Long term effects of taking Nexium?

[marygold]

Hi, I am a 19yrs old, and have had GERD for 7yrs now, but was only properly diagnosed at 16yrs old, and I have been taking Nexium for 10 months now. My last doctor told me I'd be taking Nexium for the rest of my life, and gave me a 6 month prescription before I moved (2 months ago). Is Nexium safe to use long term or not? Have there been any tests? I can't see a doctor until a month or 2 yet because I am not eligible for a medical plan here until then. Has Nexium been shown to suppress your immune system? I have a cold, and I nearly passed out in class this morning. I always seem to get way sicker than normal people do. Is there anything I can do to help my body cope? My GERD is severe, and I sleep in a hospital bed, stick to a strict diet, and do everything I'm supposed to, and it's not getting any better. I'm barely breaking even with Nexium. Can anyone relate?

[marygold]

I am taking 40mg Nexium once a day.

[Andydrew]

You can do some research online about Nexium and immune suppression and see what turns up. Google is a great search engine.

I haven't found anything that indicates immune system suppression but there are a considerable number of side effects to careful about. Those side effects can lead to a decline in overall health.

I took Nexium for 10 weeks and I couldn't tolerate it at 40mg. It really messes my system up. Although I may try to use the 20 mg.  My vision is definitely affected by Nexium.

Andy

[Dr. Erik]

It is safe to take Nexium forever. Nexium is the newest of the class of drugs called Proton Pump Inhibitors. It is pretty much the same as Prilosec. Others include Prevacid, Protonix,Aciphex. This class of drugs has been shown to be safe when taken long term. People have taken these drugs for as long as 11 years without any longterm problems. Another option for you is Antireflux surgery or Laparoscopic Fundoplication. This would most likely cure your reflux and allow you to discontinue the Nexium.

[marygold]

Many people are saying to dump out some of the capsule's contents and taking a lower dosage. I am unable to do that as my pills are in pill form and not capsule form. As I am unable to try this, how beneficial is taking a lower dosage? Does it have the same effect with fewer side effects? Does it lower the effectiveness of the medicine? Is it worth me going to the doctor and changing my dosage?

[Dr. Erik]

Try Nexium 20mg once a day

[virgo57]

I have done research on Proton Pump Acid Inhibitors and have talked to my doctor about it. They lower or block your stomach acid and your body needs this acid as alot of vitamins are absorbed through the stomach acid...mainly vitamin B12 and without this you will experience tingling in your fingers and toes as it is an vital vitamin for the nervous system. If your body goes without this vitamin for a long term it will damage your nervous system.
You should talk to your doctor as you may not be getting the vitamins your body needs which in turn will have an effect on your immune system.You may end up getting more colds and flues for a long duration. Alot of people are not aware that many of our nutrients are absorbed through our stomach acid and when it is blocked or largely suppressed you will not be getting vital nutrients your body requires.
virgo

[marygold]

I am taking a vitamin C pill and a multivitamin pill every morning as well as my Nexium, and I haven't gotten any tingling feelings as of yet. How serious is vitamin B12 deficiency?

[Concerned lady]

Marygold, I agree 100% with Virgo! Vitamin B-12 deficiencies due to taking acid blockers, can be severe, causing peripheral neuropathies &/or central nervous system nerve damage. People on acid blockers also become deficient in other parts of Vitamin B-complex, minerals (including Calcium, Magnesium, etc.), various trace minerals, and have trouble digesting and absorbing amino acids (end product of protein digestion), etc.

There's a great "neuro" forum that you should post a question on, and  address your question to "Rose". It's the "Peripheral Neuropathy" forum, over at <a href=http://www.braintalk.org>http://www.braintalk.org</a>

I will also post some Gastric Reflux Tips that you can ask your doc about, and if you & your doc have no objections, give the tips a try for at least 2 weeks. Hopefully, you'll be pleasantly surprised as many have been (not all, but many) who have tried these tips.

These tips, if they help you, can be continued, while you (under close medical supervision, & if safe for you) slowly, slowly wean off acid blockers. Then, continue using the tips (if safe for you), until your reflux is under good control for about 3 months.

Then, you can either continue using the tips, as maintenance, or, slowly wean off them, and see what happens. No matter what, keep being monitored by competent specialist docs.

Good luck to you.

Sincerely, Concerned lady
<a href=http://www.cantbreathesuspectvcd.com>http://www.cantbreathesuspectvcd.com<a/a>

[Concerned lady]

Some GASTRIC REFLUX TIPS (without acid blockers):

Please check with your doctor, first, before trying these tips to be sure they are safe, in your particular situation.

GER=Gastro-Esophageal Reflux. (Gastro=stomach. Esophagus=food tube.)

LPR= Laryngeal-Pharyngeal Reflux. (Larynx=voice box, containing the 2 vocal cords. Pharynx=throat, above the larynx. The larynx is above the trachea/windpipe.)

Reflux=acidic or alkaline stomach material that backs up into the esophagus (food tube), causing any of these problems (at least): VCD/Vocal Cord Dysfunction/Laryngospasm attacks, cough, voice problems, asthma, globus (feeling of lump in throat), constant need to clear throat, much extra throat mucus, worsening of sinus condition, sore throat, laryngitis, voice problems, pre-cancerous conditions of throat &/or esophagus, etc.

SOME GER/LPR CONTROL THINGS WE DO, that we learned from the excellent book: STOMACH AILMENTS AND DIGESTIVE DISTURBANCES, by Michael T. Murray, N.D. See page 9, References, in my website: http://cantbreathesuspectvcd.com   and, also see GER/LPR info on page 5, and on LINKS page.

