Nightly acid rebound with PPIs?

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Barnacle
New Member


Date Joined May 2009
Total Posts : 3
   Posted 5/27/2009 5:09 AM (GMT -6)   
This is my first post here and It may be a little long winded, so my apologies in advance. I'm writing this now after waking up from some nighttime reflux.

Up until a few months ago I was a pretty healthy 28 year old male. I needed to lose some weight, and had already begun to do so when my problems started. In fact, I had been eating healthy and exercising 6 days a week for 2.5 months right before my problems started.

Though I'd been eating healthy, I recently indulged this past St. Patrick's Day. I spent the day drinking, mostly on an empty stomach, and consumed a lot of alcohol, much of it containing caffeine, and then ended the night with basically half a sausage pizza. I know in retrospect how absolutely stupid this was, but I guess old habits die hard and although I'm getting older my attitude towards my health was still immature and I felt like I could handle anything.

The day after this drinking binge I was feeling fine, only slightly hungover, and I had a small bagel for breakfast with no problems. Later that day however I went out with my family to celebrate my brother's birthday at a steakhouse. I had a fairly large and greasy meal, salad, bread, burger, fried onions, and lots of caffeinated diet coke, and suddenly towards the end of the meal I began to feel faint and weak. I also began to shake and I lay down to avoid fainting. After an hour of feeling like I was going to die I went to the hospital. Gradually, after being in a seated position for a while, and then upright on the hospital bed, I began to feel somewhat better on my own. They ran blood tests and said they could find nothing wrong with me. They told me I was probably just dehydrated, gave me an IV, then sent me on my way.

Over the next few days I still felt sort of weak and tingly (numbness of the extremities, general fatigue, "heavy-headedness" etc.) but I was still under the impression I had just been dehydrated. Over the course of these few days I felt some improvement though. That was until, 4 days after the original incident, I had a meal that contained some jalapenos and hotsauce after which I immediately started to feel faint and weak again for the next day.

The one thing I can say is that I never really experienced a "burning" in my chest that I had heard was heartburn. I didn't know that irritating your stomach and esophagus could have such dire effects on your body as a whole and what it could really do to you. Being concerned that something was seriously wrong with me I went to a primary care physician and related my story to him.

This is where I began my experience with PPIs. My doctor handed me a prescription for 40mg Protonix to "settle my stomach down" and sent me on my way with no additional information. Though he didn't recommend any specific diet I took it upon myself to eat "bland", healthy foods during this time.

Flash forward 30 days. I no longer felt the faintness around eating meals but I did still feel overall crappy. Fatigue, dizziness, headaches, and some tingling. All in all I was feeling better than I had been, but still not "right" At this point my doctor recommended I go see a gastroenterologist to get an endoscopy. The Gastro I saw had an opening immediately to perform the procedure and I had my endoscopy done within a week. He checked by esophagus, stomach, and duodenum and took multiple biopsies from each location. When I returned to see him a week later he informed me that he found nothing wrong with me, aside from some very mild irritation, and that the biopsies all came back negative. I had honestly been hoping he would tell me that he HAD found something so I could find a way to fix it, the not knowing had me greatly concerned. In the end, he gave me a prescription for another 6 months of Protonix and told me "Take these for another 4 to 6 months and if you're feeling better by then you don't have to come back and see me". He handed me a chart of foods that was photocopied out of some book for treating IBS and sent me on my way.

One point I feel is crucial, he also told me I should be taking my Protonix in the morning first thing when I wake up. I had been taking it in the evening prior to him telling me to switch.

After feeling fairly steady for nearly a month (that is to say livable but still crappy) I gradually started to feel worse but with different symptoms. I began to wake up with a sour taste in my mouth and actually be wakened from sleep (and have trouble going back to sleep) with a sore throat. I've been strictly following a diet of easily digestible non-irritating foods while also trying to get all my essential vitamins and minerals. For about 30 days now I've been having nighttime reflux. I don't eat for at least 3 hours before bed, and when I do it's a small meal, I sleep on my left side, and I have been avoiding heavy exercise. Basically I've been doing everything that I've read is supposed to help reflux and yet I am getting reflux when I never had it before.


