Aetna wants me to try protonix?
Question:
I’ve been on nexium .40 mg for 1 1/2 yrs now and its amazing.but now a new plan wants me to try a cheaper alternetive-protonix. Does anyone have experience with this?How similar/disimilar are they? Aetne wants to spend less, but will step me up only if protonix doesnt do a good job….thanks in advance…ED
Response:
> I’ve been on nexium .40 mg for 1 1/2 yrs now and its amazing.but now a > new plan wants me to try a cheaper alternetive-protonix. Does anyone > have experience with this?How similar/disimilar are they? > Aetne wants to spend less, but will step me up only if protonix doesnt > do a good job….thanks in advance…ED
It’s a common insurance company maneuver. All insurance companies negotiate deals with drug companies, and it sounds like Aetna just negotiated a better deal with Wyeth Pharmaceuticals than they had with Astra Zeneca. Protonix is fine. Different people respond to different medications differently. For some people, Nexium doesn’t work worth a damn and Protonix is their salvation. And the opposite is true too. Give the Protonix a try, see if it works ok for you. If not, your doctor will write a strongly worded letter to Aetna certifying that Protonix doesn’t work for you and you’ll get Nexium. Probably. HMc
Response:
> I’ve been on nexium .40 mg for 1 1/2 yrs now and its amazing.but now a > new plan wants me to try a cheaper alternetive-protonix. Does anyone > have experience with this?How similar/disimilar are they?
Ahh, welcome to modern prescription coverage. Due to changing carriers I had to move from prevacid->prilosec->protonix->nexium. For the most part, they’re the same, although the latter three seemed to work a bit better than prevacid for me, but everyone is different. Chances are, Protonix will treat you similarly to Nexium, but if it doesn’t work out, like Howard says you can usually get your doctor to talk to the insurance company and okay Nexium (but be prepared for a larger copay). Note that it’s worth checking out the OTC availability, since sometimes the OTC stuff can be cheaper than the prescription copay, although this widely varies (for a while I was taking Zantac, and OTC generic Zantac (ranitidine) from Walmart was *way* cheaper than my $15 copay at the time), since at least one proton pump inhibitor is on the market now (Prilosec OTC). But check with your doctor before doing any drastic changes… — Richard W Kaszeta http://www.kaszeta.org/rich
Response:
– Hide quoted text — Show quoted text -> I’ve been on nexium .40 mg for 1 1/2 yrs now and its amazing.but now a > new plan wants me to try a cheaper alternetive-protonix. Does anyone > have experience with this?How similar/disimilar are they? > Aetne wants to spend less, but will step me up only if protonix doesnt > do a good job….thanks in advance…ED > It’s a common insurance company maneuver. All insurance companies negotiate > deals with drug companies, and it sounds like Aetna just negotiated a better > deal with Wyeth Pharmaceuticals than they had with Astra Zeneca. > Protonix is fine. Different people respond to different medications > differently. For some people, Nexium doesn’t work worth a damn and Protonix > is their salvation. And the opposite is true too. > Give the Protonix a try, see if it works ok for you. If not, your doctor > will write a strongly worded letter to Aetna certifying that Protonix > doesn’t work for you and you’ll get Nexium. Probably. > HMc
Howard, I know that nexium and protonix are needed for alot of people. Isnt it some potent stuff though?
Response:
My prilosec seems to work fine for my acid but I still have stomach pain. Can’t wait for the endeoscopy. OH JOY!
