An introduction and questions on PPI rebound

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flyer99
New Member


Date Joined Jul 2007
Total Posts : 8
   Posted 2/15/2010 9:50 AM (GMT -6)   
Hi all,
 
I am a mid-50's male and have been taking a PPI for more years than I can remember for acid reflux. I started out on something I can't remember, then switched to Prevacid and now I am on Losec (omeprazole). My normal dosage is one 20 mg tab/day.
 
However, back last October I had immense stress and anxiety issues (I also have anxiety disorder) and had to see an "on call" GP as my stomach was bloated, gassy, uncomfortable with no specific pains anywhere. She attributed this to increased acid due to stress and suggested I double my omeprazole dosage.
 
I did that and began to feel better and went back to my original one pill/day after about a week. I brought all this up with my regular GP in mid-November and he agreed with all the stress issues I was having that increased acid was the culprit for my stomach problems. By the end of November, the problems returned and I happened to see the same "on-call" GP that I had seen a month before. She said to again double my dosage of omeprazole but this time to take this double dosage for at least 4 weeks and to see what happens.
 
I did this, but the problems persisted. I even saw a psychologist I knew in mid-December to help me with the stress issues and to get some tips in relaxation. I started to feel really back to normal toward the end of January. So much so that I started dropping the omeprazole back to 20 mg/day every second day. Then I dropped it still further and only took 40 mg every third day, etc.
 
I saw my regular GP on February 11 for a followup and described my issues (I still have stress issues) and he recommended that I have a colonoscopy and refered me to a GI specialist. It's strange that he wouldn't have recommended an endoscopy first, but, oh well...
 
A couple of days after seeing him my stomach problems returned. I couldn't figure out why - I was doing so well. I reseached this forum and read about rebound issues when withdrawing from a PPI. I guess it's called rebound acid hypersecretion. I think I may have cut back on the omeprazole too quickly. I'm now back on 40 mg/day hoping that this resolves my stomach issues.
 
It is so difficult to wake up in the morning with this ugly acid taste in my mouth even though I sleep in an inclined position. And to walk around all day with this uncomfortable, gassy feeling doesn't make for happy days.
 
I am sorry for the long post and I have a few questions:
 
(1) Could my problems stem from H. pylori bacteria? No GP has even mentioned this as a possible cause. Can't tests be done for this?
 
(2) Why, all of a sudden, a referral for a colonoscopy. This seemed to come right out of the blue?
 
(3) Could this be a rebound issue with the omeprazole, and if so, does this mean that I'm stuck with 40 mg/day for ever?
 
I turn to your wisdom and hope that you can put me on the right track. Perhaps you can suggest some things to ask my GP or GI specialist (whenever I get to see him)?
 
Thanks so very much for allowing me to post this!
 
Bob.
 

Post Edited (flyer99) : 2/15/2010 8:58:37 AM (GMT-7)


couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 2/15/2010 11:27 AM (GMT -6)   
Welcome to HW,
Here are some possible answers.

(1) Could my problems stem from H. pylori bacteria? No GP has even mentioned this as a possible cause. Can't tests be done for this?

Yes, there is a test for this. Ask your regular GI about doing this.

(2) Why, all of a sudden, a referral for a colonoscopy. This seemed to come right out of the blue?

It was probably because you complain of gassiness.

(3) Could this be a rebound issue with the omeprazole, and if so, does this mean that I'm stuck with 40 mg/day for ever?

I worked though rebound with Nexium after my surgery. start by going six days on and one day off. After awhile, go to five on/two off, four on/three off, etc....

You mention having acid in your mouth when you wake up. Discuss with your doctor about having endoscopy, barium swallow, Ph test, and a momometry test. These will let you know if you need to say on the meds or have surgery.

Joy

flyer99
New Member


Date Joined Jul 2007
Total Posts : 8
   Posted 2/18/2010 11:30 AM (GMT -6)   
Thank you so much for your response, Joy.
 