PLEASE READ THIS GREAT BOOK. It may possibly be bought on-line, from Michael T. Murray’s website.

Some of the following we learned from people &/or other books, &/or other good websites about voice, GER, etc.

(1) DGL (De-Glycyrrhizinated Licorice) is one of our main methods of controlling the GER/LPR. We use Enzymatic Therapy brand DGL, shortly (about 20 minutes) before ALL meals (breakfast, lunch, supper, and snacks). The DGL does NOT cause high blood pressure, and does NOT cause fluid retention/edema, because a bad (steroidal) part of whole/crude licorice has been removed, leaving the DGL. Chewable DGL tablets are available at most health food stores, and at good pharmacies. DGL capsules are said to not be effective:
  
The DGL tablet(s) must be chewed, to mix with saliva, to be effective. If a DGL tablet is too dry (which could cause a cough), one could put a few drops of water on the tablet, and then chew it up. Chew DGL tablet(s) for a few seconds, to mix with saliva, shortly before (about 20 minutes before) EVERY meal, and if necessary, between meals (Read label directions). Chewing the DGL tablets for TOO long a time,  may cause a burning sensation on the tongue & in the mouth. (I do not know if this is from the DGL, or another ingredient).
  
The DGL seems to not only promote healing of throat, esophagus and stomach, but also seems to help prevent OUR reflux.(resulting in no more globus/lump in throat sensation, no more constant throat clearing, excess mucous, excess phlegm, no more NIGHT-TIME VCD/Vocal Cord Dysfunction/Laryngospams attacks, no more laryngitis, etc. for us)

We like the taste of the plain, fructose-free, DGL CHEWABLE tablets, but for those who hate the taste, try mixing a crushed DGL tablet with a tiny bit of mashed organic banana, and then chew, to mix with saliva. Avoid any DGL that contains mint. (Mint—in all forms, can cause gastric reflux episodes. AVOID MINT!!).

(2) We use Thayers brand of SLIPPERY ELM Throat Lozenges when we feel the need. (Soothing, coating, healing, nourishing). Slippery Elm (inner bark from a tree) also comes in teabag form, or in bulk, etc. as an herbal supplement.

(3) We drink the occasional small glass of CARROT JUICE (organic, fresh) which soothes, coats, heals the digestive tract, is nourishing, and stimulates the immune system, with beta-carotene, soothing and coating PECTIN (a type of fiber), and other good nutrients. Carrot soup, cooked carrots are also good. Beta-carotene is heat resistant. Beta-carotene later is turned into Vitamin A inside us. Do not overdo on carrot juice. If your skin turns orange, drink less carrot juice. Avoid beta-carotene pills -- too potent (can harm the liver, if one has liver problems).

(4) We tried elevating the head of the bed a few inches, by putting 6 inch to 8 inch BLOCKS, ON THE FLOOR, under the head end of the bed. This creates a slant (tilt), where the head is 6 to 8 inches higher than the feet. This helps some people, but not all people. (Check with a pediatric Gastro-enterologist, about raising the head end of a bed of a child, or a crib of an infant). Also, see (16) about a special GERD PILLOW, for adults.

(5) We try NOT TO BEND OVER too often, and we try to AVOID STRAINING (Valsalva maneuver). We AVOID LIFTING HEAVY objects. (No weight lifting!) (at least until after no more reflux symptoms for 3 months). Sit without any pressure on the abdomen or stomach (knees lower than hips). Avoid running (shakes up the stomach). Avoid gymnastics, etc. Walking is best, until fully recovered.

(a) If CONSTIPATION is causing any straining, see Ref.15,18,23,24,25 on page 9 for ideas about gently treating constipation, including eating whole grains, not white (de-natured ones), etc.  For us, exercise, increased water intake, acidophilus/bifidus, digestive enzymes, avoiding junk food, improved diet, chewing slowly (takes will power!), eating when not under stress or angry, etc., all are helpful.

(6) NO MORE TIGHT pants, belt, corset,--AVOID TIGHT CLOTHING, avoid tight elastic around waist, etc.

(7) We try to not eat too much junk food. Some people avoid acidic  food, while others need to eat acidic food, if their stomach is not producing any (or enough) acid. (It is good to avoid acid, if one has an ulcer.) These gastric reflux tips methods often can help to heal ulcers. Some people need betaine hydrochloride supplements, which becomes HCl/hydrochloric acid, or, some use vinegar (acetic acid) in salads, or mixed with water, while others need to avoid eating excess acid. Each person is unique. We avoid all artificial sweeteners. Anyone with diabetes can read the excellent book Reversing Diabetes, by Dr. Julian Whittaker, M.D..

Diet soda pop contains the harmful artificial sweetener Aspartame (Equal/Nutrasweet), which can cause WEIGHT GAIN, HEADACHES, UPSET STOMACH, BLURRED VISION, BLINDNESS, TWITCHING, SEIZURES, BRAIN TUMORS, HYPERACTIVITY, MOOD SWINGS, ETC. Also, soda pop often has strong acids, plus other harmful artificial ingredients. Plain water, gentle herb teas, certain fruit juices (diluted with water, to prevent dehydration), brown-rice-milk, etc. are healthier substitutes for soda pops.