– Hide quoted text — Show quoted text -> I’ve been on nexium .40 mg for 1 1/2 yrs now and its amazing.but now a > new plan wants me to try a cheaper alternetive-protonix. Does anyone > have experience with this?How similar/disimilar are they? > Ahh, welcome to modern prescription coverage. Due to changing > carriers I had to move from prevacid->prilosec->protonix->nexium. > For the most part, they’re the same, although the latter three seemed > to work a bit better than prevacid for me, but everyone is different. > Chances are, Protonix will treat you similarly to Nexium, but if it > doesn’t work out, like Howard says you can usually get your doctor to > talk to the insurance company and okay Nexium (but be prepared for a > larger copay). > Note that it’s worth checking out the OTC availability, since > sometimes the OTC stuff can be cheaper than the prescription copay, > although this widely varies (for a while I was taking Zantac, and OTC > generic Zantac (ranitidine) from Walmart was *way* cheaper than my $15 > copay at the time), since at least one proton pump inhibitor is on the > market now (Prilosec OTC). But check with your doctor before doing > any drastic changes… > — > Richard W Kaszeta > http://www.kaszeta.org/rich
Response:
– Hide quoted text — Show quoted text -> > I’ve been on nexium .40 mg for 1 1/2 yrs now and its amazing.but now a > > new plan wants me to try a cheaper alternetive-protonix. Does anyone > > have experience with this?How similar/disimilar are they? > > Aetne wants to spend less, but will step me up only if protonix doesnt > > do a good job….thanks in advance…ED > It’s a common insurance company maneuver. All insurance companies > negotiate > deals with drug companies, and it sounds like Aetna just negotiated a > better > deal with Wyeth Pharmaceuticals than they had with Astra Zeneca. > Protonix is fine. Different people respond to different medications > differently. For some people, Nexium doesn’t work worth a damn and > Protonix > is their salvation. And the opposite is true too. > Give the Protonix a try, see if it works ok for you. If not, your doctor > will write a strongly worded letter to Aetna certifying that Protonix > doesn’t work for you and you’ll get Nexium. Probably. > HMc > Howard, I know that nexium and protonix are needed for alot of people. Isnt > it some potent stuff though?
The entire class of drugs, proton pump inhibitors, is VERY effective at controlling stomach acid output. HMc
Response:
– Hide quoted text — Show quoted text -> > > I’ve been on nexium .40 mg for 1 1/2 yrs now and its amazing.but now a > > > new plan wants me to try a cheaper alternetive-protonix. Does anyone > > > have experience with this?How similar/disimilar are they? > > > Aetne wants to spend less, but will step me up only if protonix doesnt > > > do a good job….thanks in advance…ED > > It’s a common insurance company maneuver. All insurance companies > negotiate > > deals with drug companies, and it sounds like Aetna just negotiated a > better > > deal with Wyeth Pharmaceuticals than they had with Astra Zeneca. > > Protonix is fine. Different people respond to different medications > > differently. For some people, Nexium doesn’t work worth a damn and > Protonix > > is their salvation. And the opposite is true too. > > Give the Protonix a try, see if it works ok for you. If not, your doctor > > will write a strongly worded letter to Aetna certifying that Protonix > > doesn’t work for you and you’ll get Nexium. Probably. > > HMc > Howard, I know that nexium and protonix are needed for alot of people. > Isnt > it some potent stuff though? > The entire class of drugs, proton pump inhibitors, is VERY effective at > controlling stomach acid output. > HMc
I bet but can it be good for long term use? Can it damage the system ever if used to long?
Response:
> The entire class of drugs, proton pump inhibitors, is VERY effective at > controlling stomach acid output. > HMc > I bet but can it be good for long term use? Can it damage the system ever if > used to long?
When the class first came out (Losec — now Prilosec), it was only FDA approved for short term use as there was speculation (and no long term data) that it would increase the risk of stomach cancer. It has long been known that no stomach acid would result in higher levels of circulating gastrin because it’s acid that determines gastrin output via negative feedback. In other words, gastrin stimulates acid output and acid controls gastrin levels. So, if there is too much acid, there is no gastrin, and if there is too little acid, there is lots of gastrin. If you take these anti-acid drugs, you will have high circulating levels of gastrin. Gastrin is a trophic hormone — it stimulates the stomach lining and the speculation was that that constant stimulation would increase the risk of stomach cancer. This has not been shown to be the case, and the FDA has approved PPIs for long term use. I have seen multiple polyps in the stomach many times in patients who have been on long term proton pump inhibitors, but biopsies always show little or no malignant potential, as far as we know. It IS speculated that the use of anti acid medications such as H2 receptor antagonists and PPIs increases the risk of esophageal cancer. The use of these medications alkalinizes the stomach, changing the pH and allowing bile salts to come out of solution. These bile salts are highly irritating to the lining of the lower esphagus, but don’t cause the severe symptoms that acid causes. So even though a person’s heartburn symptoms go away, their risk of esophageal cancer actually increases. The point is that these medications don’t do anything to stop the reflux, they only change the character of the refluxate, and although there are fewer symptoms, the esophageal changes of Barrett’s esophagus (and it’s attendant cancer risk) actually progress more rapidly. The incidence of esophageal cancer has been increasing rapidly over the last 35 years, and the graphs coincide exactly with the discovery and increasing use of anti-secretory medications. The use of these medications only stops the SYMPTOMS of GERD, but doesn’t actually stop the reflux. Managing the symptoms might be appropriate if there is no evidence of Barrett’s esophagus on EGD, but ongoing surveillance is important because of the increased risk of esophageal cancer. HMc
Response:
Two questions. 1 Are polyps caused by propton pump inhibitors lessening the acid content of the stomach? 2 "Stomach Pain" is listed as one of the side effects of proton pump inhibitors, how does a patient know if his pain is caused by the drug instead of his ulcer or other problem? Derek.
