H2RAs vs PPIs?

As far as expense. If you have good prescription insurance you can get the prilosec cheaper I think. I get mine through mail refills from kaiser permanente. I get a three month supply for 10 or 20 bucks if I recall.

Post Edited (FunGuy) : 12/7/2009 11:02:34 PM (GMT-7)

Hmm, I hadn't heard about PPIs and SIBO. I think I recently read something though that PPIs could cause calcium deficiency problems.

I checked PPI prices at my Canadian pharmacy and they were pretty much the same as in the US, which is weird. Except for one type of PPI which is generic there.

Keeper that is interesting stuff about the slowing of peristalsis from PPI's. I wonder how that relates to another posting on this forum that said many of us seem to have accelerated peristalsis. I have noticed it in myself that food seems to pass through my system quickly. PPI's could spend more time in the small bowel but move rapidly through the stomach and large bowel?? Curious?

I get a generic omeprazole prilosec of some sort at the pharmacy. I have a co-worker who buys Prilosec at Walmart and I think she pays more.

Well I disagree with Keeper. I have been on PPI's for a few years. I do not have diarrhea, do not have any of the other issues they discuss. Many with Crohns suffer with Acid Reflux/GERD due to the Crohns or in my case the surgical changes. If I do not take the PPI's I am MISERABLE with nausea, diarrhea. Pure misery. So I will stick with my PPI. JMHO

I can't really argue with you - the stuff does its job. I was on a couple of them for over a year - or was it two? Anyway, I was not happy with the fact that I was not able to tell if there was stomach inflammation. Sure, there was no acid reflux, but there was reflux. I found that I was able to control acid reflux by diet control (after a week or two getting past the rebound acidity that happens when you stop PPI's). By watching my diet, I eliminated foods that caused me problems. The resulting diet was an accidental variation on the SCD plan (I did not discover the SCD until a few years later), with a couple of starches (rye and oats and rice) allowed and a mounting belief that sugars and candy were giving me problems (but not wanting to admit that!). I have not had any reflux since then - none. I am sure now that reflux is due to gut inflammation and there are several ways that this can happen, but there is almost no interest in the question in the literature. My useless GI did not seem to have any idea that reflux might be connected with Crohn's and mistook my questions - deliberately? - as asking about Crohn's lesions in the stomach. Anyway, that's my bias - I just don't like having a problem just covered over.

BTW - Nanners, it could be that the low grade SIBO that comes from PPI's did not cause you any problems, but it does cause C as well as D (depending on the bacteria that are overgrowing).

I was on Protonix and I was having "D" , so my doctor said lets start over and see what is causing this. He took me off the Protonix, reduced my Asacol, add Questran and put me on Pepcid complete.
The "D" is gone so I'm not sure what fixed it. I do know that the Protonix worked way better then the Pepcid as I need to take Pepcid twice a day if not I feel it.

Reflux in Crohn's is likely due to intestinal inflammation. There are several likely mechanisms that could be at work and it may be that different ones apply for different people. In my case, since food seems to trigger acid problems, I have to assume that there is some sensitivity to some foods. Food sensitivities are controversial. The problem with them is that they can fade away over a fairly short period of time (weeks to months). They form in the first place because of gut permeability. The gut becomes more permeable from several causes (NSAIDs, alcohol, stress, intestinal infection like Norwalk or food poisoning and any other cause of gut inflammation - like a Crohn's flare). The foods that form sensitivities are usually the ones that you use as a main part of your diet at the time of the permeability increase. That is why wheat gluten (only proteins form antibodies) or even beef have been identified as being a problem. Once a sensitivity has formed, every time thereafter when you eat that food, it will trigger a reaction in the stomach's mast cells (front line immune cells) that causes extra acid to form. It also causes general inflammation which distorts the stomach and the esophageal valve then leaks. This can be fixed by avoiding that food trigger.

Then there is the small intestinal brake effect. Some foods when not properly digested in the stomach are sensed as being undigested and the SI slows peristalsis. The most common food here is fats and oils. With PPI's, some proteins also will slow the SI. This results in SIBO (Small Intestinal Bacteria Overgrowth) and a host of related problems. Here's a link for reference: http://www.practicalgastro.com/pdf/December08/DiBaiseArticle.pdf

The link article mentions low stomach acid (hypo- or achlorhydria) as a cause, but also strictures or low pancreatic enzymes or bile problems can all cause SIBO. All these problems initially slow the passage of food through the SI and result in backing up the digestive process and prevents the stomach from passing its contents into the SI as fast as usual. This results in normal stomach contractions pushing stomach contents back up into the esophagus - acid reflux. Once SIBO is established, diarrhea might result, or constipation could be the result. If it is constipation, the reflux problem would continue.

Once SIBO has happened, the bacteria compete with your gut for the partially digested food. In this situation, starches, sugars and other polysaccherides cause rapid bacterial growth with resulting gas/bloating and pain/sensitivity (and brain fog for me). In my experience, eliminating carbs and sugar while consuming only water - fasting - or predigested foods like clear broth or gelatin will clear the bacterial problem in a day or two. To prevent recurrence, you need to know what caused the problem and adjust your diet or supplements to fix it. The article mentions antibiotics, but there are other problems with using them (the article talks about that a bit). It also mentions probiotics but it is short on any real information about that. This is probably due to the complexity of the problem and individual responses.

Sorry for the long ramble - there's a lot to the subject and I have left out some conjectures.

I did not say that SIBO was the only cause - the first bit of my last post was about food intolerances which is caused by a whole different set of foods (proteins) than SIBO. I have a suspicion that hiatal hernia is a result of stomach contractions which are pushing against a resisting SI - whether due to strictures, dietary fat overload, inflammation or SIBO. I too was told that I had a hiatal hernia, I am not sure any more on what evidence.

There is another possibility as well. The fat that wraps around the intestines which is a characteristic of Crohn's could play a role. It is a bit less well understood. They don't know whether it is a result or cause of Crohn's inflammation, for instance. However, they do know that it reacts to intestinal inflammation by producing a flood of extra inflammatory compounds like TNF and IL-1. Since it is on the abdominal cavity side of the intestines, those inflammatory molecules can leak into the space around the internal organs. From there, the inflammation could reach several organs including the stomach. It would have a greater impact if the fat was on a section of the intestines near to or touching the stomach. This is purely a speculation, but it looks possible to me.

Zantac worked well for me for many years. After it lost its effect I was put on Losec 20 - also excellent. After this wasn't helping I started Nexium - still on it. I have found that if I take losec 20 in the evening now I will have D. I don't know why, but the the D is a sure thing for me.

Julia