An introduction and questions on PPI rebound

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)

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!

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.

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!

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!
Denise

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)

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)