– Hide quoted text — Show quoted text -> > The entire class of drugs, proton pump inhibitors, is VERY effective at > > controlling stomach acid output. > > HMc > I bet but can it be good for long term use? Can it damage the system ever > if > used to long? > When the class first came out (Losec — now Prilosec), it was only FDA > approved for short term use as there was speculation (and no long term data) > that it would increase the risk of stomach cancer. It has long been known > that no stomach acid would result in higher levels of circulating gastrin > because it’s acid that determines gastrin output via negative feedback. In > other words, gastrin stimulates acid output and acid controls gastrin > levels. So, if there is too much acid, there is no gastrin, and if there is > too little acid, there is lots of gastrin. If you take these anti-acid > drugs, you will have high circulating levels of gastrin. > Gastrin is a trophic hormone — it stimulates the stomach lining and the > speculation was that that constant stimulation would increase the risk of > stomach cancer. This has not been shown to be the case, and the FDA has > approved PPIs for long term use. I have seen multiple polyps in the stomach > many times in patients who have been on long term proton pump inhibitors, > but biopsies always show little or no malignant potential, as far as we > know. > It IS speculated that the use of anti acid medications such as H2 receptor > antagonists and PPIs increases the risk of esophageal cancer. The use of > these medications alkalinizes the stomach, changing the pH and allowing > bile salts to come out of solution. These bile salts are highly irritating > to the lining of the lower esphagus, but don’t cause the severe symptoms > that acid causes. So even though a person’s heartburn symptoms go away, > their risk of esophageal cancer actually increases. The point is that these > medications don’t do anything to stop the reflux, they only change the > character of the refluxate, and although there are fewer symptoms, the > esophageal changes of Barrett’s esophagus (and it’s attendant cancer risk) > actually progress more rapidly. The incidence of esophageal cancer has been > increasing rapidly over the last 35 years, and the graphs coincide exactly > with the discovery and increasing use of anti-secretory medications. > The use of these medications only stops the SYMPTOMS of GERD, but doesn’t > actually stop the reflux. Managing the symptoms might be appropriate if > there is no evidence of Barrett’s esophagus on EGD, but ongoing surveillance > is important because of the increased risk of esophageal cancer. > HMc
Response:
> Two questions. > 1 Are polyps caused by propton pump inhibitors lessening the acid content of > the stomach? > 2 "Stomach Pain" is listed as one of the side effects of proton pump > inhibitors, how does a patient know if his pain is caused by the drug > instead of his ulcer or other problem? > Derek.
1. Yes. The decreased stomach acid results in higher circulating gastrin, which stimulates the polyp growth in stomach lining. 2. It’s not classified as "stomach" pain, but as "abdominal" pain. Usually it is cramping in the small intestine or in the colon. One would sort it out by the nature of the pain, or ultimately by EGD if it could not be diagnosed clinically. HMc
Response:
> Two questions. > 1 Are polyps caused by propton pump inhibitors lessening the acid content > of > the stomach? > 2 "Stomach Pain" is listed as one of the side effects of proton pump > inhibitors, how does a patient know if his pain is caused by the drug > instead of his ulcer or other problem? > Derek. > 1. Yes. The decreased stomach acid results in higher circulating gastrin, > which stimulates the polyp growth in stomach lining.
What is polyp growth? – Hide quoted text — Show quoted text -> 2. It’s not classified as "stomach" pain, but as "abdominal" pain. Usually > it is cramping in the small intestine or in the colon. One would sort it out > by the nature of the pain, or ultimately by EGD if it could not be diagnosed > clinically. > HMc
Response:
– Hide quoted text — Show quoted text -> > Two questions. > > 1 Are polyps caused by propton pump inhibitors lessening the acid > content > of > > the stomach? > > 2 "Stomach Pain" is listed as one of the side effects of proton pump > > inhibitors, how does a patient know if his pain is caused by the drug > > instead of his ulcer or other problem? > > Derek. > 1. Yes. The decreased stomach acid results in higher circulating gastrin, > which stimulates the polyp growth in stomach lining. > What is polyp growth?