We try to avoid artificial ingredients, including fake fats (like Olean, Olestra, etc.), because these can greatly hurt the digestive system, and prevent absorption of vital nutrients, such as fat-soluble vitamins (A, D, E, K) from foods. These fake fats also prevent digestion and absorption of needed fats & oils, used to repair myelin nerve cell sheaths (made of fatty material, mostly cholesterol). Hormones are also made of mostly cholesterol.

Avoid no-fat, or extremely low fat diets. Fats & oils (organic olive oil, organic sesame oil, organic butter in small amounts, organic nuts, etc.) are needed to produce hormones, and to produce myelin sheaths for certain nerve cells. Diets too low in fats & oils, can cause neurological (nerve) damage, and hormonal imbalances.

(8)  We try to drink more water, to prevent chronic dehydration. We like hard (nicely mineralized) well or spring water.
We do not drink distilled water (soft water, no minerals), because it can leach minerals out of our bones, possibly contributing  to osteoporosis. (See Ref.18,23, on page 9.) We avoid water softeners (chemicals) because they can be toxic, and because good minerals help keep us healthy. People with KIDNEY PROBLEMS &/or GLAUCOMA, etc. should ask their docs how much water is safe to drink, since too much water can be dangerous for them! (But, dehydration can cause problems also.)

(9) We use ACIDOPHILUS/BIFIDUS ( edible beneficial bacteria which keep bad YEASTS away, such as Candida Albicans, formerly called Monilia). ACIDOPHILUS/BIFIDUS also can eat or control some bad bacteria, and some viruses. The acidophilus/bifidus are also called PRO-BIOTICS and are beneficial intestinal flora (mainly for the large intestine). We keep the jars refrigerated, but not too cold. These are available at health food stores & pharmacies. (See Ref.14,15,23,24,25, on page 9).

Acidophilus/bifidus can re-populate the large intestine, with good bacteria, after antibiotics &/or steroids, etc. have killed off these good bacteria! Some of us have to continue eating the acidophilus/bifidus (daily, or from time to time), but the results seem worth the effort to us.

Yogurt and buttermilk contain similar beneficial bacteria, but are milk products, so see (11) below about milk products.

(10) We use DIGESTIVE ENZYMES. My husband likes Acid-Ease by Prevail, which contains Slippery Elm (inner bark), Marshmallow Root, Gamma-Oryzanol (from Rice Bran Oil), and the plant enzymes Amylase (digests starch), Lipase II (digests fat), and Cellulase I (digests cellulose from plant cell walls). The Acid-Ease does not contain Protease, which can be very irritating to ulcer/GER folks.

The Acid-Ease is NOT an acid blocker. It is not an antacid. It soothes, coats, nourishes, and promotes healing. Its enzymes help with leaky gut syndrome.

   I use Total Enzymes (which does have Protease, a protein digesting enzyme) by Nutri-West, a company that sells only to health practitioners (Chiropracters, Physicians, and others), who can order, at cost, by calling 1-307-358-5066.

   Digestive enzymes are NOT FOR EVERYBODY, but are helpful for MANY people.

(11)  My husband has found that AVOIDING MILK PRODUCTS helps him feel less congested, with less mucus in throat. Milk and milk products can cause gastric reflux episodes. Brown-Rice Milk (look for gluten-free) can substitute for milk (but not for babies!).

Gluten is in wheat (includes spelt & kamut), rye, oats, barley, & buckwheat. Read labels to avoid hidden gluten, in some soy sauces, gravies, grain alcohols, beer (barley malt), etc. People with Celiac Disease need to avoid all foods containing gluten. BROWN RICE (organic) is gluten-free. Corn is gluten free, but is very allergenic (allergy causing), so avoid corn. Avoid millet, at first, because there is disagreement about whether millet is safe or not, for Celiac patients.

MILK MAY CAUSE MORE ACID to be produced, IN THE STOMACH!

I occasionally eat milk products, like yogurt, cheese, whipped cream, or my ACIDOPHILUS/BIFIDUS, which is mixed with goat milk powder. So, at these times, I take LACTASE ENZYMES, to digest (break down into easily absorbed small molecules) the milk-sugar called LACTOSE. Many people (due to heredity &/or disease) have Lactose intolerance, where the small intestine does not secrete the lactase enzyme. Result is that the milk-sugar (lactose) travels further down the small intestine than it should. Then, bad bacteria eat the lactose, giving off lots of gas (the gases are by-products of the bad bacteria’s own digestion process), and this causes folks to get bloated, gassy, have diarrhea, and cramping. I use Lactaid brand lactase enzymes, and it works for me. Ordering direct from them can save money.

(12) Using the above methods has almost completely freed my husband of needing to use Tums, and seems to be nicely controlling his and my GER/LPR. We have never used acid blockers.

ACID BLOCKERS CAN HAVE DANGEROUS SIDE EFFECTS: Some examples are:

Acid must be present in the stomach, in order for the stomach to make a substance called Intrinsic Factor. Intrinsic factor must be present with Vitamin B 12, in the stomach, for absorption of Vitamin B 12 to happen, in the ileum (last part of the small intestine), I believe.

Acid blockers therefore prevent absorption of Vitamin B 12. Malabsorption (lack of absorption) of Vitamin B 12, causes NERVE DAMAGE (pain, numbness, pins & needles sensation, etc.) in the peripheral nerves (outside the brain & spinal cord). This is called PERIPHERAL NEUROPATHY. For details about this problem, see the Peripheral Neuropathy forum at http://www.braintalk.org

If Vitamin B 12 continues to NOT be absorbed, eventually there can be NERVE DAMAGE to the Central nervous system (brain & spinal cord).

