The role of Dexilant in end-stage PPI therapy.

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Gastricman
Regular Member


Date Joined Jan 2013
Total Posts : 294
   Posted 3/8/2013 9:11 AM (GMT -6)   
Hi all,
 
There are a number of people in this forum who are considering an NF or Linx procedure, including myself. I'm sure that many of you know about the surgical Nissen Fundoplication for reflux while the Torax Linx is still proving itself and the EndoStim is still in it's early clinical trial phases. What I have been doing is modifying my lifestyle combined with Dexilant (dexlansoprazole) therapy which is considered the "last stage PPI" prior to surgery.
 
I have been taking the drug for 6 months now, 1/2 hour before dinner and have found that it is working  pretty decently. Is it perfect? Definitely not. My LES is weak and I need to avoid some activities that greatly limit my lifestyle, like bending over or exercising too much. The drug is just a stop-gap measure until I make a decision.
 
The point of this post is if you don't need immediate surgical intervention, it might be a good idea to ask your doctor about it. Dexilant has a good safety profile and shares most of the side effects from other PPI's since it is in the same family. What is unique about the drug is that it is timed released. So when I take my 60Mg capsule, in a few hours there will be another release of the drug. If Dexilant could "buy you more time" until these other surgical alternatives are proven (with the exception of the NF, which is already proven,) it might be worth a shot. Everyone is different and what is basically helping me for the moment, might not help you.
 
When I had my last Ph/Manometry, I needed to be off my PPI (then Protonix) for a full 2+ weeks to ensure accuracy of the testing. When my GI doc informed me that I would be going on the Dexilant until I reached my decision about surgery, I knew this was the drug of last resort to avoid esophageal stricture. I know that the benefit of Dexilant is not going to last me forever, as with all my other PPI's in the past.
 
If anyone else is on this drug and could make any futher comments/suggestions/observations, please do so.
 
FWIW,
 
Gastricman

DOGGBONES
Veteran Member


Date Joined Apr 2012
Total Posts : 707
   Posted 3/8/2013 10:21 AM (GMT -6)   
GM,
"Last stage ppi", that almost sounds like "what do you want for your last meal".....sigh. Well I have ran the gambit of all the ppis approved in the US and now I'm on 30mg Dexilant. At one point on was on 60mg x2 daily and came to the conculsion this is not the answer. I went to 60mg once daily then down to 30mg once daily (yes I did have rebound from hell at both step down phases) but I stayed the course and glad I did.
 
Dexilant & a few tums (most of the time with diet mods) keeps my gerd at bay but I usaully struggle with water brash every day. I'm trying ti figure out if water brash bad symptom or the bodies mode of defense against reflux.
 
Though I consider surgery from time to time.....before I go that route I think I would attempt to go off meds completely and see what happens for a few months on diet and life stye changes first.

opnwhl4
Veteran Member


Date Joined Dec 2008
Total Posts : 4961
   Posted 3/8/2013 10:32 AM (GMT -6)   
I was on Dexilant for a while between the esophagus tear and last nissen redo. It did seem to work well and I liked the idea of not having to worry about when to eat when taking it.

GM-

You know I have always wondered that after an initial PH study they always want you off PPIs for another. It always seemed to me if you are having issues on the meds they should keep you on the meds and see if they are doing any good at all. My GI was going to do this, but I had opted for the nissen and he figured it wasn't worth the additional discomfort.

Wonder if anyone else has had their GI do this?

Take care,
Bill
opnwhl4
Moderator: GERD/Heartburn
Nissen 6/06 and 5/09
#3 on 8/24/11

DOGGBONES
Veteran Member


Date Joined Apr 2012
Total Posts : 707
   Posted 3/8/2013 11:00 AM (GMT -6)   
My GI had me on ppis for my ph study.

Gastricman
Regular Member


Date Joined Jan 2013
Total Posts : 294
   Posted 3/8/2013 11:30 AM (GMT -6)   
Hi there,

I have had 24 Hour Ph studies both on and off PPI, with being off the most accurate to determine the level (concentration) of acid passing through the LES. It all depends on the doctor performing the Ph test.

I can tell you that it probably doesn't matter in the end. If the PPI cannot adequately control the acid component of reflux, surgery will most likely be indicated.

Generally, the PPI should not have an effect on the non-acidic component as the chemistries are different.

GM
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