Something that grows in dark, moist places and looks like a mushroom. Derek
Response:
> What is polyp growth?
Google. Or, look at http://www.endoskopischer-atlas.de/m18e.htm and at http://tinyurl.com/rgcx . In fact, look at this guy’s whole site, it’s pretty good http://tinyurl.com/rgd1 HMc
Response:
- Hide quoted text — Show quoted text -> > The entire class of drugs, proton pump inhibitors, is VERY effective at > > controlling stomach acid output. > > HMc > I bet but can it be good for long term use? Can it damage the system ever > if > used to long? > When the class first came out (Losec — now Prilosec), it was only FDA > approved for short term use as there was speculation (and no long term data) > that it would increase the risk of stomach cancer. It has long been known > that no stomach acid would result in higher levels of circulating gastrin > because it’s acid that determines gastrin output via negative feedback. In > other words, gastrin stimulates acid output and acid controls gastrin > levels. So, if there is too much acid, there is no gastrin, and if there is > too little acid, there is lots of gastrin. If you take these anti-acid > drugs, you will have high circulating levels of gastrin. > Gastrin is a trophic hormone — it stimulates the stomach lining and the > speculation was that that constant stimulation would increase the risk of > stomach cancer. This has not been shown to be the case, and the FDA has > approved PPIs for long term use. I have seen multiple polyps in the stomach > many times in patients who have been on long term proton pump inhibitors, > but biopsies always show little or no malignant potential, as far as we > know. > It IS speculated that the use of anti acid medications such as H2 receptor > antagonists and PPIs increases the risk of esophageal cancer. The use of > these medications alkalinizes the stomach, changing the pH and allowing > bile salts to come out of solution. These bile salts are highly irritating > to the lining of the lower esphagus, but don’t cause the severe symptoms > that acid causes. So even though a person’s heartburn symptoms go away, > their risk of esophageal cancer actually increases. The point is that these > medications don’t do anything to stop the reflux, they only change the > character of the refluxate, and although there are fewer symptoms, the > esophageal changes of Barrett’s esophagus (and it’s attendant cancer risk) > actually progress more rapidly. The incidence of esophageal cancer has been > increasing rapidly over the last 35 years, and the graphs coincide exactly > with the discovery and increasing use of anti-secretory medications. > The use of these medications only stops the SYMPTOMS of GERD, but doesn’t > actually stop the reflux. Managing the symptoms might be appropriate if > there is no evidence of Barrett’s esophagus on EGD, but ongoing surveillance > is important because of the increased risk of esophageal cancer. > HMc
OH MY! OH MY! WHAT TO DO! I am so confused. I am taking Protonix so I don’t have acid reflux so I don’t get esophegeal cancer and long term use will likely CAUSE the cancer. What do you suggest people with this chronic problem do exactly? This is really perplexing. I’d rather take no meds if given a choice. Please tell me what to do here as I have been on Protonix for several years and am only 47. I love my life and want to keep on livin it! ( : Is there anything that will actually stop the reflux…diet, etc.?
Response:
– Hide quoted text — Show quoted text -> What is polyp growth? > Google. > Or, look at http://www.endoskopischer-atlas.de/m18e.htm > and at > http://tinyurl.com/rgcx . In fact, look at this guy’s whole site, it’s > pretty good http://tinyurl.com/rgd1 > HMc
Yuck!