My suspicion is that I did a number on my stomach and esophagus that one day back in March and that if I knew then what I knew now about my digestive system I probably could have gently and naturally let what was likely a case of gastritis and heartburn heal through diet and lifestyle changes. However my anxiety and ignorance led me down the path of doctors and drugs who put me on a PPI without ever really knowing what my problem was. I've had some trouble and anxiety with my symptoms that have helped to confuse matters. For a couple weeks I had mid-abdominal cramps, lower-back pain and a whole different kind of awful feeling that nearly sent me back to the doctor.... until realized I hadn't had a BM in 4 days and that a daily calcium supplement and a lot of bananas and brown rice had just backed me up completely. Once I modified my diet a bit all these problems went away.

So now I come to the final part of my story, and my question, which again is being typed as I sit here after waking up from an episode of nighttime reflux.

Everywhere I read it says PPIs take time to take effect and that they stop acid production for 24 hours. However I've seen on these forums that many people are taking doses twice daily. Is it possible that switching my PPI intake to first thing in the morning actually causes me to reflux acid at night? Again, this nighttime reflux only appeared once I switched my PPI dose to the morning. Could the PPI actually be causing my reflux in the first place?

I am planning on trying to step down the PPI soon as I suspect that I did not need it in the first place and that it has actually caused me more problems than anything, but before I do I am going to attempt to switch my dose to nighttime and see if this helps. I just wanted to see if anyone here had experienced a similar problem if they skipped a nighttime dose of PPIs or if they switched the timing of their dose.

Thank you for reading (if you made it this far), and thanks in advance for any responses this may garner.

beareilly
Veteran Member


Date Joined Mar 2009
Total Posts : 553
   Posted 5/27/2009 6:15 AM (GMT -6)   
Hi & Welcome,
I suffered from Night time Gerd. Although,I had Gerd 24 hours a day,Gerd minus heartburn.It was prevalent in the night. I ate my biggest meal by 3pm and was on every med known to man. A few meds that I took,produced my activity to me and the doctor changed my meds. During all my endoscopes, he found that my LES was weak besides numerous other issues that lead me down the road to my surgery.LES was defective,which means it wasnt opening and closing correctly,Part of the reason my food would just wash right up my throat.I had the worst taste in my mouth for 3years straight. I can say that I am now GERD FREE!! Like I said earlier, I never experienced heartburn issues while having gerd, I had other defining issues,my esphagus closed 3times, sour taste, esphagitis,gastritis,BACKWASH!!!
I have since had surgery.If you go read the other posts here on the Gerd forum. It maybe of some help.
Have you tried pepcid? Pepcid AC? Its over the counter and it worked for me for a while.
Good luk
Bea

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7188
   Posted 5/27/2009 6:40 AM (GMT -6)   
Hi Barnacle,
Welcome. You've come to the right place. There are lots of members here who are experienced in the symptoms you're suffering from.

It's not uncommon to experience "silent GERD"--you've got reflux, but you don't feel the symptoms.

My doctor is a huge fan of taking your PPI dosage before dinnertime (I take 40mg Protonix at 5:30 nightly.) My GERD was not resolved by just one dose daily, so I was taking 40mg Protonix twice a day.

I would stay with the Protonix. I was on Prilosec and Nexium before switching to Protonix during a hospitalization due to GERD/asthma. I have found it to be more effective than others I was on. Unfortunately, my GERD was not resolved by PPI's...it was fine for the GERD...I could handle that. I did have some breakthrough, and would take TUMS and Maalox, but it was good enough to live with.

My problem was that the GERD was causing severe asthma symptoms. That's the reason I finally broke down and had the Nissen Fundoplication surgery. My doctor told me that my situation was life-threatening, and that I needed to get the surgery. I held off for about 4 years, and had it in February. I wish I had had it sooner.