ALSO, the minerals calcium, iron, zinc, other minerals, and important trace minerals, etc. cannot be properly absorbed, when there is no acid in the stomach (due to acid blockers, etc.).

AND, protein does not start to get properly digested (broken down--eventually into amino acids), in the stomach, when there is no acid in the stomach.

Doctors and pharmacists can advise about VERY gradual(slow) tapering down (weaning) schedules (when and if safe) for the acid blockers. Some acid blockers, when stopped too quickly, can cause rebound acid secretion in the stomach, resulting in excess hydrochloric acid secretion. The REBOUND ACID SECRETION often causes worse GERD symptoms!

ALSO, SOME FORMS OF REFLUX ARE NOT ACID REFLUX, but are ALKALINE REFLUX, (bile is alkaline). Besides refluxed stomach acid (HCl/hydrochloric acid), Pepsin (an acidic proteolytic/protein digesting, enzyme) & bile (alkaline) can irritate & damage: the esophagus, throat, vocal cords, & lungs. Acid blockers do nothing to stop alkaline reflux!!

(13) Do not drink ICY COLD DRINKS, and AVOID VERY HOT DRINKS. Use room temperature drinks, or slightly cool, or warm, but not ultra-hot. Extremely cold or hot liquids can irritate the stomach, which is bad for ulcers &/or gastric reflux.

(14) Ask physical therapists, chiropractors, osteopaths, etc. if they know any safe adjustments that might lessen GER/LPR, if you wish.

(15) Read (by Dr. James A. Koufman) PATIENT INFORMATION SHEET ON REFLUX by Center for Voice Disorders of Wake Forest University. Here’s a link:  <a href=http://www.bgsm.edu/voice/pt_info.html>http://www.bgsm.edu/voice/pt_info.html</a>   Dr. Koufman was a pioneer in showing the connection between stomach reflux (can be acid reflux OR alkaline reflux) and breathing problems!

(16) Some have found a special (large) GERD pillow helpful for preventing GERD episodes while sleeping and while lying down. Here is a link to the Prop up pillow website:  http://www.propuppillow.com

(17) Avoid harmful chemical air pollution, which can aggravate gastric reflux. See page 5 of VCD website for more about this.

(18) Using the above methods, in addition to the SINUS SURVIVAL tips, has helped us to prevent VCD attacks, in us.

(19) Please check with your doctor, in advance, to be sure that it is OK for you to try these tips, in your particular case. Also, please get monitored by your doctor, to be sure that no more damage to the throat, esophagus, stomach, vocal cords, lungs, etc. is happening, from possible SILENT gastric reflux.

Pregnant or nursing ladies should check with their doctors, before trying any of these tips.

Avoid any herbs, foods, etc. that you may be allergic to.

Check with your doctor and pharmacist, to be sure that there would be no harmful interactions between any of your medications, diet that you may be on, and any herbs, foods, etc. mentioned in these tips.

Check with your doctor, to be sure that these tips would not interact badly with any medical condition you may have.

These tips help my husband and me (adults). Some of these tips may be OK for children, and others may not be OK for children. Check with your doctor! Babies with gastric reflux need DIFFERENT treatments, not these tips (except for raising the head end of the crib, if your doctor says it is OK to do this, etc.). Check with your doctor!

[marygold]

Thanx, but I don't have a doctor. My last doctor had no interest in treating me, he would just write out the prescription and send me out. I tried asking him questions, but he didn't, couldn't, or wouldn't give me any solid answers. I've also just moved and my medical in BC expired, and I'm not eligible to get a medical plan/coverage in this province for a while yet, and then I have to find a doctor which will probably take a while longer. Do I have to ask a doctor's advice? I've done lots of research on my own, and I've been going to the doctors' websites on this stuff, and asking lots of people, such as my biology prof and some medical and pharmacy students and profs. (There are up sides to going to University.) Since I can't get any "official" medical advice, what should I do? I'm on my own, and I've been treating myself on my own for so long, even before I was even properly diagnosed. I figured out that raising the head of my bed brought relief even before my formal diagnosis. I am my own doctor because no one else is. Sometimes it's great to talk to someone who knows about this stuff too, and that's why I'm here. Bounce a few ideas around, get a new perspective, and not feel like I'm so alone with this. I wish my old doc had told me about some sort of support group. I dunno why he didn't. I'm still looking for one around here, but I'm not having too much luck. I've never really been under medical supervision ever. I've become fiercely independent.

[JackieG]

Hi Marygold:

Sounds like you have been forced to be independent. You need to do whatever steps are required to regain your medical coverage eligibility as soon as possible, because while you are doing the right things (sleeping with your bed eleveated, watching your diet, etc) you need professional medical care. Like you, I suffered from GERD for many years. I am much older than you (47) and eventually I had the worst possible outcome one can have from longterm GERD. You are much too young not to get it treated. In your case, it sounds like surgery to tighten the Lower Esophageal Sphincter ("LES") is needed, but you need professional medical care to be sure.

As to the conflicting advice you recieved on long-term Nexium use, IT IS NOT benign over the long term. Virgo57 is right about the Vitamin absorption problems long tem use can cause. Beyond that, prolonged use of PPIs can cause gastric cancer. I have been using them since 1989, non-stop, and in each of my last two semiannual endoscopies, gastric polyps were found and removed. Fortunately, they were benign, but my surgeon tells me they are almost assuredly the result of such long term use of PPIs. If your only option is chronic reflux or Nexium, by all means continue to use the Nexium. However, you're too young to be put at risk from such a long term problem, and you really need to do whatever you have to in order to get back to a GOOD doctor (sounds like your last one was a jerk). GERD can be successfully treated by surgical strengthening of the LES, but again, you need a good doc to work with you.

