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sore throat from PPI taper

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Posted 6/2/2016 10:35 PM (GMT 0)
Hello. I was put on a PPI a year ago for gastritis and a burning throat. The PPI made my burning stomach go away quickly, and after 6 months the burning throat went away. I am now weaning off the PPI because it gives me bad side effects. However, I've noticed the burning throat is back. I also take 300mg Zantac. Does anyone know if the burning throat goes away eventually? It scares me. I don't want to go back on PPI's -- their side effects scare me even more. I am eating a very low acid bland diet, sleeping with a wedge, not eating 3 hours before bed, using slipperly elm, DGL, digestive enzymes and probiotics and doing everything else "right." Maybe I should take Gaviscon Advance after meals? I think the sore throat came on when I tried to add more fat to my diet since I"m so skinny. The added fat must have increased my acid production (I don't know how you eat paleo with GERD...I have gastritis and it would just cause more acid).So I live on white rice, cooked veggies, bananas, white fish and oatmeal. Anyway, will the sore throat go away when the acid rebound period ends? Thanks very much. Also - how quickly after getting a sore throat could it become Barrets Esophagus?
Posted 6/8/2016 6:21 PM (GMT 0)
Sorry to hear that your burning throat has returned. I read your post twice and it appears that you're doing the right things. I noticed you are taking a PPI and 300mg of Zantac. What PPI are you weaning off of and what is the dosage?

Does your burning throat manifes only in the mornings or at different parts of the day?

Yes, adding fat can increase acid production in some people though in some people they have such low acid that it can cause gas to build up and push acid up through the lower esophageal sphincter.
Posted 6/9/2016 12:27 AM (GMT 0)
Hi Paul. I've been on 60 mg Dexilant plus 300 mg Zantac for about a year. I was totally over-medicated. Now I'm down to about 3.2 mg Dexilant a day, plus the 300 mg Zantac. So I'm close to being off the Dexilant, but I need to go even slower because my last reduction caused such bad rebound the acid went into my throat. So now my throat burns always. It's sort of a raw, irritated, mucousy feeling. I'm so super scary skinny and I can't eat enough calories to stop losing weight! I'm afraid to eat fat because of the reflux. Any tips? The last two days have been a tiny bit better. I've been surviving mainly on blended steamed veggies, bananas and a tiny bit of white fish. I don't want to up my Zantac because then I would just have to wean off 450mg or 600mg instead of the 300 mg I've been on. Once off these PPIs I will NEVER go on them again. They are crack cocaine to my body in terms of physical dependency.
Posted 6/10/2016 2:09 AM (GMT 0)
LiveJoy,

I read about your difficulty tapering off of 60 mg Dexilant and associated adverse effects due to acid rebound. You must understand that Dexilant is currently the most potent PPI drug available on the market due to its time release formulation. Therefore, it may pose a significant challenge to some individuals as they discontinue its use.

You also stated, "I don't want to up my Zantac because then I would just have to wean off 450mg or 600mg instead of the 300 mg I've been on." Actually, you are mistaken. You need to INCREASE dosing of H2 Antihistamines such as Zantac, Pepcid AC, etc, in regimens up to 2-4 times per day at spaced intervals. Consult with your doctor regarding increasing Zantac dosing. This WILL help reduce acid rebound effects from reducing Dexilant. Furthermore, unlike Dexilant and PPIs, stopping Zantac or related H2 antihistamines will pose NO REBOUND RISK.

I hope I have corrected your understanding regarding Zantac usage and tapering of PPIs. One last point is that you may expect rebound effects to last 2-4 weeks after your LAST DOSE of Dexilant. Eventually you'll feel better.
Posted 6/10/2016 2:38 AM (GMT 0)
QiDoc thank you!!!!!! Can I ask you a question? My GI Dr suggested to just drop the remaining 3.2 mg of Dexilant I"m on now cold turkey (which I got to by taking out beads from the capsule gradually) and instead add 300 mg Zantac to my current for a total of 600mg. I am getting really bad rebound now. Severe burning from my chest, up my throat, to my mouth. Acid coming up from reflux after meals.

Would you suggest this approach (stopping Dexilant cold turkey but going to 600 mg Zantac) OR continue a gradual reduction from 3.2 mg Dexilant to 2.5 mg to 2 mg etc and up Zantac to 450 or 600mg?

