problems while i was using splenda.  if i had eaten this way before, i would never have had a problem.  this body hasn’t seen a margarita or mexican food for 4 months now…no sodas, fried foods, fatty foods etc.  i eat small amounts intentionally avoiding that sensation of being "full".  i just eat to ease the hunger and wait and do it again when i need to.  no big dinners and i raise the head of my bed and i don’t wear tight clothing around the middle.  if splenda was indeed the "bad guy", that would explain why none of that was working very well.  i am gonna stay off the rest of 2003 and see what happens.  I WANNA GET OFF MY MEDS!!!!  anyone else out there ever had an issue with this?  howard, how about any of your patients?  i have to believe there are foods that have a negative affect on this condition in certain sensitive individuals. melanie

Response:

In article – Hide quoted text — Show quoted text -> In article <350bd14.0312161924.63812e87 > > I have had heartburn incidences periodically for over 15 years. > > Starting at the end of September, I had the flare up from hell. > > Nonstop pain.  Last weekend I had no pain.  Oddly enough, I was out of > > town.  I kept thinking to myself what was different.  I realized that > > I had not brought my Splenda (sugar substitute with me) and was using > > Equal and regular sugar.  Since I have been home, I have used only > > real sugar and still no pain. Coincidence?  Maybe.  But it was in > > September that I started using Splenda.  Anyone else ever have > > problems with this?  I know it is not the cause of my original > > problem, but it seems that it heightened the pain intensity and > > amount. > YES!   > I have been increasingly sick for over a year and recently > discovered that all the non-absorbable sugars tend to cause > excessive gas.  I was using Splenda almost exclusively > during this time but never put the two together. > In my case the increased gas definitely has been connected > to increased reflux.  I have stopped all artificial > sweeteners and I’m not all better, but I’m noticeably > improved. > I’ve been trying xylitol (Miracle Sweet) which comes from > Finland and is, I believe a natural and absorbable sugar.   > I think it’s ok but I’m so flared that it’s hard to tell. > My gastro (AFTER I found out about the artificial > sweeteners), also told me that some people have trouble > with the sugars in milk products as well. > Keep us posted as to how you’re doing and what you’ve > found.   > Louise > hi louise! > thanks for your input.  10 days splenda free and there is a major > difference.  like i said, it wasn’t what caused years of reflux, but > what has amazed me is how i have controlled my diet so well and still > had horrible problems while i was using splenda.  if i had eaten this > way before, i would never have had a problem.  this body hasn’t seen a > margarita or mexican food for 4 months now…no sodas, fried foods, > fatty foods etc.  i eat small amounts intentionally avoiding that

 hi, I assume that you do know about the "standard" no-no foods such as carbonated beverages, chocolate, alcohol, mint, and for me, definitely garlic and onions.  I also discovered that the menthol in cough drops is a peppermint based substance and should be avoided. Do you find that gas builds up when you have the worst reflux? Louise —

Response:

flare up because of SPLENDA?

Question:

I have had heartburn incidences periodically for over 15 years. Starting at the end of September, I had the flare up from hell. Nonstop pain.  Last weekend I had no pain.  Oddly enough, I was out of town.  I kept thinking to myself what was different.  I realized that I had not brought my Splenda (sugar substitute with me) and was using Equal and regular sugar.  Since I have been home, I have used only real sugar and still no pain. Coincidence?  Maybe.  But it was in September that I started using Splenda.  Anyone else ever have problems with this?  I know it is not the cause of my original problem, but it seems that it heightened the pain intensity and amount.

Response:

In article <350bd14.0312161924.63812e87 > I have had heartburn incidences periodically for over 15 years. > Starting at the end of September, I had the flare up from hell. > Nonstop pain.  Last weekend I had no pain.  Oddly enough, I was out of > town.  I kept thinking to myself what was different.  I realized that > I had not brought my Splenda (sugar substitute with me) and was using > Equal and regular sugar.  Since I have been home, I have used only > real sugar and still no pain. Coincidence?  Maybe.  But it was in > September that I started using Splenda.  Anyone else ever have > problems with this?  I know it is not the cause of my original > problem, but it seems that it heightened the pain intensity and > amount.