Response:
– Hide quoted text — Show quoted text -> > > The entire class of drugs, proton pump inhibitors, is VERY effective at > > > controlling stomach acid output. > > > HMc > > I bet but can it be good for long term use? Can it damage the system ever > if > > used to long? > When the class first came out (Losec — now Prilosec), it was only FDA > approved for short term use as there was speculation (and no long term data) > that it would increase the risk of stomach cancer. It has long been known > that no stomach acid would result in higher levels of circulating gastrin > because it’s acid that determines gastrin output via negative feedback. In > other words, gastrin stimulates acid output and acid controls gastrin > levels. So, if there is too much acid, there is no gastrin, and if there is > too little acid, there is lots of gastrin. If you take these anti-acid > drugs, you will have high circulating levels of gastrin. > Gastrin is a trophic hormone — it stimulates the stomach lining and the > speculation was that that constant stimulation would increase the risk of > stomach cancer. This has not been shown to be the case, and the FDA has > approved PPIs for long term use. I have seen multiple polyps in the stomach > many times in patients who have been on long term proton pump inhibitors, > but biopsies always show little or no malignant potential, as far as we > know. > It IS speculated that the use of anti acid medications such as H2 receptor > antagonists and PPIs increases the risk of esophageal cancer. The use of > these medications alkalinizes the stomach, changing the pH and allowing > bile salts to come out of solution. These bile salts are highly irritating > to the lining of the lower esphagus, but don’t cause the severe symptoms > that acid causes. So even though a person’s heartburn symptoms go away, > their risk of esophageal cancer actually increases. The point is that these > medications don’t do anything to stop the reflux, they only change the > character of the refluxate, and although there are fewer symptoms, the > esophageal changes of Barrett’s esophagus (and it’s attendant cancer risk) > actually progress more rapidly. The incidence of esophageal cancer has been > increasing rapidly over the last 35 years, and the graphs coincide exactly > with the discovery and increasing use of anti-secretory medications. > The use of these medications only stops the SYMPTOMS of GERD, but doesn’t > actually stop the reflux. Managing the symptoms might be appropriate if > there is no evidence of Barrett’s esophagus on EGD, but ongoing surveillance > is important because of the increased risk of esophageal cancer. > HMc > OH MY! OH MY! WHAT TO DO! I am so confused. I am taking Protonix so > I don’t have acid reflux so I don’t get esophegeal cancer and long > term use will likely CAUSE the cancer. What do you suggest people > with this chronic problem do exactly? This is really perplexing. I’d > rather take no meds if given a choice. Please tell me what to do here > as I have been on Protonix for several years and am only 47. I love > my life and want to keep on livin it! ( : Is there anything that > will actually stop the reflux…diet, etc.?
I confess that the relationship of long term anti-secretory medication to esophageal cancer is a little controversial in the medical world, but the mounting evidence is compelling. The situation is not dissimilar to the relationship of smoking to lung cancer. Many physicians fought the concept that those two things might be related for many years. The base reasons are the same — chronic irritation of the bronchial tree and chronic irritation of the lower esophagus. Personally, I think the evidence supporting the relationship of anti-secretory medication to Barrett’s esophagus and esophageal cancer is compelling as do the majority of physicians that deal with these issues on a daily basis. You may remember an advertising campaign by RJ Reynolds Tobacco in the 50s that featured TV and print ads focused on doctors smoking cigarrettes while relaxing. You are unlikely to see those ads again anytime soon. If your symptoms are under good control ie. medication, lifestyle changes, and watching your diet are controlling your reflux symptoms to your satisfaction, then nothing needs to be done UNLESS your EGD shows evidence of esophageal damage from the reflux. If you have an EGD which shows inflammation, stricture, or Barrett’s esophagus, then it is time to consider surgical intervention. Chronic relux sufferers need to have periodic EGD to evaluate the lower esophagus. Every 2-4 years depending on findings. If you haven’t had one, you need one. Medication and lifestyle changes only control the SYMPTOMS of reflux. Those things do nothing to address the CAUSE of the relux, that being dysfunction of the lower esophageal sphincter. The only way reflux can be stopped is with surgery. State-of-the-art in that regard is either a Nissen laparoscopic gastric fundoplication (look at http://tinyurl.com/rkvi ) or the Stretta procedure (look at http://tinyurl.com/rkvn ). Both are, or can be, effective anti-reflux treatments that can CURE acid reflux, not just manage the symptoms. HMc
Response:
howard! you are such a wealth of knowledge and so wonderful to give of your time so freely here. i would love your take on this situation. by the way i am waiting for my appointment with a gastro….can’t get in until nov. 25th. i know it’s a long wait but my internist and i agree that there is no crisis here and he is the one i want to see. i have been on protonix off and on for a couple of years and have never treated my reflux very seriously until recently. it seems that when my diet gets crazy i start thinking the protonix isn’t working and have twice tried other drugs. i had the same result with nexium and prilosec. after a couple days i was elated. it seemed that i could have my margaritas and mexican food and get by with no acid reflux. i felt like a criminal getting by with the crime. well, within about 7-10 days i would feel like there was a big lump in my diaphram and that i couldn’t belch to save my life. it was like there was no digestion going on whatsoever. the feeling was worse to me than the actual acid reflux and pain/pressure i had experienced in the past. once i would stop the new drug, that problem would resolve within a couple of days and i would get back on the protonix. i am now diligently keeping a food diary and being very good about my diet. i am losing weight because i am eating smaller portions. i have also elevated my bed. things are soooo much better now. i am just curious if you have heard of others having that experience with those meds? thanks again for sharing your time and knowledge with all of us here….guess we are all a mess!
