Posted 7/10/2017 7:25 PM (GMT 0)
>but have read the success rate is much lower for PPI refractory GERD.
I've heard this as well, and both my GI specialist and surgeon told me this directly. Another line of thinking [that the medical community hasn't really adopted, so take it with a grain of salt] is that many people are developing GERD because of decreased digestive efficiency. Think of it this way - food enters the stomach, and then the stomach lowers its pH, excretes digestive enzyme, churns the food, etc., before draining it to the small intestines over a period of 1-4 hours. For stomachs that are less efficient, the food 'hangs out' for longer periods of time, causing build-up of food (increased pressure on the esophagus), and could potentially cause more irritation to the lining of the stomach.
PPIs have a tendency to make this worse because they generally prevent your stomach from reaching low pH levels that are optimal for digestion. When I am on strong PPIs (like 60mg lansoprazole or dexilant), food apparently hangs out in my stomach for >12 hours (the surgeon who did my fundoplication found food in my stomach 12 hours after eating), which is very unusual.
For this problem, some people have found the supplement 'Betaine HCl with Pepsin' to help with or even cure GERD problems, because it supposedly makes the stomach more efficient. While this didn't cure my GERD symptoms long-term, I can say that I've had more relief on this supplement long-term than I ever did with PPI medication.