Thank you again so much. I pray I hear from you soon. You seem very knowledgeable.
Posted 6/10/2016 3:30 AM (GMT 0)
Livejoy, you are welcome. You seemed very lost regarding your condition. Since I am not your Doctor, I cannot directly advise you. However, your Doctor's guidance seems very reasonable. In other words, stopping Dexilant sooner, rather than later is probably a good idea - since you previously stated you did not wish to take Dexilant anymore. I do not have objections to PPIs in general, as long as the individual tolerates them well and is monitored for worsening disease under the care of a knowledgeable physician.

In general, it is safe to take 150 mg Ranitidine (Zantac) 4x/ Day. Up to 6 GRAMs ranitidine per day have been used (for Zollinger Ellison Syndrome- a tumor that causes Gastric acid hypersecretion). In other words, I'd divide the Zantac and take the 600 mg in 150 mg increments 30 minutes to 1 hr before Breakfast, Lunch and Dinner and prior to Bed. Again, what your Doctor is proposing seems reasonable and should help you.

I myself have LPR and have had a Nissen Fundoplication. I've had the good fortune to have a world expert care for me, and I've learned quite a bit from my physician and my own research in to acid reflux disease.

Post Edited (QiDoc) : 6/9/2016 9:33:58 PM (GMT-6)

Posted 6/10/2016 3:38 AM (GMT 0)
THANK YOU! Do you think the over the counter 150 mg Zantac is the same as the prescription Ranitidine? I have the 150 over the counter Zantac at home or can have my dr call in a prescription....
By the way...YOU have made my day! Sending you blessings, whoever you are, wherever you are in this universe....
Posted 6/10/2016 3:43 AM (GMT 0)
Oh -- one other thing...do you think doing it this way (dropping the remaining Dexilant cold turkey and taking 600 mg Zantac ...will cause less rebound that what I'm doing now (ie: tapering very slowly off the Dex with the 300mg Zantac my body has been on for a year)? Will it be likely to cause less damage to my throat? Should I start with 450 mg Zantac and see if maybe that's adequate to control the rebound? I know you're not a doctor but what's your educated guess? Thank you again.
Posted 6/10/2016 4:38 AM (GMT 0)
Livejoy, you are welcome. Again, you do not understand clearly your situation. Yes, it is better at this point to stop cold turkey Dexilant. Yes, take as much Zantac as needed to control your symptoms. Don't second guess this! You're only going to prolong and worsen your suffering. After 2-4 weeks and consulting with your Doctor, you can decide what you'd like to do with the Zantac dosage.

Ranitidine is the same OTC vs Rx, the only difference is that Rx come in higher dosages.
Posted 6/10/2016 4:40 AM (GMT 0)
Thank you again! :)
Posted 6/10/2016 4:50 AM (GMT 0)
Again, you are welcome. You can also add Gaviscon OTC liquid 30 min - 1 hr after meals. Zantac is best taken prior to meals, though it still works taken after meals.
Posted 6/10/2016 5:09 AM (GMT 0)
As you can tell, I'm fearful. My fear around this is that by dropping the PPI and going to 450-600mg Zantac I will still have bad rebound and will then have to get back on a PPI PLUS now be on a higher dose of Zantac than I already am on. BUT I sure would love to get off the PPI asap. I'm so grateful for your advice QiDoc. I will try the Gaviscon.
Posted 6/10/2016 5:30 AM (GMT 0)
Follow through Livejoy and you'll come out the other side.

This is actually the best Gaviscon for protecting the throat. From UK. Recommend.

https://www.amazon.com/Gaviscon-Advance-Liquid-Peppermint-Flavour/dp/B002QEPFKS/ref=sr_1_2_a_it?ie=UTF8&qid=1465536392&sr=8-2&keywords=gaviscon+advance
Posted 6/23/2016 3:38 PM (GMT 0)
Hi QiDoc. I've been off the PPI for 9 days now (thank God!). I am having acid rebound but am plowing through the discomfort and have upped my Zantac from the 300mg I was on to 450 mg. My doctor suggested I also use Carafate 3-4 times a day. Do you know if Carafate is addictive like PPIs are? Does it cause rebound when you stop using it? If so I don't want to try it. Thank you so much for your help.
Posted 6/27/2016 2:42 AM (GMT 0)
Hi LiveJoy,