Good luck. I know what you are going through!

Best regards,
Chicken Soup

[smiles4ever]

i definately agree that nexium might have something with you just getting sick with everything all the time.  I have been on Nexium for 7 months now, and I just get everthing!  the flu, colds, just not feeling well, etc.  I think it has something to do with not enough vitamins getting absorbed and therefore you're getting sick (like virgo said)  best of luck, hope it all works out

[Dr. Erik]

You are giving misleading informatin about the prolonged use of PPI's. There is not one documented case in which long term use of a PPI has caused Gastric or Esophageal cancer. People in Europe have been taking these drugs a lot longer than people in the U.S.

[JackieG]

Hi Eric:

First, it is good to see you post again! You've been away too long, and you have always been one of the most informative members on this Board (at least in my view).

As for your view that my post contained misleading information, the information came from my surgeon, who is recognized as one of the leading esophageal cancer surgeons in the US. I am inclined to accept his opinion.

I am also aware that Europe is less conservative in their approval process than the US FDA. In the late 1980's I was on Prilosec for a prolonged period when its use in the US was generally limited to no longer than 6 or 8 weeks because it caused stomach cancer in rats. At that time, it was already in widespread and longer term use in Europe.

I am not claiming that my esophageal cancer was caused by prolonged use of PPIs. I don't believe that it was. I am certian that it was the result of long-term GERD, which finally led to a very long segment of Barrett's, then High Grade Dysplasia, then cancer.

I do believe that there can be long-term adverse consequences from very long-term PPI use, including the possibility of stomach cancer. Again, I am relying on my surgeon for that information. I hope I don't find out the hard way, because after last year's esophagectomy, there isn't much internal plumbing left for them to take out of me!!

I have no idea how to quantify the long-term stomach cancer risk. I assume that long term PPI use is preferable to no treatment and enduring GERD over the long term. Unfortunately, I know what longterm GERD can lead too. The best course is to alter one's lifestyle and diet to control the GERD, if possible. If that is not enough, surgery to strengthen the LES should be considered. In all cases, PPIs should be considered in the shot to intermediate term, until one can fix the GERD problem. However, once we're talking about long-term PPI use, my surgeon tells me there is a stomach cancer risk.

I suppose from time to time you and I will hold differing views, although I expect only on rare occasions. Please rest assured that I am not speculating when I post comments like the one to Marygold. I am either relating my personal experience, or, as in this case, passing on what my doc told me. For me to speculate or mislead someone on this site would be immoral and dangerous. I have no intention of doing so.

I am happy to see you back on the board, and hope that you stay with us. You add a lot of value.

Best regards,
Chicken Soup

[zelda29]

This is the first time I have ever heard anyone describe the symptoms of GERD like I have. I do not have heartburn, but feel a lump in my throat, a constricting feeling, I have a sore throat a lot, excessive mucous, constantly clearing my throat.  Doctor is also surprised when I complain of these symptoms. I  have been diagnosed with a sliding hiatial hernia, and been told I have "silent" heartburn. Have been told to take Prilosec, and have been taking it about one year, with no change. Some days I am really bad with constricting feeling in throat.  I am glad I read your post, I was beginning to think that something else was wrong, besides my hiatial hernia. I think i will research more on this "globus" you talked about.

[Dr. Erik]

I am sorry to hear about your Esophageal cancer and Esophagectomy. I take it that you had the stomach pull-through procedure following the ressection? Or was it the Interposition of the Colon? I didn't realize that you had EC from reading your recent posting. I guess I've been away from this forum too long.
How are you doing with eating and reflux since the procedure?
I am having persistant reflux despite Nexium 80mg and Pepcid. I am on the edge of surgery for the fourth time. Due to the scar tissue from the previous surgeries, the Surgeon is afraid that he could inadvertantly damage the esophagus during the surgery and have to do an Esophagectomy. I am scared to have the surgery and scared not to and face the possible consequences. Esophageal cancer and/or Barrett's.

I do believe it is possible for long term use of PPI's to cause problems and maybe pre-cancerous polyps, I just meant that there were no documented cases in medical literature to date. Please let me know how you are doing?

[Dr. Erik]

I was wondering what hospital and what surgeon you used? Maybe he/she could help me. I need some help. I don't want to make my situation worse with the surgery but I don't want to suffer like I have been and still be at a risk for Esophageal cancer. Thanks in advance for any help you can offer.

     -Erik

[JackieG]

I live in Pittsburgh, so I used Dr. Rodney Landreneau at Allegheny General/West Penn ("AGH"). He did the transhiatal esophagectomy ("THE"). There is another outstanding esophagectomy surgeon at the University of Pittsburgh Medical Center ("UPMC") named James Luketich who sees patients from all around the country. Both hospitals were listed in USNews' top 50 cancer centers the past several years (This year I think AGH was 47th and UPMC was 11th). I can get you their office numbers and addresses if you would like.

I don't blame you for being concerned about the prospects of the esophagectomy. It is MAJOR surgery. My surgery lasted 15 hours (they're don't usually last that long), and the risks associated with the procedure itself are pretty worrisome. If you need to go that route, please be sure you pick a surgeon that has done alot of these procedures at a large, well-known medical center. Mortality rates (defined as surgery plus 30 days) run from 2% - 3% at the best hospitals with skilled surgeons to as high as 29% at small community hospitals. So, in this case, "practicing" medicine is very important. Of course, the younger you are the better you will tolerate the surgery. I guess, in an odd way, I was lucky to be diagnosed last year at 46 years of age.

