hoobajoo

Just wanted to say thanks to everyone for all the helpful ambien facts. Since you were all so helpful, I thought I'd ask another health related question for my girlfriend. My girlfriend has acid reflux and I was wondering if anyone else has experienced this and what they did to treat it. With the help of doctors, she's tried many different medications to treat her acid reflux but none have been all that successful. I don't know what all she's tried but I know she's currently taking Acidopholus(suppose to help you digest your meal) and she's also tried Prevacid, tums, and other medication. I know that surgery is a possibility to try and fix the valve that allows food into stomach and prevents it along with stomach acid from coming up. I was just curious if anyone else has experienced acid reflux(more than just after a big meal) and what they did to treat it?

kulrblind

Prevacid is a pump inhibitor, which in my (un-medically-trained) mind is the most common and effective treatment for GERD (Gastroesophageal reflux disease). Basically, it should have cut down on the amount of acid being produced in your girlfriend's stomach. It's interesting that it's not worked for her. If she didn't take it in large enough doses or for a long enough period of time, she may not have benefitted from the medication. However, maybe the medication is not right for her (or maybe she has a different form of GERD?). Personally, I've been on losec for quite some time now (also a pump inhibitor), and it's the bees knees. Seriously. When I was first put on it, I was on a double dose daily, but quickly moved to a single dose. Antacids are partially useful, but not for long term relief. There are also a few tricks people can employ to decrease the effects of GERD and heartburn (sleeping positions, dietary changes, etc). The foregoing stands to be corrected.


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Jay Francis

I've had this for about 16 years and take a Nexium every evening before bed to keep it under control. She needs to eat her evening meal earlier in the evening, and avoid acidic things like vinegar, wine, acid foods, etc. I used to also take metaclopromide with the Nexium but don't seem to need it now that it is under control.

*When I started, I was taking Prilosec and then switched to Nexium when Prilosec went to an over the counter formulation.

heccubusiv

unless you have good insurance that will pay for zantac or prevacid, prilosec OTC is the best bet.... if the medication is over the price of prilosec OTC, we just tell the doctor they are going on the cheaper medication

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Baron Opal

There are several medications that you can use. I know you mentioned that you tried some of these, but I'll be complete.

First line therapy for indigestion / acid reflux are antacids. These medications directly neutralize acid in the stomach. The provide the quickest relief, but also last the shortest. Examples are Tums, Mylanta, Maalox, etc. There are also similar product that have alginic acid in them, like Gaviscon. These don't actually neutralize the acid themselves but rather make a foamy barrier that floats on the stomach contents. When the stomach refluxes its contents, it tends to be this neutral foam rather than the acidic stew.

Second line are the H2 antagonists. These are drugs like Zantac, Pepcid, and Tagamet. There are receptors in the stomach that trigger the production of acid. H2 antagonists block these receptors. Less signal is recieved, so less acid is produced. These take a little longer to work, maybe a half-hour, but last longer, perhaps 4-8 hrs depending on the patient. A problem with these drugs is that they tend to work optimally only for about two weeks. Then, the stomach tends to adapt to the interference with the acid producing signal.

Lastly we have the proton pump inhibitors. (PPI) These drugs are really quite slick. What they do is they permanently disable the acid pumps in the cells lining the stomach. Eventually, the stomach regenerates them, but it takes a couple of days. Now, these drugs only work when the stomach is actively secreting acid. The best time to take these drugs is usually a half-hour before a meal. That gives time for the drug to accumulate in the stomach tissue before the pumps are activated by eating.

What causes acid reflux? When the pressure below the pyloic sphincter is greater than the pressure above it and the sphincter is incompetent and cant withstand the pressure. This can come from having too big a belly. Many patients find relief from simply losing weight. This can take a while, however. Many foods can weaken the sphincter, like spicy peppers and caffiene. Alchohol increases stomach acid production.

If you have lost some weight and changed your diet as best you can, then drugs can help a lot. For sporadic bouts of acid reflux, antacids and H2 antagonist usually work just fine. For more serious problems, taking a PPI once daily works well, although a few patients may need to take it twice a day. You can always take the PPI for control and an antacid as needed. The three types of medications stack very nicely.

Remember, though. You don't want to completely turn off your stomach's acid production. That is how your body defends itself from bacteria hitching a ride in on what you eat. That can cause problems.

Lastly, there are some disorders that require higher doses of medications or even surgery. This can be very serious problems. Usually this involves a physician using an endoscope to peek down your throat to see just what kind of damage you are dealing with. Often medications can control the situation, but surgery to repair the damage might be appropriate. At this point, we travel beyond my scope of practice.

(Oh, there's also metocloperimide (Reglan) which quickens the stomach emptying. We try to avoid that, however, because of the side effects and other medication interactions.)

