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Reflux

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Magda was a new patient who was referred by one of my ENT colleagues for “refractory reflux”. She’d been on the proton pump inhibitor Nexium at a dose of twice daily for over a year, and was still complaining of symptoms. She’d cut out caffeine, alcohol, chocolate and late-night eating when the symptoms first began, and was a pretty healthy eater at baseline: oatmeal or fruit for breakfast; a salad for lunch, and chicken or fish with rice or quinoa plus veggies for dinner. At 5’8” she weighed 126 pounds, and was an avid exerciser. Magda was 29, didn’t take any other medications besides Nexium, and had no other medical problems. Hmmm. Why would a lean, active, healthy 29-year-old woman with good eating habits suddenly start having acid reflux? The symptoms had developed seemingly out of the blue, on the heels of a bad viral upper respiratory tract infection 14…

Proton pump inhibitors (PPIs – acid blocking medications prescribed for reflux and GERD) are linked to increased rates of acute gastroenteritis in the winter months when enteric viruses are at their peak. In a cohort matched study containing 233,596 patients receiving proton pump therapy and 626,887 not receiving the therapy, researchers found that the PPI group had 1.81 times higher instances of infection. JAMA Takeaway: Previous studies have linked long-term PPI use to a host of health complications, including dysbiosis, kidney damage, cardiovascular disease, declining bone health, and even an increased risk of death. If you are taking a PPI and are considering tapering off the drug, check out our article on this subject and work with your healthcare professional for support to be sure this is the right decision for you and your condition.

Did you know that small intestinal bacterial overgrowth (SIBO) is often mistaken for acid reflux? In my practice, at least half the patients who come in with a reflux diagnosis are actually suffering from SIBO. Why is the mistaken diagnosis so common? The symptoms of the two conditions are very similar and even identical in some cases. Burning upper abdominal pain that can feel like acid reflux is one of the commonest manifestations of SIBO. High levels of gas produced by bacteria in the upper GI tract can cause the lower esophageal sphincter to open inappropriately, mimicking acid reflux. To further complicate matters, acid suppressing drugs like proton pump inhibitors (PPIs) are a common cause of SIBO, but since SIBO symptoms are often misdiagnosed as acid-reflux, PPIs are frequently used to treat SIBO, perpetuating the cycle of symptoms. So how can you tell the difference to gain a proper diagnosis?…

Susan: In mid-2008, I had a severe food poisoning incident with lots of diarrhea and vomiting. Later that year, I broke a toe and took Advil every day for a month. In October 2009, I started having problems being regular with my digestion. I saw a physician who gave me a course of antibiotics and proton pump inhibitors (PPIs). After taking them I was still experiencing abdominal pain and bloating. Dr. Chutkan: An episode of food poisoning can be the triggering event for small intestinal bacterial overgrowth (SIBO) because the gut flora is thrown out of balance. The pathogen crowds out a lot of the beneficial gut bacteria, and even after the infection is over people are often still symptomatic because their healthy gut bacteria remain depleted and other species start to overgrow. Non steroidal anti inflammatory drugs (NSAIDs) like Advil compound things because they make tiny holes in the intestinal…

Recently diagnosed with esophagitis and reflux, my doctor recommends I take proton pump inhibitors (PPIs) for the rest of my life, but I’d prefer to use alternatives, such as a healthy diet, exercise and stress reduction. Is this possible? -Dan Dr. Chutkan: Dan, you’re on the right track in being cautious of lifelong PPI use. Stomach acid is one of the most important components of digestion, and when you block stomach acid for extended periods of time with these drugs, you put yourself at risk for suboptimal digestion of minerals like calcium and magnesium, as well as an increased risk of infections like Clostridium Difficile and pneumonia. While PPI’s are one way to treat reflux and esophagitis (inflammation of the esophagus), there are lifestyle modifications that can be really useful in managing symptoms, independent of PPI’s and their adverse side effects. These lifestyle practices include: Eat five to seven small meals to avoid overfilling your stomach.Exercise regularly…