YES!   I have been increasingly sick for over a year and recently discovered that all the non-absorbable sugars tend to cause excessive gas.  I was using Splenda almost exclusively during this time but never put the two together. In my case the increased gas definitely has been connected to increased reflux.  I have stopped all artificial sweeteners and I’m not all better, but I’m noticeably improved. I’ve been trying xylitol (Miracle Sweet) which comes from Finland and is, I believe a natural and absorbable sugar.   I think it’s ok but I’m so flared that it’s hard to tell. My gastro (AFTER I found out about the artificial sweeteners), also told me that some people have trouble with the sugars in milk products as well. Keep us posted as to how you’re doing and what you’ve found.   Louise

Response:

- Hide quoted text — Show quoted text – > In article <350bd14.0312161924.63812e87 > I have had heartburn incidences periodically for over 15 years. > Starting at the end of September, I had the flare up from hell. > Nonstop pain.  Last weekend I had no pain.  Oddly enough, I was out of > town.  I kept thinking to myself what was different.  I realized that > I had not brought my Splenda (sugar substitute with me) and was using > Equal and regular sugar.  Since I have been home, I have used only > real sugar and still no pain. Coincidence?  Maybe.  But it was in > September that I started using Splenda.  Anyone else ever have > problems with this?  I know it is not the cause of my original > problem, but it seems that it heightened the pain intensity and > amount. > YES!   > I have been increasingly sick for over a year and recently > discovered that all the non-absorbable sugars tend to cause > excessive gas.  I was using Splenda almost exclusively > during this time but never put the two together. > In my case the increased gas definitely has been connected > to increased reflux.  I have stopped all artificial > sweeteners and I’m not all better, but I’m noticeably > improved. > I’ve been trying xylitol (Miracle Sweet) which comes from > Finland and is, I believe a natural and absorbable sugar.   > I think it’s ok but I’m so flared that it’s hard to tell. > My gastro (AFTER I found out about the artificial > sweeteners), also told me that some people have trouble > with the sugars in milk products as well. > Keep us posted as to how you’re doing and what you’ve > found.   > Louise

hi louise! thanks for your input.  10 days splenda free and there is a major difference.  like i said, it wasn’t what caused years of reflux, but what has amazed me is how i have controlled my diet so well and still had horrible problems while i was using splenda.  if i had eaten this way before, i would never have had a problem.  this body hasn’t seen a margarita or mexican food for 4 months now…no sodas, fried foods, fatty foods etc.  i eat small amounts intentionally avoiding that sensation of being "full".  i just eat to ease the hunger and wait and do it again when i need to.  no big dinners and i raise the head of my bed and i don’t wear tight clothing around the middle.  if splenda was indeed the "bad guy", that would explain why none of that was working very well.  i am gonna stay off the rest of 2003 and see what happens.  I WANNA GET OFF MY MEDS!!!!  anyone else out there ever had an issue with this?  howard, how about any of your patients?  i have to believe there are foods that have a negative affect on this condition in certain sensitive individuals. melanie

Response:

In article – Hide quoted text — Show quoted text -> In article <350bd14.0312161924.63812e87 > > I have had heartburn incidences periodically for over 15 years. > > Starting at the end of September, I had the flare up from hell. > > Nonstop pain.  Last weekend I had no pain.  Oddly enough, I was out of > > town.  I kept thinking to myself what was different.  I realized that > > I had not brought my Splenda (sugar substitute with me) and was using > > Equal and regular sugar.  Since I have been home, I have used only > > real sugar and still no pain. Coincidence?  Maybe.  But it was in > > September that I started using Splenda.  Anyone else ever have > > problems with this?  I know it is not the cause of my original > > problem, but it seems that it heightened the pain intensity and > > amount. > YES!   > I have been increasingly sick for over a year and recently > discovered that all the non-absorbable sugars tend to cause > excessive gas.  I was using Splenda almost exclusively > during this time but never put the two together. > In my case the increased gas definitely has been connected > to increased reflux.  I have stopped all artificial > sweeteners and I’m not all better, but I’m noticeably > improved. > I’ve been trying xylitol (Miracle Sweet) which comes from > Finland and is, I believe a natural and absorbable sugar.   > I think it’s ok but I’m so flared that it’s hard to tell. > My gastro (AFTER I found out about the artificial > sweeteners), also told me that some people have trouble > with the sugars in milk products as well. > Keep us posted as to how you’re doing and what you’ve > found.   > Louise > hi louise! > thanks for your input.  10 days splenda free and there is a major > difference.  like i said, it wasn’t what caused years of reflux, but > what has amazed me is how i have controlled my diet so well and still > had horrible problems while i was using splenda.  if i had eaten this > way before, i would never have had a problem.  this body hasn’t seen a > margarita or mexican food for 4 months now…no sodas, fried foods, > fatty foods etc.  i eat small amounts intentionally avoiding that

 hi, I assume that you do know about the "standard" no-no foods such as carbonated beverages, chocolate, alcohol, mint, and for me, definitely garlic and onions.  I also discovered that the menthol in cough drops is a peppermint based substance and should be avoided. Do you find that gas builds up when you have the worst reflux? Louise —

Response:

Propulsid???