Baron Opal, Pharm.D.

alpo

Baron - That's a pretty nice review!!

Dilbert1234567

i'm on protonix and it works great for me, also low acid orange juice is a blessing.

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Stompy

How do you diagnose this?

I've been getting some very odd chest pains lately around my solar plexus, but I know it's not HEART problems.

It like... feels very tight, and sometimes I can feel it in my nasal/roof of mouth area.. (hard to explain). Sometimes it hurts to breathe for a few seconds..

Does that sound like indigestion/acid reflux?

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Devoid

I'm positive I've got acid reflux. I was on prevacid for a while because I thought it was an ulcer and my doc told me to try it for a while and see what happened. It went away, and I didn't think much of it. Recently, though, it's returned, partly due to stress, partly due to drinking and spicy food. So, for me, the medication helped, but you have to stick with it if you want to suppress/eliminate the problem.

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VitaminH

That sounds a lot like acid reflux. I know what you mean being in your nasal area, as I've experienced it. I tried some proton pump inhibitors, but they give me stomach cramps so I've had to resort to being extra careful in my diet and taking the occasional pepcid.

Baron Opal hit up all the drugs very well (obvious due to his PharmD status) so I won't touch any of that.

Zantac is really cheap and has been off patent for awhile. The expensive ones are Prilosec (although better since the OTC and generics have arrived), Prevacid, Protonix, Nexium and Aciphex.


Edit: Ironic that I talked about drugs right after I said I wouldn't....what can I say, they're my life.

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Nazggul

I had a mild case last year. I cut the coffee back to one cup and the tea back to one cup a day. I also cut out acid juices like Cranberry juice and homemade pasta sauce (tomatoes are quite acidic). Now I feel back to normal. Jumping right into drug treatments may be overkill if she hasn't tried changing her diet first. Also, bumping your metabolism through exercise should help. I would do the diet and exercise first, then resort to medication. Maybe she's done that already though.

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thingstodo

It is a good thing she sees a doctor. Too many people try to treat too many symptoms themselves when doctors, while not being perfect, do have a little more experience. Especially if is it one that listens and communicates with you rather than just saying "here, take this." It is also good to get many opinions like you are doing because it all contributes to personal responsibility for better health.

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alpo

I'll be the first to admit that we as doctors are far from perfect. Unfortunately, the way the system is set up, we all too often resort to the "here, take this" route. There are many days where I have more than 10 patients per hour scheduled. If everyone showed up, that's 6 minutes per patient. In those 6 minutes, I have to quickly review the chart, find out what is going on, what's new, do a physical exam, make my treatment decisions, write prescriptions or referrals if needed, fill out any forms that the patient needs, fill out insurance and billing paperwork, and document the events of the visit in the chart. It's a pretty daunting task to complete in 6 minutes. If it takes me a couple of minutes longer, I'm late for my next patient who is not very happy to have been kept waiting. Not that I'm making excuses, but you can see why sometimes, resort to doling out meds. I like to think that I listen to all of my patients needs and give them whatever time they need to talk about their issues. Do I run behind schedule? Just about every single day. I hope my patients understand that although they may have to wait a little longer, I'll take the time to listen to and address their needs. Now it's not like, I'm raking in the cash doing all this. I work about 18 hours per day, 6 days per week on average and I'm struggling to pay off the $200,000 in medical school loans that I have accumulated. I'm certainly not complaining ... I knew what I was getting myself into when I applied to med school. I just think it's important understand sometimes why you have to wait when you go to the doc, and why sometimes your doc seems rushed. The number of patients I see per day is dictated by insurance companies, etc.

I know we as docs get a bad rap, sometimes very well deserved, but speaking for many of us, we try to do the very best we can for each and everyone of our patients within the current health system framework.

Ok, I'll end my rants now. Sorry for hijacking this thread.

Shades

I've got this, a pretty bad case. So does my Dad and my Grandpa. According to the different doctors we see (different cities/states), stress has little to nothing to do with the condition. Your stomach is producing too much acid. A strong sign of acid reflux, over classic heart burn, is actually tasting or feeling acid up your throat. Your breath will become worse.

I'm on Nexium. I tried taking it for just 4 weeks and then stopping, then 3 months and stopping, but it always comes back. You're supposed to take it in the morning, because it really only lasts about 18 hours. There are no long term side effects, at least none that have turned up in the 5 or 7 years it's been on the market (can't remember). Surgical techniques are still underdeveloped. They don't even completely fix the problem, just take it down a notch. All of the doctors I and my family have seen recommend against surgery, say to take pills, change diet, and so on. Surgery is a last, last resort.

I've tried Zegerid, a powder you drink in water. It works the same as Nexium, but doesn't taste too good.