Response:
– Hide quoted text — Show quoted text -> > > > The entire class of drugs, proton pump inhibitors, is VERY effective > at > > > > controlling stomach acid output. > > > > HMc > > > I bet but can it be good for long term use? Can it damage the system > ever > > if > > > used to long? > > When the class first came out (Losec — now Prilosec), it was only FDA > > approved for short term use as there was speculation (and no long term > data) > > that it would increase the risk of stomach cancer. It has long been > known > > that no stomach acid would result in higher levels of circulating > gastrin > > because it’s acid that determines gastrin output via negative feedback. > In > > other words, gastrin stimulates acid output and acid controls gastrin > > levels. So, if there is too much acid, there is no gastrin, and if there > is > > too little acid, there is lots of gastrin. If you take these anti-acid > > drugs, you will have high circulating levels of gastrin. > > Gastrin is a trophic hormone — it stimulates the stomach lining and the > > speculation was that that constant stimulation would increase the risk > of > > stomach cancer. This has not been shown to be the case, and the FDA has > > approved PPIs for long term use. I have seen multiple polyps in the > stomach > > many times in patients who have been on long term proton pump > inhibitors, > > but biopsies always show little or no malignant potential, as far as we > > know. > > It IS speculated that the use of anti acid medications such as H2 > receptor > > antagonists and PPIs increases the risk of esophageal cancer. The use of > > these medications alkalinizes the stomach, changing the pH and allowing > > bile salts to come out of solution. These bile salts are highly > irritating > > to the lining of the lower esphagus, but don’t cause the severe symptoms > > that acid causes. So even though a person’s heartburn symptoms go away, > > their risk of esophageal cancer actually increases. The point is that > these > > medications don’t do anything to stop the reflux, they only change the > > character of the refluxate, and although there are fewer symptoms, the > > esophageal changes of Barrett’s esophagus (and it’s attendant cancer > risk) > > actually progress more rapidly. The incidence of esophageal cancer has > been > > increasing rapidly over the last 35 years, and the graphs coincide > exactly > > with the discovery and increasing use of anti-secretory medications. > > The use of these medications only stops the SYMPTOMS of GERD, but > doesn’t > > actually stop the reflux. Managing the symptoms might be appropriate if > > there is no evidence of Barrett’s esophagus on EGD, but ongoing > surveillance > > is important because of the increased risk of esophageal cancer. > > HMc > OH MY! OH MY! WHAT TO DO! I am so confused. I am taking Protonix so > I don’t have acid reflux so I don’t get esophegeal cancer and long > term use will likely CAUSE the cancer. What do you suggest people > with this chronic problem do exactly? This is really perplexing. I’d > rather take no meds if given a choice. Please tell me what to do here > as I have been on Protonix for several years and am only 47. I love > my life and want to keep on livin it! ( : Is there anything that > will actually stop the reflux…diet, etc.? > I confess that the relationship of long term anti-secretory medication to > esophageal cancer is a little controversial in the medical world, but the > mounting evidence is compelling. The situation is not dissimilar to the > relationship of smoking to lung cancer. Many physicians fought the concept > that those two things might be related for many years. The base reasons are > the same — chronic irritation of the bronchial tree and chronic irritation > of the lower esophagus. Personally, I think the evidence supporting the > relationship of anti-secretory medication to Barrett’s esophagus and > esophageal cancer is compelling as do the majority of physicians that deal > with these issues on a daily basis. You may remember an advertising campaign > by RJ Reynolds Tobacco in the 50s that featured TV and print ads focused on > doctors smoking cigarrettes while relaxing. You are unlikely to see those > ads again anytime soon. > If your symptoms are under good control ie. medication, lifestyle changes, > and watching your diet are controlling your reflux symptoms to your > satisfaction, then nothing needs to be done UNLESS your EGD shows evidence > of esophageal damage from the reflux. If you have an EGD which shows > inflammation, stricture, or Barrett’s esophagus, then it is time to consider > surgical intervention. > Chronic relux sufferers need to have periodic EGD to evaluate the lower > esophagus. Every 2-4 years depending on findings. If you haven’t had one, > you need one. > Medication and lifestyle changes only control the SYMPTOMS of reflux. Those > things do nothing to address the CAUSE of the relux, that being dysfunction > of the lower esophageal sphincter. The only way reflux can be stopped is > with surgery. State-of-the-art in that regard is either a Nissen > laparoscopic gastric fundoplication (look at http://tinyurl.com/rkvi ) or > the Stretta procedure (look at http://tinyurl.com/rkvn ). Both are, or can > be, effective anti-reflux treatments that can CURE acid reflux, not just > manage the symptoms. > HMc
I would like to add to this Howard with your aproval. A healthy diet itself can decrease chances of cancer with the right amount of antioxidents and greens as well correct?