I have ongoing problems with aspiration, which is a product of the new plumbing, but it is getting more manageable. I'll also be going for an incisional hernia repair after the holidays. The nine inch incision from breast bone to navel has herniated twice now. Other than that, things are going well.

I hope you don't need the surgery, but if you do, I have a wealth of information from my research going in to the surgery that I can pass on to you. There is also a great esophageal cancer support group on line that I can direct you to. You could solicit information from them (even if you don't have cancer), because virtually all of the members have had esophagectomies.

Best of luck to you, and please stay on this board as often as you can. Your advice and information has been of great benefit to alot of people, and we need all the sage advice we can get.

Chicken Soup

[Concerned lady]

Dear Zelda,

Thanks! These "tips" don't work for everyone, but they do work for many, including my hubby & me, and many who have written to me, when they found my VCD website (Vocal Cord Dysfunction), at http://cantbreathesuspectvcd.com

The most common cause of the VCD attacks (laryngospasms) in the people who have written to me (over 200, so far) is a type of GERD called LPRD/Laryngeal-Pharyngeal Reflux Disease. It's a "higher" up form of reflux than the "heartburn" type.

I hope you'll try out all those tips (if you & your docs have no objections), and let us know how they work for you. Give the tips a 2 week trial (every day), at least.

Good luck to you!

Sincerely, Concerned lady

[Concerned lady]

I wish the best for you both, and I apologize for some older, previous messages in which I was being an old cynic. You both are good people!

Concerned lady
http://cantbreathesuspectvcd.com

[JackieG]

Hi Concerned Lady:

I can't remember any previous posts from you that you should feel you need to apologize to me for, but I do appreciate your best wishes and kind sentiment.

best regards,
Chicken Soup

[g350h350]

I am just now running out to exercise my credit card and refill my prescription for Nexium.

I have been taking Losec (prilosec in US, I think?) or Nexium for about 12 years.  I have found it to be essential to control severe heartburn, which begins to reappear about 36 hours after my last dose.  It has also been found to control a chronic cough that I suffered with for about 15 years prior to finding a very thorough, progressive respirologist who nailed the GERD diagnosis.

I am 47, and have a variety of ailments and complaints, from plantar fascitis and working all the way up to ringing in the ears.  I'm not apt to blame the Losec or Nexium for any of them.  I had a very thorough gastro workup a little less than a year ago, with no problems found.

I'm continuing with Nexium for now;  we discussed laparoscopic fundoplication, mainly because the provincial health plan covers surgery, but not prescription drugs;  I decided against the surgery because I'm feeling fairly well controlled, and the surgery carries its own set of risk and side effects.  I was particularly swayed by a note I saw somewhere, that indicated there was a 1 in 50 chance that the laparoscopic approach would not work so that traditional open surgery would be undertaken.  

I was unaware of the effect on vitamin absorption, and resolve to start taking vitiman supplements more religiously, figuring that the more that's down there, the more that will get absorbed???

[Concerned lady]

Dear Person on the Provincial health care plan,

There's a great forum (Peripheral Neuropathy forum) over at http://www.braintalk.org where people such as "Rose" are very knowledgable about the vitamin mal-absorption leading to nerve damage problem, that is caused by acid blockers, and other things.

It's a helpful, supportive forum. I hope you'll check it out! :-)

Sincerely, Concerned lady
http://cantbreathesuspectvcd.com

[Concerned lady]

Dear Chicken Soup,

Thank you. I was once cantankerous in responding to someone whom you had responded to, when I was in an old cynic mood about the many poor quality docs out there. But, I wasn't against your good advice, so I do want you to know that I respect your advice a lot! :-)

Your kindness and gentle-ness of posts is contageous, and has taught me a good lesson.

Sincerely, Concerned lady
http://cantbreathesuspectvcd.com

[marygold]

I have to take Nexium religiously too, because my symptoms also show up as little as 36hrs since the last dose. I always take my vitmains at about the same time as the Nexium so's I remember them. I also figure that the more that's down there, the greater the chances that something'll get absorbed. Some's better than none. You haven't had any bad side effects or complications from Nexium in the 12 years you've been taking PPI's?

What province are you in? If you know anything about the Alberta medical plan, I'd be so grateful. I just moved to Alberta from BC and need to find out about the medical plan here as my BC medical expired. Thanx.

[g350h350]

I have no ill effects that I can attribute to the Nexium or Losec (other than the loss of about $1,600 per year!).  At the moment, I suffer from chronic fatigue (no caps) which I believe has finally been related to a definitive diagnosis of obstructive sleep apnea.  I snored long before I had heartburn, so I don't think there's a connection.  Nothing else I suffer from can easily be associated with the PPI thingies.

With respect to provincial health plans..probably a topic for other forums, but I am in Ontario, so don't know anything about Alberta.  Your earlier posts really provoked my curiosity, such that I did a web search to see what I could find.  I know that back in the days when I moved from province to province, you were never "not covered"...the province you moved from covered you until you were covered in the province you moved to.  I know that things have been getting tougher/stricter, but I still think there's some pointed questions you should be able to ask the BC and Alta offices.  