Baron Opal

Shades -

Yes, sometimes you are on the medication chronicly if you want relief from the symptoms. Your stomach's acid may "idle" at a level too high for your comfort and the medication is what keeps it down. I too have acid reflux, but for me I know that the problem is generated by my weight. If I get heavy, the heartburn comes back and stays until I loose the weight. Still, with omeprazole (Prilosec) coming OTC that should give many people a more inexpensive route if antacids and H2 blockers are ineffective.

alpo-

Yeah, they spend their 6 minutes with you, and then come to us for more info! Still, I can appreciate the time crunch you are under. I had to clean up a mess from an NP the other night that put me way behind in filling prescriptions. That and counsiling the patient's mother was time consuming as well. It was something that had to be do, and it put the mom's thoughts at ease.

Enough hijack.

alpo

/re-hijack

Opal -
I know that I try to do my best to spend as much time as necessary with my patients. I think they are willing to wait a little longer because they know I won't rush them when they have problems that need close attention. I also try to utilize the rest of the health care team that is available to me. I couldn't get through a day without the clinical pharmacist, NP's, and nutritionists helping me along the way. I think it requires all of us working together to help give our patients the care they need and deserve.

/end hijack

Baron Opal

Indeed, the team approach is best.

MSD

Yeah, that.

That's exactly what I had, except that the pain would spread down as far as my knees, up into my jaw, and out to my fingertips.

Nocturnal

Sounds like a hiatus hernia. I have the same symptoms and had a gastrothcopy (sp?) to find out for sure. It can be controlled zantac etc or key hole surgery to wrap the top of the stomach around the bottom of the gullet. I'm a chicken and have gone the zantac/rani route to this point. It is particularly bad when I eat spicy foods or pastry or pizza and even worse if I lay down after eating.

merc22

If you are drinking Mountain Dew, stop it. If you are drinking pop, stop it. Mountain Dew in particular seems to be a big culprit for acid reflux. Some of my friends have acid reflux, but once I convinced them to stop drinking the Dew, they feel a helluva lot better.

Lebell

Something that hasn't been mentioned yet is Sleep Apnea.

For myself, I had terrible reflux at night, but after I was diagnosed with Sleep Apnea and got a C(ontinuous)P(ositive)A(ir)P(ressure) unit, my reflux mostly dissappeared.

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snowy

I have really, really awful chronic heartburn and acid reflux that seems to come and go with my stress level. I've tried Protonix in the past and am hesitant to do so again as it didn't seem to be much of an improvement over regular Pepcid.

After reading this thread it seems I'm going to have to go back to the doctor if I want any kind of relief...nothing seems to work any more.

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VitaminH

There are two available Pepcid strengths OTC, Pepcid AC Maximum strength is the 20 mg tabs, which is the lower prescription strength available. Have you tried both? If not, you could always give Prilosec OTC a shot too, it's a Proton Pump Inhibitor like Protonix, so it essentially does the same thing to your body, but everyone reacts differently to everything. It's never a bad idea to see the doc about this sort of stuff either.

Simple things like exercise and such can help relieve stress and will help with the reflux as well.

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munchen

I just wana throw somehting out here for all of y'all with heartburn. i've had it scince i was 15 and my family has it and others i know. I went to an allergist for food allergy testing and found some very minor allergies. I cut that food out of my diet and havent had it since, drug free. I also felt a hell of alot better in general. My family got tested and same deal, all better. So if you havent looked down the allergy avenue i would definitly check it out.

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raeanna74

I've not personally dealt with reflux but my Dad had big trouble with it and had the stomach wrapped around the valve thing done. Since then he cannot eat bulky things like thick mashed potatoes, peanut butter, etc. They stick in the valve and he feels like he's almost choking. It stopped the acid though. Until he got that done there were many other things he did to help stop things. He was careful to avoid greesy foods and hot spices. He avoided laying or even sitting down after eating. He found it helped if he took a short walk after eating. He ate in small frequent amounts while taking Pepcid. Avoiding putting any more pressure than necessary on that valve helped some. He still had some heartburn but it wasn't as bad. In the end he had to get help from a Dr but these things helped some.

One note - His heartburn started when he got heliobacter pylori bacteria in his stomach. It frequently starts heartburn and if it's not caught early enough it can damage the stomach valve. Get her to a Dr to check for that and to see what else needs to be done.

I hope your girlfriend can get the help she needs.

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sapiens

I've had acid reflex for several years. After a while, I got used to it. I thought it was normal. Then I developed a persistent cough. My coughing fits sometimes led to vomiting. My doctor diagnosed my acid reflex and sent me to a gastroenterologist. If your girlfriend has had persistent acid reflux symptoms, I would recommend seeing a gastroenterologist. You may want to have an endoscopy to make sure that there hasn't been any serious damage done. I had one and then my gastroenterologist prescribed Aciphex. Their rebate covers my monthly insurance copay.

Joan of Arc

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