Response:
– Hide quoted text — Show quoted text -> howard! you are such a wealth of knowledge and so wonderful to give > of your time so freely here. i would love your take on this > situation. by the way i am waiting for my appointment with a > gastro….can’t get in until nov. 25th. i know it’s a long wait but > my internist and i agree that there is no crisis here and he is the > one i want to see. i have been on protonix off and on for a couple of > years and have never treated my reflux very seriously until recently. > it seems that when my diet gets crazy i start thinking the protonix > isn’t working and have twice tried other drugs. i had the same result > with nexium and prilosec. after a couple days i was elated. it > seemed that i could have my margaritas and mexican food and get by > with no acid reflux. i felt like a criminal getting by with the > crime. well, within about 7-10 days i would feel like there was a big > lump in my diaphram and that i couldn’t belch to save my life. it was > like there was no digestion going on whatsoever. the feeling was > worse to me than the actual acid reflux and pain/pressure i had > experienced in the past. once i would stop the new drug, that problem > would resolve within a couple of days and i would get back on the > protonix. i am now diligently keeping a food diary and being very > good about my diet. i am losing weight because i am eating smaller > portions. i have also elevated my bed. things are soooo much better > now. i am just curious if you have heard of others having that > experience with those meds? thanks again for sharing your time and > knowledge with all of us here….guess we are all a mess!
I have seen people respond and not respond to virtually all of the anti-secretory medications on the market. Some of those medications work great for some people and not for others. Some people who have had such meds work well for years stop responding. The reasons for this are variable and speculative. They appear to relate to changing function of the lower esophageal sphincter. As I said previously, anti-secretory medication doesn’t affect the LES, only the amount of acid available for reflux. And this can vary during the course of a day. Prilosec blood levels can change during the day and if you take it once in the morning as typically recommended, the blood levels may be low in the evening. Nexium is basically the same drug as Prilosec, but with different absorption and release so it supposedly maintains higher blood levels over a 24 hour period. I have seen this to be *generally* true, but certainly not *universally* for example. The key point is that medication and lifestyle changes are the way to go as long as they are controlling your symptoms to your satisfaction AND as long as their is no progression of damage to the lower esophagus (esophagitis, stricture, Barrett’s). If lifestyle changes and medications AREN’T controlling your symptoms to the point where you can live with it, or if there IS evidence on EGD of esophagitis, stricture, Barrett’s, then it’s time to consider surgery. Surgery for GERD is remarkably effective, but like all surgery should only be done if there is no other way to address the issue safely and effectively. I cannot emphasize enough that long term GERD patients need a screening EGD to evaluate for reflux damage because of the very well-defined relationship of esophageal cancer to reflux. Barrett’s esophagus is readily discernable on EGD. HMc
Response:
> I would like to add to this Howard with your aproval. A healthy diet itself > can decrease chances of cancer with the right amount of antioxidents and > greens as well correct?
Doug, there is no question that a healthy diet is an important aspect of long term health, but there are huge variations within that "healthy diet" label. The theory of anti-oxidants and free-radical scavenging relative to cancer and heart disease is very interesting and is borne of some interesting lab work. However, it has never been shown in practice in randomized double-blind studies to be significant. One problem is the bioavaliability of the various anti-oxidants. These things are not closely monitored by the FDA as prescription drugs and there is a huge variability in quality, ranging from good bioavailability to outright scam. I believe that the key to many human ailments lays in free-radical scavenging, but we aren’t there yet. So far, there has been nothing in the anti-oxidant arena that has been shown to be effective, even though the science behind the theory is interesting, and may hold some promise. Just my opinion…. HMc
