Prilosec vs Nexium vs EGD

[d97cards]

Thanks for this chance to visit. My mom is 80. Good health. She had surgery 20 years ago where 18 inches of small bowell were removed due to loop of small bowell being trapped in an adhesion. Since then, off and on, has had diarhhea/GERD. Has had cononoscopy ( 1 year ago) and EEG about 8 years ago. Now, takes 20 mg Prilosec  daily  and takes Questran (for the excessive bile allegedly not absorbed due to the reduction of small bowell because of surgery,)  every day. Symptoms now--burning in throat, some hoarseness, shallow breathing, hives-like symptoms, itching, diarhhea (yellowish bile-like).
Her gastro doc says to increase Prilosec to twice a day.
Here's my questions
1. He's suggested Nexium as an alternative. Can you comment about the differences and about the relative successes compared to Prilosec?
2. Im concerned that the gastro needs to do an EEG  or CT scan to SEE  what is going on, instead of playing with these meds which are not working. That seems like the time when you need to do more tests. My mom  is very worried and its causing her quite a bit of concern about whether she has a malignancy ...lots of anxiety, sleeplessness....at 80.  Is that unreasonable to ask for at this time. We really like him but I want to be sure that there is no cancer or ulcer or whatever. I mean, its been 8 years since  another gastro doc did an EEG, which saw nothing except a really red esophogus.  
3. Is there a known problem with taking Questran or Prilosec for a long time?
Thanks so much for all the comments you all would care to make

[Kevin Pho, MD]

To answer your questions:
1) There are some studies that suggest Nexium reduces esophageal erosion, but in practice they are from the same class of medication and should work the same.  There are some anecdotal reports of patients responding better to one PPI versus another.

2) I think you mean an EGD (an EEG is used to diagnose seizures).  It is not unreasonable to ask for this as it is the most comprehensive test we have to evaluate the upper GI tract.

3) Chronic use of Questran may be associated with bleeding problems (especially in high doses).  Prilosec is a relatively safe medication that can be used for a chronic period of time.  You may want to discuss this specific question with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[tessa0825]

.....I agree with you and would ask for an EGD so her esophagus can be properly evaluated....EGDs dont necessarily show or prove reflux but it becomes pretty obvious if there is damage in there or a wide open LES valve then you must be refluxing....Does she see a GI Spec.or is all this handled by her PCP? I can't imagine a GI Spec. not repeating an EGD in 8 yrs. expecially considering her symptoms....They can do a 24 hr. PH probe test to check for reflux, my Mom would have been 81 right now, I don't think she could have tolerated that test...There is also a test called a barium swallow that is easier to do that can check reflux.....Some Drs. do think Nexium is better at healing erosions, ulcers, etc. than what some of the other PPIs are....I hope you get some answers soon and that your Mom starts feeling better..

[d97cards]

Thanks alot. I appreciate the comment. Sometime you just dont know where to go.
It seems like tonight, after mom ate, she felt ok, then the burning in the chest starts along with shallow, quick breathing. Shes taking Prilosec and Questran. Hopefully, the doc here can comment when he gets back

[d97cards]

Is there any problem with taking a little Mylanta liquid if the Prilosec is not stopping this burning from sternum to throat for my mom?? Prilosec is just not putting out the fire. Her doctor was out,(on vacation) but the partner (another doc) immediately said that he would arrange with our doctor's scheduler to set up an egd and an ultrasound of the abdomen. So, our doc gets back Monday and the tests are set for Wednesday. Are those the definitive tests to see if there are any probs with gall bladder , liver and pancreas???...along with the scope results. Its easier to battle heart burn IF you know its food, medicine or stress and NOT something serious. Know what I mean????

[yoshi]

prilosev is now over the counter while nexxium is not ,so there is a big price difference.