I will pose this question to you and others as well. Why wouldn't my family doctor refer me to a GI specialist first and let him/her decide (after meeting with me) his/her course of action regarding tests and so on. Would not the GI specialist want to be aware of all symptoms and possible treatments prior to ordering tests.
 
I just don't understand this. I would like to meet with the GI specialist and discuss things with him/her before proceeding with any types of tests.
 
Does this make sense or am I way off here?
 
Thanks so much!

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 2/18/2010 6:44 PM (GMT -6)   
You can ask for a referal from your doctor. My insurance allows me to go to any doctor I choose without a referal.
The GI doctor would be the one to order the test for you.

Joy

Marburg
Regular Member


Date Joined Mar 2006
Total Posts : 493
   Posted 2/19/2010 1:25 PM (GMT -6)   
Here's my 2 cents.
1) There are several tests for H. Pylori. The one most often done in a doctor's office is a blood test. This only checks for antibodies and will not tell you if you have an active infection. There is an endoscope with biopsy of any inflamed areas (more accurate) and will tell if you have an active infection but they could also miss the bacteria if it isn't in the sample. There is a colonscopy with samples or a stool test which will also tell if you have an active infection.

2) The doctor probably referred you for the colonscopy because of the gas complaints. Gas most often stems from the colon which the endoscope can not reach. It is a preventive test and is normally recommended in people after age 50. A lot of GI specialists also do colonscopy tests (mine does).

3) Yes, it could be rebound issues. Some of us will always be on PPI's and some will not depending on how your body reacts.

flyer99
New Member


Date Joined Jul 2007
Total Posts : 8
   Posted 2/19/2010 4:57 PM (GMT -6)   
Thanks. I would prefer to talk all of this over with the GI specialist prior to any tests. He is the man that should know all about this area. However, being in Canada it will probably take a few months just to get to see the specialist anyway. I had an EMG test last year via a referral to a neurologist and I waited one year almost to the day for the test. Here you have to have a referral to see a specialist - no option. Thanks for the replies... they are very helpful!

Post Edited (flyer99) : 2/19/2010 4:01:47 PM (GMT-7)


azgringo
New Member


Date Joined Feb 2010
Total Posts : 3
   Posted 2/20/2010 6:35 PM (GMT -6)   
Flyer --

Regarding PPI's and rebound: Rebound is very common when discontinuing PPI's. Rebound can last 1 to 3 months and can be managed using OTC antacids and H2 blockers. It takes a long time for your stomach to adjust back to normal levels. I, too, am trying to stop taking omeprazole 20 mg tab and am having horrible rebound! I'm taking otc Pepcid AC 20 mg to fend off the rebound.

As for your bloating, gas, etc... A new study that just came out linked long-term PPI use to Small Intestine Bacteria Overgrowth (SIBO.) SIBO causes gas, bloating, abdominal discomfort and diahrreah.
http://ibs.about.com/b/2010/02/10/sibo-following-ppi-therapy.htm
In fact, 50% of long-term (average of 3 years) PPI users tested positive for SIBO. You might want to consider asking your GP for an HBT (hydrogen breath test.) This test isn't 100% accurate (60% is average.) However, if SIBO is diagnosed, it is treated with a high dose broad-spectrum antibiotic.

Best of luck to you!

flyer99
New Member


Date Joined Jul 2007
Total Posts : 8
   Posted 2/20/2010 8:25 PM (GMT -6)   
Azgringo,

Thanks so much for your post. I read the article provided by your link and it was really interesting. I am going to print this off and show it to either my family doctor or GI specialist (whoever I can see first) along with information on the urea breath test (UBT) for h.pylori. I have a suspicion that my problem could be (at least partially) diagnosed with something as simple as these breath tests. Again, thank you so much for posting this. I had no knowledge of SIBO.
 