The alternative (i.e. no coverage) is pretty much inconceivable in this country -- what if one was involved in an accident or became acutely ill shortly after moving?  Mr. Chretien would not be impressed.

Good luck!

[marygold]

Just a side note on the no coverage thing. My mom was on welfare in BC, and that means that us kids have medical through them until we're 19, then we have to get our own. I moved out here when I was still 18, and turned 19 in the middle of sept. I can't get medical out here util I've lived here for 3 months, and when I turned 19 and lost my BC medical, I had only been here half a month. So, I have 2 1/2 months in which to be extra careful not to get hurt or sick or anything. I didn't think that no coverage could happen, but I guess it can and does. Chretien wouldn't be happy? I wouldn't be happy! Anyway, that was just a little aside.

I also have been awfully tired lately, especially sitting in class, and I was wondering if it was due to the Nexium, and exercise usually helps me stay more awake. But you bring up a good point, one I completely forgot about. Sleep Apnea runs very strongly in my family, mostly on my mom's dad's side. I just met a second cousin on his side out here that I never knew about, and in her family, there's strong sleep apnea too. I know that there's still a chance that may not be it, but it's a very likely contender. Thanx. Now I ain't quite so worried.

[JackieG]

Erik:

The following medical literature supports your contention that there in no evidence that long-term PPI use leads to gastric cancer. That would make my earlier comment (and by extension, my surgeon's opinion) incorrect. This is a lengthy excerpt, but worth reading, I think. Note also that it cites a statistic I had never seen before: 1 in 64 Barrett's patients progress on to cancer. While 1 in 64 may not seem like bad odds, given all the people that have Barrett's, it means a lot of EC cases, and that is very tragic. Here is the excerpt:
=============================================================
The following information is from book "Barretts Esophagus" edited by Tilanus and Atwood, 2001, by Kluwer Academic Publishers.  No where in this book does it suggest that PPIs cause esophageal or gastric cancer!

from the book:
p288:
"It does not appear, despite earlier fears, that medication increases the risk of adenocarcinoma. Chow et al found no association with the use of H2 antagonists, or anticholinergic drugs. Vaughn et al found no correlation with the use of drugs that relaxed the lower esophageal sphincter, in particular with calcium channel blockers."


p77:
"The natural history of GERD (gastro esophageal reflux disease) is changing. The widespread use of PPIs has altered the severity of GERD and frequency of complications.  Proton pump inhibitors can be classed as disease-modifying agents:
* they have the ability to heal esophagitis and esophageal ulcers.
* they have the ability to maintain remission (of GERD) in 100% of patients if used at appropriate doses.
* They prevent the recurrence of esophageal strictures, something not achieved by H2Ras (H2 receptor antagonist )
* Recent review of the published data also suggests that these drugs are safe for long term use at the doses currently used.
* the one area in which PPIs do not appear to modify disease relates to progression of Barretts Esophagus. During a 6.5 year follow-up, 9.5% of patients developed barretts despite being on sufficient medication to cure their esophagitis. One of 64 patients with known barretts also progressed to carcinoma.
* Review of studies suggests that there is little or no reduction in the length of existing barretts  with PPIs.

p232:
"A decrease in cancer risk might be anticipated if treatment could induce a reduction of Barretts. A number of case reports have suggested that reduction of Barretts esophagus can be accomplished by anti reflux treatment. However, other studies could not confirm this.
* It is reasonable to assume that the long term goal of therapy should be to eliminate any acid exposure to barretts tissue.

** and p167 - bile:
" Several animal and patient studies have demonstrated that mixed reflux of acid and bile salts is significantly more destructive than acid reflux alone, suggesting a possible synergistic interaction existing between bile, especially taurine conjugates, and acid.
* The high pH environment created by proton pump inhibitors inactivates these bile acids.
* In animal studies, Cell repair of esophageal lining in the presence of acid and bile reflux generates columnar epithelium, ie. barretts.
* In animal studies, cell repair of esophageal lining in the presence of bile without acid, generates normal squamous  (healthy) cells.

With apologies, and continued best regards,
Chicken Soup

[moozie]

Hello , I'm new here but I really need some help.  I have read all of the above information and I'm so glad that I found you guys, I was beginning to think I was going crazy. A few months ago a dentist gave me medication for a bad tooth.  One night I woke up and thought I was having a heart attack, I rushed to the ER and they gave me zantac and sent me home. The next morning I went to my own doctor and he gave me Nexium.  Well , it took a while but it worked.  Soooooo, I thought I was all better after a few weeks and stopped taking the meds for a couple of months. Well guess what? about 3 weeks ago I started taking Nexium again because the pain has come back. The pain radiates all through my esophagus and sometimes in my neck(throat). My doctor says it's reflux.  I am a smoker and I am very very worried that it is cancer. I suffer from severe anxiety as well and I'm really good of imagining all kinds of things. Nexium is not working so now today he has given me Losec.  I'm afraid of taking it. Are there any side effects ?

I read that there is someone from BC ( canada ) on this message board.  If that person or anyone else would like to email me I would really appreciate it. My email is ***@****.

I appreciate any comments on Losec, or if anyone can tell me when I will start feeling better. I've been taking Nexium now for one week and nothing has changed that's why my doctor is trying Losec. What I don't understand is why did it work before.

I feel like I'm going crazy...Please help!!

Thanks so much

[marygold]

Hey, Moozie!