Question:

My doctor has suggested I try to get ahold of some propulsid or cisapride, which next I travel, which I do quite regularly. In which countris is propulsid or cisapride legal to be sold? Thanks. —

Response:

> My doctor has suggested I try to get ahold of some > propulsid or cisapride, which next I travel, which I do > quite regularly.

Are you sure?  Propulsid has some pretty serious risks and contraindications. — Richard W Kaszeta http://www.kaszeta.org/rich

Response:

> > My doctor has suggested I try to get ahold of some > propulsid or cisapride, which next I travel, which I do > quite regularly. > Are you sure?  Propulsid has some pretty serious risks and contraindications.

I’m sure he told me to….  He did have me get an EKG first to verify that my QT level (whatever that is), was within normal limits. But I’m not sure I should do it although I’m having a pretty bad time with reflux and throat problems even at 60mg of Prevacid per day and pretty rigorous dietary controls, bed raised etc. He led me to believe that it is legal and accepted medical practice in most countries, save the US and Canada.  I know it’s available in Mexico but I’m wondering if anyone knows what other countries consider it safe.  How about western Europe for example? I’m not sure at all – but it’s very tempting and I don’t know who to trust. Louise —

Response:

– Hide quoted text — Show quoted text -> > My doctor has suggested I try to get ahold of some > > propulsid or cisapride, which next I travel, which I do > > quite regularly. > Are you sure?  Propulsid has some pretty serious risks and contraindications. > I’m sure he told me to….  He did have me get an EKG first > to verify that my QT level (whatever that is), was within > normal limits. > But I’m not sure I should do it although I’m having a > pretty bad time with reflux and throat problems even at > 60mg of Prevacid per day and pretty rigorous dietary > controls, bed raised etc. > He led me to believe that it is legal and accepted medical > practice in most countries, save the US and Canada.  I know > it’s available in Mexico but I’m wondering if anyone knows > what other countries consider it safe.  How about western > Europe for example? > I’m not sure at all – but it’s very tempting and I don’t > know who to trust.

Prokinetic agents like propulsid or metaclopramide (Reglan) aid in esophageal clearing of reflux. They are best used in conjunction with anti-secretory drugs like Nexium. The difference between Propulsid (which is off the market in the US) and Reglan are not that great in practical use. If Reglan doesn’t help you for whatever your problem is, then I doubt the Propulsid will either. At least not enough to justify the risk or go the hassle of importing it. HMc

Response:

> Prokinetic agents like propulsid or metaclopramide (Reglan) aid in > esophageal clearing of reflux. They are best used in conjunction with > anti-secretory drugs like Nexium. The difference between Propulsid (which is > off the market in the US) and Reglan are not that great in practical use. If > Reglan doesn’t help you for whatever your problem is, then I doubt the > Propulsid will either. At least not enough to justify the risk or go the > hassle of importing it. > HMc

Reglan does have some nasty psychological side-effects in some people though. My gastro sited that 15% of those who take reglan will develop side-effects from severe insomnia to extreme depression. It seems it also can cause parkinsons like symptoms… "Reglan is a neuroleptic medication used to treat gastrointestinal problems that have had many cases of Tardive Dyskinesia reported in response to it. Reglan is supposed to increase the stomach and small intestine contractions to help the passage of food. As every medication, Reglan has side effects associated to it and some of them are very serious. In February 1996, the FDA warned that Reglan causes an increased risk of Parkinsonism. Reglan can also cause people to have mild to severe depression, so patients that already suffer depression may want to consider an alternate treatment plan to Reglan. Tardive Dyskinesia has been most often linked to the use of antipsychotic drugs, but the potentially permanent muscle disorder has also been reported side effects of Reglan. Especially older Reglan patients should first consider the risks and benefits of Reglan since elders have a higher incidence of suffering Tardive Dyskinesia." http://www.tardive-dyskinesia.com/reglan/

Response:

> My doctor has suggested I try to get ahold of some > propulsid or cisapride, which next I travel, which I do > quite regularly. > In which countris is propulsid or cisapride legal to be > sold? > Thanks.