In regard to your question, Carafate is not addictive. It does interfere with food and drug absorption as it binds to bile and inhibits pepsin activity. Therefore, you need to follow dosing and administration guidelines very carefully. It is possible that your doctor is not familiar with the Gaviscon Advance product that I had shared with you earlier. That Gaviscon, manufactured in the UK, forms an acid barrier and prevents esophageal reflux due to its high sodium alginate content. It is possible that Gaviscon is safer and has fewer potential side effects than carafate.
Posted 6/27/2016 3:15 AM (GMT 0)
Thank you! I would like to ask one more question....I was previously eating a very high carb, low fat diet because I read that was best for gastritis. However, I've found (working with Dr Norm of the Fast Tract diet), that a low carb, high fat diet is really helping me through the acid rebound and with the GERD and gastritis. Do you know if going from an almost no fat diet to a high fat diet can kick off gall stones and if so, how to prevent that? My poor gall bladder was probably was in hibernation for a long time and now it is being kicked into gear.
Posted 6/27/2016 3:32 AM (GMT 0)
Livejoy,

Your Liver and Gallbladder produce bile to metabolize cellular waste products including dead red blood cells every day, not only to digest fats. I would not be overly concerned that your Gallbladder was asleep. Glad you are feeling better.

http://www.vivo.colostate.edu/hbooks/pathphys/digestion/liver/bilirubin.html
Posted 6/27/2016 3:41 AM (GMT 0)
Thank you! You have been such a life saver for me and I'm so glad I followed your advice and stopped the PPI and upped the Zantac.Today is day 12 off the PPI and though I still have acid rebound discomfort, it's tolerable and I know in time it will get better and I can get off the Zantac too. You made a big difference in my journey and I'm forever grateful. Good karma coming your way.
Have you heard before of low carb/high fat diets helping gastritis and gerd? So far it seems to be helping me.
Posted 6/27/2016 4:08 AM (GMT 0)
Also, QiDoc, do you think the Gaviscon Advance is as helpful for gastritis as it is for GERD (as compared to Carafate)? I have both issues. Thank you so much.
Posted 7/9/2016 3:04 AM (GMT 0)
LiveJoy, Gaviscon Advance UK, 1000 mg Sodium Alginate works like an "acid buffer" that temporarily coats the esophagus from acid reflux. I don't believe Gaviscon Advance UK 1000 mg Sodium Alginate has any effect on the outcome of gastritis.
Posted 7/9/2016 3:42 AM (GMT 0)
Thank you so much for your reply. It's been three and one half weeks off the PPI and I'm still having rebound. It mainly feels like chest burn and sometimes stomach burn after meals. Is it normal to last this long? Can it last for months and even years? thank you again (PS -- I'm using Zantac and Gaviscon)
Posted 7/9/2016 8:51 PM (GMT 0)
Thanks SsjGogo. I have gastritis so hcl would not be a good idea for my stomach lining. I think actually my acid levels are up from the acid rebound. I hope to cut back on my Zantac soon too. I want off all the meds. So grateful to be free of the PPI. I'm following a low carb diet, similar to the Fast Tract Diet. It seems to be helping in some ways. All the best of health to you and thank you!
Posted 7/12/2016 5:05 AM (GMT 0)

LiveJoy said...
Thank you so much for your reply. It's been three and one half weeks off the PPI and I'm still having rebound. It mainly feels like chest burn and sometimes stomach burn after meals. Is it normal to last this long? Can it last for months and even years? thank you again (PS -- I'm using Zantac and Gaviscon)

Livejoy, you had mentioned you have a gastritis diagnosis. Please clarify. Acute or chronic? H. pylori positive or negative? Autoimmune related or not?
Posted 7/12/2016 4:57 PM (GMT 0)
Hi QiDoc. The endoscopy performed Sept 2014 showed “active antral gastritis with inflammatory mounds and some erosions,” plus “hiatal hernia with Schatzkie’s ring.” The pathology report said “gastric mucosa exhibiting mild nonspecific chronic inflammation: negative for intestinal metaplasia and dysplasia. Negative for hpylori.” I don't know if it's autoimmune or not. Thank you again so much for your help.
Posted 9/7/2016 12:58 PM (GMT 0)
QiDoc are you still on this forum? Would love to ask you something
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