You've come to the right place. I'm Marygold, (ta-da!) formerly of BC, recently moved to Edmonton, Alberta and still adjusting to the snow. (Sometimes climate will worsen GERD, as I found out from moving.) I have had GERD since I was 12, and have self educated myself as much as I can, including reading medical textbooks. Smoking does make the LES slack, so, you may not want to hear this, but cutting down should help some. I have all sorts of tips and tricks for you, so I'll try to email you in a day or 2, after I get some sleep. I am on 40mg Nexium once a day, and it works for me. I have been on it for about 10months now (except for yesterday, when I forgot), and the pain always returns when I don't take it, even for one day. My GERD is severe, and chronic, which I don't think I like. (I'm slightly hyper right now, sorry.) The earliest I remember the signs of GERD (although I didn't know what it was then, and was not properly diagnosed until 4 yrs later) was when I was always losing my voice when I was 12. I never felt anything in my esophagous, only in my throat, which led to my doc diagnosing me with tonsilitis for 4 years before I told him to just take them stupid things out! He did, and nothing got better. Turns out what made me lose my voice all the time was the acid coming up my throat and heading towards my lungs, and burning out my vocal cords. Now, 7 years later, I cannot raise my voice (at least not for more than one sentence) and speak very softly. I've taken so many different drugs, and Nexium was the only one that worked, so each drug depends on your own body. There is no set way each drug will work, so don't get discouraged when one doesn't work that you've heard works for so many other people. I have so much more I could say, but due to the length of this posting already (and the amount of sleep in my eyes) I think I'm going to sign off here.

Goodnight!

Marygold

[JackieG]

I can understand why you are anxious if you are beginning to suspect that you have esophageal cancer ("EC"). From what you describe in the post above, you probably don't have EC. The most common initial symptom of EC is difficulty swallowing. Unfortunately, that is the result of the tumor having grown large enough to cause the difficulty swallowing, and by then the tumor has usually penetrated the esophageal wall. This means that diagnosis of EC usually occurs after the spread of the cancer to other organs, which accounts for the very low 5 year survival rates for this disease.

By all means, continue to ask your GP to order additional tests, such as an endoscopy of the esophagus with biopsies of any suspicious areas, an esophageal motility test, and a ph test. You want to find out what is causing the problem so you can deal directly with the problem, rather than the symptoms.

I suspect Marygold is going to email you some very helpful tips on dietary and lifestyle changes to try to stop the reflux.

Good luck,
Chicken Soup

[JackieG]

See the response by "Dr. Tomasello" to the post dated 11/12/02 and entitled "chest pain on exertion". I don't know if "Dr Tomasello" is an MD/GP, and her/his posts are relatively new, but the tips on lifestyle and dietary changes in "Dr. Tomasello's" response are comprehensive and textbook for GERD/Reflux, so you would do well to try them.

Again, good luck,
Chicken Soup

[moozie]

Thanks you guys,

How long does this medication (losec)take to work? I'm still in pain.

Please help!!! My anxiety about this is so severe, it still feels like I'm having a heart attack, and I'm really scared.

Moozie

[JackieG]

I'm not a doctor, and I only have the information you have put in several posts here, but my guess is:

1) you're not going crazy.
2) You don't have esophageal cancer, and
3) You're not having a heart attack.

You may want to do a WEB search on Losec (in the US it is marketed under the name Prilosec, so I'd search that term as well). You should get good information on potential side effects and how long it takes to begin to have full effect. I suspect that you may want to give it 2 or 3 weeks to see if it helps. If not, tell your GP and ask for an endoscopy. That will be the first test they should do to see if reflux has irritated your esophageal lining. Reflux can cause a sharp chest pain that people sometimes confuse with a possible heart atttack (I did in the late 1980's). If your GP is treating you with Zantac, Nexium, and Losec, she/he must have good reason to believe that your discomfort is the result of reflux and not a heart problem.

I understand your anxiety, but sometimes it takes a while for the medicine to really kick in. It also would be helpful to follow the GERD diet and lifestyle suggestions in "Dr. Tomasello's" post that I referred to above (if you are not already doing so). In any event, I would ask for an endoscopy the next timne you see your GP.

Good luck,
Chicken Soup

[moozie]

Hi Chicken Soup,

I really appreciate you telling me not too worry, cuz it seems that's all I ever do.

The pain seems to have calmed down exept for alot of pressure in my throat, but by reading some of the posts, it seems like it's a common problem with GERD. Going to the doctor on Friday am, I will let you know what he says.

It's been one week now on Losec, I suspect I have to stay on it for a while longer ;) and that it takes a couple of weeks to feel a bit better.

Thanks again
I would appreciate any emails.
***@****

Moozie

[g350h350]

I have been on PPI's (former Losec, now Nexium) for many years without any ill effects that I can associate with the PPI.  I was unaware of the view that PPI's may impede vitamin absorption.  Accordingly, I've renewed my resolve to take vitamin supplements regularly.  Because I'm cheap, I tend to take the Nexium (40mg) on a 2 out of 3 day basis...I can go about 36 hours before the return of symptoms.

Here's my question: is there a "best time" to take the vitamins from an absorption point of view?  That is,I assume that the effect of Nexium on stomach acid varies, with peaks and valleys associated with when the Nexium is taken.  I also assume that there is a known or reasonably assumed period for the Vitamin to be absorbed.  Is there a "vitamin absorption management strategy" that can be exploited here?

[marygold]

I'm not sure about a specific time that vitamins should be taken, but I take them with breakfast with my Nexium (40mg). Vitamins should be taken with a meal for better absorption.

[marina144]

A related discussion, GERD and 120mg nexium was started.