I've got to run and get ready for work, but I'll try to post more in response to your questions this evening. Best wishes.
I've had long-lasting GERD flare ups that resolved after a few months. You will recover, and be able to eat normally again.
Keep the faith!
Denise

stkitt
Elite Member


Date Joined Apr 2007
Total Posts : 32602
   Posted 5/27/2009 7:36 AM (GMT -6)   
 
Good Morning and welcome to HealingWell.  I am glad to see you have already received great advice from several of our wonderful members.
 
I am on  Prilosec and I was taking it twice a day for awhile when I had a flair of  severe heartburn and reflux but now I take it once a day.  I take mine in the morning, however I think  Denise's physician has a good point ...........taking it before dinner time.  Something you may want to discuss with your physician.
 
Bea's suggestion to eat your last meal of the day earlier  also makes good sense if you are having reflux at night.
 
I hope you stick with us and know we are here for you.
 
Kitt
 

 
 

Kitt, Co-Moderator:
Anxiety/Panic, 
Depression,  & 
 
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zenyata
New Member


Date Joined Jan 2009
Total Posts : 7
   Posted 5/27/2009 6:27 PM (GMT -6)   
Barnacle -
 
I've been going through much the same situation as you've encountered.
 
I also recently had my PPI dosage increased to 40 mg (prilosec) taken as 20 mg twice per day.  My GI doc explained to me that while the pharma companies claim the drug will last 24 hrs it really should be "up to" 24 hrs. because 24 hr effectiveness tends to be a statistical outlier with most people seeing decreasing effectiveness in the 12 - 14 hr range.
 
As others have mentioned I am supposed to take mine at least 1/2 hr before breakfast and 1/2 hr before dinner.
 
Hope this helps.
 
-Z

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7188
   Posted 5/28/2009 5:22 AM (GMT -6)   
My doc concurred with Z's. Ideally it's a half hour before meals. The nighttime dose works better for someone experiencing reflux while sleeping. Laying down puts pressure on your LES, making it more likely to reflux. I agree with Z as well in that the PPI's definitely don't last 24 hours at the strength and effectiveness that they have for 12 hours.
I assume the head of your bed is raised, right? That's key.
Good luck to you!
Denise

Barnacle
New Member


Date Joined May 2009
Total Posts : 3
   Posted 5/28/2009 6:15 PM (GMT -6)   
Thanks for the responses. Though this is my first time posting I've been reading these forums for about a month and have found a great deal of useful advice. It also helps to know that there's other people going through similar issues and that I'm not alone.

As far as the head of my bed goes it's kinda off and on. I have severe difficulty sleeping in this position (raised the head of the bed by 8 inches with blocks) and the sleepless nights can be worse than the reflux. I have yet to try the wedge pillow but if my problems continue I may go that way.

Just a small sample of an update. I took my Protonix ~ 6 PM last night instead of first thing in the morning. Slept the whole night through and felt pretty good when I woke up in the morning. Just one night but it seems successful, hopefully this will continue.

SnowyLynne
Veteran Member


Date Joined Apr 2004
Total Posts : 1539
   Posted 5/28/2009 6:25 PM (GMT -6)   
Raise the head of your bed about 4 inches if you can,put bricks under the legs of the head of the bed.........
SnowyLynne


beareilly
Veteran Member


Date Joined Mar 2009
Total Posts : 553
   Posted 5/29/2009 10:28 AM (GMT -6)   
Barnacle,
 besides bricks you can buy a bed wedge.Its a wedged pillow and sleep on thta. Its like laying on a sliding pond or sumthing to that nature. I had no relief from the bricks and I had 4 bricks under each side of the headboard and I was using the wedge. Its like this ,if you LES isnt working there isnt anything that will halp it other then surgery.The food will continue to shoot ou or should i say bakwash.
Hope it helps for u
Bea
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