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Can someone explain heartburn even after PPI once daily

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GERD & Acid Reflux
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Posted 11/22/2013 12:53 AM (GMT 0)
Hi,
My story is like this : I am 30 yr old, i used to be a smoker(half pack per day), weekend drinker, I used to eat normal food sandwiches without much fat and definitely not fried food. A cup of coffee everyday.

I started having a mild chest pain Upper left side of the chest to be precise. I did not pay much attention to it, but even after a week i was getting that pain. So I went to my physician. He said its probably reflux. He gave ranhitidine 150 mg and since the day i started taking them I started having heartburns as well( i did not have them before).
My doctor switched me to protonix 40 mg daily , I am following all the dietary restrictions, eat small portions. No triggers. Non Spicy food. Veggies(cooked) and fruits mainly.

But the symptoms dont go away. I am experiencing heartburn. Sometimes really bad episodes.

If PPI's suppress acid then why is it that i am getting heartburns?? My doctor, i think , is suggesting changing the medicine ( when i spoke to him over phone), i have appointment with him tomorrow.

Thanks
mrk
Posted 11/22/2013 1:24 AM (GMT 0)
I take nexium twice a day and I still get heartburn. My doctor told me that even though I still get heartburn, my acid is suppressed enough so my esophagus shouldn't get enough damage to cause cancer.

Hope this helps.

Stephen
Posted 11/22/2013 2:20 AM (GMT 0)
Thanks Stephen for the reply.
But if there is no acid, then what is causing the heartburn??
Posted 11/22/2013 1:16 PM (GMT 0)
What is causing the heartburn may be that since your body is producing less acid now, your LES is not functioning properly. Your body waits until your stomach has produced the right amount of acid before the LES will close properly. If this does not happen, it allows acid to go into your esophagus with little to no resistance. It seems to me that doctors tend to treat the symptoms instead of finding out the cause. Being on the medication will never fix your problem. Our bodies need acid to properly break down food for digestion. Part of your problem with the chest pains was that your body wasn't producing enough acid and excess gas was causing bloating and pain and you should have possibly been put on HCL supplements to see if that helped. Homeopaths tend to find the cause of the problem and look at ways to fix that. Doctors tend to prescribe you medicines that treat the symptoms, but never help with the underlying problem. Everyone should have an option to choose what they would like to do based on different options. I would suggest trying to find someone who is more knowledgeable about the digestive system and causes of your problem so you could possibly get the source to fix it.
Posted Yesterday 5:01 AM (GMT 0)
I have been on PPIs since about 1995 for GERD. Started with prilosac and then Nexium when the prilosac stopped working. My symptoms were much like yours before PPIs and again when they stopped working. Again in 2010 I started having the same symptoms only, it had been so long, I forgot about acid reflux and was checked with ultrasound and then a cat scan for gall bladder problems. New doctor immediately said, "your Nexium has stopped working. He put me on Dexilant and my symptoms went away. Later my insurance changed and wouldn't cover Dexilant. I went back to Nexium without problems. Finally determined that my problem was "when" I was taking Nexium and with what. I had started using Metamucil for cholesterol control and was taking my Nexium close to the same time. Metamucil was essentially blocking some absorption of the Nexium. The bottom line is 1. take your PPI first thing in the morning and try not to eat much and especially anything that might interfere with the PPI absorption. 2. Remember that all PPIs are not the same. Some work better for one person than another. If yours isn't working, ask your Dr. for another until you get one that works for you. 3. Don't mess with GERD. If your heartburn persists, get an EGD to check both for hernia, Barrett's Esophagus or maybe even cancer.

Dx Barretts Esophagus 1995'
Annual EGDs confirm no change since due to PPIs.
Insurance won't cover HALO Radio Frequency Ablation until it advances toward cancer.
Posted 12/13/2013 9:24 PM (GMT 0)
Thanks Javery and Pop8371 for the reply.

@Javery - I think i m not very sure about the low acid theory. Although i agree that finding the real cause of GERD would help tackling the problem better. I don't understand the healthcare system in US. Why are all the medical action targeted towards symptom control?? Wouldn't it be easier and cheaper to find out the underlying cause and deal with it?

@Pop8371 - Glad to hear that your symptoms are under control. You are doing great.
I read throughout the forum that i have to keep experimenting with the PPI's till i find the right one.
I am dexilant now( was previously on protonix)


Some more updates, I dont know if people are interested, but still i thought it would give some insight

I had my EJD done, there was mild gastritis in my stomach. Esophagus was clean. Gastritis and Gerd are unlrelated. So I pushed my doctor to do some more tests and find out the real cause of my reflux.

So i got my manometry and ambulatory 24-hr ph test done. I haven't got the results yet. Holiday season is looming i wish i can get the results soon.

Meanwhile , I have changed medication from protonix to dexilant. Not much relief when i was taking dexilant once daily.

Now i am taking 30mg Dexilant twice daily. I think it has subsided some of the heartburn. its only been 3 days since i started taking dexilant twice. So i will wait for few more days to conclude if its working.

I am also trying to gather all the herbal options and will start taking them soon.
Will let you know guys about further course of action.

Thanks for listening.
Ravi
Posted 12/13/2013 10:31 PM (GMT 0)
Has anyone mentioned bile reflux to you? It can cause gastritis in your stomach. PPIs will not help with bile reflux.

Gunner
Posted 12/20/2013 5:37 PM (GMT 0)
Hello Gunner,
No one mentioned bile reflux to me yet.
Is is a good idea to talk about it with my GI??

Anyway my Ph test results are out, strangely enough , My 24 hr Ph monitoring test was done while i was on dexilant 30mg once a day.
The results are the following :
34 reflux episodes occured throughout the duration of the study. Esophageal acid exposure was normal in the upright position(0%) and in the recumbent position(0.6%)

For the manometry test :
mildly increased lower esophageal sphincter relaxation pressure of 17.6 mmHg but with a normal lower esophageal sphicter pressure mid respiration.

My doctor says the symptoms are not becasue of acid. He thinks its functional heartburn. he is trying to suggest some anti-depressants.

I am completely clueless now on how to proceed with this.

Meanwhile , i can feel more and more LPR symptoms. cough in the mornings. nasal back flow while sleeping. as if the throat is getting closed.
Posted 12/23/2013 1:43 AM (GMT 0)
recentgerder

I hate the term function heartburn. Any abnormal reflux can cause problems with time. I would get a 2nd opinion. Since you were on PPIs and still had some issues that tells me it would be much worse without them.


Take care,
Bill
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