Edited: Interesting, I did some more reading on the breath tests and it mentions that you must cut out all PPI's (like omeprazole) that you are taking two weeks before the tests (a few sites say one week). My stomach will go crazy if I have to cut out my omeprazole "cold turkey) for two weeks... I have been taking it for years.

Post Edited (flyer99) : 2/20/2010 8:00:12 PM (GMT-7)


dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 2/20/2010 9:50 PM (GMT -6)   
Hi Flyer,
Yes, going off PPI's for tests can be a real challenge for those of us with reflux. It's a dreaded situation, but a necessary one sometimes. Your first step needs to be a visit to the GI doc. He/she will order whatever tests are necessary to diagnose what's going on with you. For some of the time you'll be off PPI's you can take antacids. Drinking water helps soothe my burn when I'm going through it.

It's possible that you could get some rebound, but if you're still on the 20mg, it's unlikely. It's when you go off all PPI's that you have problems.

Whatever your symptoms were that brought you to an increase in dosage very likely are causing your problems when you try to go off. You don't have to worry about being on a higher dosage for the time being. Many, many people have taken that level of PPI dosage for years. As you wait for your GI doc, the higher dosage may help keep symptoms at bay. I wouldn't recommend trying to reduce your dosage until you find out what's going on.

As for bacteria overgrowth and the symptoms connected...it's the first I've hard of that. While I'm sure it can happen to some, I've been on that level of meds for many years with no symptoms whatsoever.

Good luck finding an answer to your questions. Hopefully you'll get to see a GI doc soon.
Glad you've joined us! Let us know what happens. We'll be here cheering for your speedy recovery! yeah yeah yeah yeah yeah
Denise

petunia22
Regular Member


Date Joined Sep 2008
Total Posts : 48
   Posted 2/21/2010 7:24 AM (GMT -6)   
Bob,
What kind of diet are you eating? Some have had success with GERD problems by changing to a very low carb diet, as described in Heartburn Cured by Norm Robillard. It's the only way I got off Nexium ( along with a few herbal remedies to help with the rebound hyperacidity)
Especially important is eliminating white flour and sugar.
Wishing you the best of luck.

flyer99
New Member


Date Joined Jul 2007
Total Posts : 8
   Posted 2/21/2010 8:26 AM (GMT -6)   
Thank you Denise and thank you petunia22.

Denise, yes I would like to visit my GI doc and let him decide a course of action for me rather than my family doc simply ordering up some tests. I am still on the increased dosage of two 20 mg pills of omeprazole/day and will stay on that until I see the GI doc (whenever that will be). Some days are much better than others, some days I feel really great and others not so good, but I will persevere. And, yes, I can't bear the thought of going off 40 mg/day of omeprazole prior to these tests but from what I read it is necessary to get correct readings. Oh, I'll hang in there... I just hope and pray that I can get to see a GI doc within a year (our wonderful health care system).

Petunia22, I have been undergoing major lifestyle changes over the past year or so. I have dropped 44 pounds from my start weight and have about 30 more to go to reach my target weight. I have changed my diet dramatically but gradually. I have cut out all dairy (as I am lactose intolerant), all fast foods (bummer) and eat whole wheat/multi grain products rather than white flour products. I also try my best to eat smaller meals but a bit more often during the day and maybe a light snack in the early evening. I am always under my daily suggested carb levels for the day. I find that I can eat around 100 carbs/day without a problem, but under that I can't seem to get enough food. I cannot eat salads as they completely disagree with me as does acidic fruits, especially oranges. I take Vitamin C and D supplements as well as Omega fish oil. And, over the last year, I have taken up exercise and walk and bike 1-2 miles every day (hope to do more). I think that is doing more for me than the change in diet, but it all works together as a "package deal".

My big problem is stress and anxiety. I am slowly learning to turn around all of my negative thoughts into positive ones and that helps along with daily meditation and relaxation. I used to have panic disorder a lot, but thankfully, I have that under control. I just have to try and be more stress-free.