Does your doctor know that there is a limited access program for propulsid? The prescription medication PROPULSID

GERD incidence rates for various countries?

Esomeprazole is a medication used to treat gestational acid reflux disease (GERD). Buy esomeprazole tablets and feel better today!

Question:

> Mark, everbody is completely well, right up until the day they get sick… > The mechanism behind TILESR’s is that the LES inappropriately get a signal > to relax. There are several things that can initiate this. Most frequent is > simply a full stomach. There are some foods/substances that can cause this > such as nicotine, alcohol, caffiene, and some spices. There is some > speculation that it can be induced by stress, but this link has not been > demonstrated. > The cause? It just happens. Some people are genetically prone to it. In your > case, I would suspect that GERD runs in the family. > HMc

Thanks again. It seems your suspicions could be correct… I just spoke with my father and found out that he has had GERD for a while. I always remembered him popping a lot of Antacids when I was a kid but I never made the connection. thanks for the insight. Mark

Response:

> It seems your suspicions could be correct… > I just spoke with my father and found out that he has had GERD for a > while. > I always remembered him popping a lot of Antacids when I was a kid but > I never made the connection.

Indeed, like a lot of medical conditions, people may have had problems in your family for years, but it was never diagnosed.  While nobody in my family had ever had heard of "GERD", quite a few of my relatives have had chronic "heartburn." That, and sometimes people don’t talk about their medical problems, even to relatives.  A friend of mine came down with Crohn’s disease, and only after the diagnosis and surgery did she discover that her father and grandfather both had the same disease (although neither of them had required surgery).  And I didn’t find out that red-green colorblindness ran in my mother’s family (or that I had it myself) until I had my medical exam for the Naval Academy, which rather put a damper on things… (yes, you can get quite far in life before you realize that you are red-green colorblind). — Richard W Kaszeta http://www.kaszeta.org/rich

Response:

– Hide quoted text — Show quoted text -> Thanks for the reply. I had not considered the link between obesity > and Gerd as I am not overweight (probably closer to underweight) > So what originally causes the lower esophageal sphincter to not > function correctly? > It seems strange to me that all of a sudden one’s LES can stop working > correctly (as was the case with me…out of the blue one day a year > ago) > In my case, I am not overweight. I am realtively young(23). I do not > smoke or drink. I never eat fast food, or fatty foods. I dont eat > chocolate…or candy…etc The only meats that I eat are chicken and > fish. > but…I have had problems with stress in the past. > Is it possible for stress alone  to cause the LES to not function > correctly?

Mark, everbody is completely well, right up until the day they get sick… The mechanism behind TILESR’s is that the LES inappropriately get a signal to relax. There are several things that can initiate this. Most frequent is simply a full stomach. There are some foods/substances that can cause this such as nicotine, alcohol, caffiene, and some spices. There is some speculation that it can be induced by stress, but this link has not been demonstrated. The cause? It just happens. Some people are genetically prone to it. In your case, I would suspect that GERD runs in the family. HMc

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– Hide quoted text — Show quoted text ->The mechanism behind TILESR’s is that the LES inappropriately get a signal >to relax. There are several things that can initiate this. Most frequent is >simply a full stomach. There are some foods/substances that can cause this >such as nicotine, alcohol, caffiene, and some spices. There is some >speculation that it can be induced by stress, but this link has not been >demonstrated. >The cause? It just happens. Some people are genetically prone to it. In your >case, I would suspect that GERD runs in the family. > A hiatal hernia will exaggerate them, also.

Actually, a hiatus hernia would affect LES resting pressure, but usually wouldn’t contribute to inappropriate LES relaxation. The latter are neurally mediated. Here are the basics: The LES is the barrier between the stomach and esophagus. Reflux occurs when intragastric pressure exceeds intraesophageal pressure, and when that pressure gradient is greater than the pressure of the LES. Therefore, anything that increases that gradient might promote reflux. Also, anything that causes lower pressure in the LES would facilitate reflux (at lower pressure gradients). Obese people (and pregnant people) have higher intrabdominal pressure due to the intrabdominal fat (baby), so that gradient is greater, more likely to exceed the LES pressure and cause reflux. That intrabdominal pressure goes even higher when that person bends over. When lying down, gravity now has no contribution to the pressure gradient. So reflux is more common when lying down, or when bending over. Additionally, some people (fat or thin) have a low LES resting pressure, so that pressure gradient between stomach and esophagus needs to be less for reflux to occur. And, some people have more active transient LES relaxation in response to full stomach, nicotine, alcohol etc. So, you could be a thin person, but have a low LES resting pressure (such as with hiatus hernia), or very active TLESR’s and get bad reflux. It is more common in obese people because of their higher intrabdominal pressure. And, it’s also true that the intrabdominal fat can push upward and aggravate a tendency to hiatus hernia, which in turn can lead to lower LES pressure, which in turn can lead to reflux. So, how do we cure GERD? (CURE, not just treat the symptoms with prilosec). We either have to lower intrabdominal pressure, increase LES pressure, or stop the TLESR’s. Or any combination of the three. If an obese person with GERD loses a lot of weight, their intrabdominal pressure goes down and their GERD will very likely go away. This is one reason why obesity surgery cures GERD. If a person with GERD has a Nissen fundoplication, that will increase the resting LES pressure and splint its relaxations, and GERD is cured. If a person with GERD has a Stretta procedure, that will increase LES pressure, AND it will ablate afferent nerve fibers that contribute to TLESR’s, and the GERD is cured. Medical antisecretory treatment only decreases the amount of acid present in the stomach. It doesn’t stop the reflux. In fact, reflux still occurs, but the refluxate is highly alkaline. This alkaline reflux doesn’t cause symptoms, but still has the capacity to severely damage the esophagus over time (Barrett’s esophagus). Medical treatment may very well not do anything to lower the risk of esophageal cancer. As I have said before, symptom management with antisecretory medication may be entirely appropriate if it   a) controls the symptoms to the patient’s satisfaction, and     b) there is not evidence of  Barrett’s esophagus. HMc

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- Hide quoted text — Show quoted text – > Obesity is a very substantial contributing factor to GERD. Since obesity is > so rampantly epidemic here in the US, it’s not surprising that GERD is too. > Likewise, there is some correlation between lower incidence of GERD and > lower incidence of obesity in countries where the amount and type of food is > less obesity-inducing. > Diet does not cause GERD. GERD is caused by a dysfunctional lower esophageal > sphincter. That dysfunction causing reflux symptoms is exacerbated by the > increased intraabdominal pressure associated with obesity. > So, to the extent that diet contributes to obesity, GERD is indeed > diet -associated, and the classic American diet definitely makes it more > common in the US. > HMc

Thanks for the reply. I had not considered the link between obesity and Gerd as I am not overweight (probably closer to underweight) So what originally causes the lower esophageal sphincter to not function correctly? It seems strange to me that all of a sudden one’s LES can stop working correctly (as was the case with me…out of the blue one day a year ago) In my case, I am not overweight. I am realtively young(23). I do not smoke or drink. I never eat fast food, or fatty foods. I dont eat chocolate…or candy…etc The only meats that I eat are chicken and fish. but…I have had problems with stress in the past. Is it possible for stress alone  to cause the LES to not function correctly? thanks, Mark

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Does anyone have any info on what countries have what incidence rates for GERD (not sure if I am wording this correctly). I remember reading somewhere that in Africa for instance GERD is pretty rare… It would be interesting to take a look at countries where GERD is relatively rare, and see if the native diet has anything to do with it… Mark

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> Does anyone have any info on what countries have what incidence rates > for GERD (not sure if I am wording this correctly). I remember reading > somewhere that in Africa for instance GERD is pretty rare… > It would be interesting to take a look at countries where GERD is > relatively rare, and see if the native diet has anything to do with > it…

Obesity is a very substantial contributing factor to GERD. Since obesity is so rampantly epidemic here in the US, it’s not surprising that GERD is too. Likewise, there is some correlation between lower incidence of GERD and lower incidence of obesity in countries where the amount and type of food is less obesity-inducing. Diet does not cause GERD. GERD is caused by a dysfunctional lower esophageal sphincter. That dysfunction causing reflux symptoms is exacerbated by the increased intraabdominal pressure associated with obesity. So, to the extent that diet contributes to obesity, GERD is indeed diet -associated, and the classic American diet definitely makes it more common in the US. HMc

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