Thanks for your responses. You are so kind.
 
Bob.

Post Edited (flyer99) : 2/21/2010 7:39:04 AM (GMT-7)


dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 2/21/2010 8:42 AM (GMT -6)   
Hi Bob,
Check out Eckhart Tolle's, The Power of Now. He has an amazingly calming voice and gives lots of great strategies. You'll want to listen to the audio book, not try to read it. Pretty heavy duty reading. I found it the first thing that really gave me very practical relaxation strategies that really worked for me. Whenever I feel stress coming on, I "get into the NOW" and feel wonderfully relaxed. Maybe you can borrow it from the library. Actually, I think he may live in Canada.

Be sure to google "GERD triggers" and stay away from all of them. I'm sure you're already avoiding caffeine, chocolate, peppermint, gum chewing, carbonated beverages, etc. Just in case you're not aware of all of them, you can search them out for yourself. Actually, everyone is different, and a trigger for one is different than a trigger for another.

As far as GP vs GI docs...my family doc/primary care physician is very knowledgeable, and if push came to shove, I think he could do a good job diagnosing me. Can your primary care docs confer with the specialists regarding results and treatment? Honestly, I think you could go a long way using that route if it takes a long time getting into a specialist.

Hang in there, Bob. We're here for you! Sounds like you're doing great with your weight loss. My GI doc said that even 5 pounds can make a big difference, so you're on the right path there.

Have a great day!
Denise

flyer99
New Member


Date Joined Jul 2007
Total Posts : 8
   Posted 2/21/2010 8:59 AM (GMT -6)   
Hi Denise,

Amazingly, I have the audiobook "The Power of Now" as well as another audiobook of Tolle's called "A New Earth". It is hard for me to comprehend a lot of it... I have to listen to them several times to get what he says. I can imagine trying to read them! I also listen to audiobooks of Dr. Wayne Dyer... I find he has some great thoughts and is very relaxing. His meditation audio called "Getting in the Gap" is very good. Something I do also that has helped is to try and stay away from negative newscasts on tv and radio. It seems that everything is so negative today.

As far as the GERD triggers you have mentioned I have given up all of them. I do not drink caffeine or carbonated beverages (I mainly stick to water). I can't drink milk as I am lactose intolerant. I do have the odd peice of chocolate but small and only on a special occasion. I will google them again and see if there is any more that I can do.

My GP does receive all reports from any specialist tests but it is very unusual for them to personally confer. The GP receives a written report and goes by that. The doctors here are so stressed with their patient loads that all tests and results seems to be "rush, rush" with no real time to talk with the patient (mostly just a few minutes). It takes me almost two months after calling to get an appointment with my GP. I think my GP and GI doc could work together on this but, unfortuately, they could not, in all likelyhood, find time to confer. It's disappointing but I'll hang in there and get in to see one or the other when I can.

Thanks, Denise, for your help!

Bob.

Post Edited (flyer99) : 2/21/2010 8:02:23 AM (GMT-7)


dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 2/21/2010 9:04 PM (GMT -6)   
Hi Bob,
I do know what you mean about Eckhard Tolle's work. I had to listen to it LOTS of times to get the idea, but I've had some real breakthroughs with using his strategies. If I can get into the "now", it really makes things so much more peaceful. I find chapters 1-5 to be the most helpful. I do notice if I'm not feeling well or have a lot of pain, it's much more difficult to get the positive effects.

I love Wayne Dyer books as well. One of his first ones, "Your Erroneous Zones" changed my life many years ago. I'll have to check out "Getting in the Gap". I've noticed that those spiritually based philosophies share many similarities.

I'm sorry that you have to wait so long to be seen. Actually, I just made an appointment with my GI doc, and I'll have to wait a couple of months to see him. Hopefully it'll give me some time to get better.

I hope you have a peaceful and GERD-free week!
Take care,
Denise
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