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Avatar universal

PPI or any other suggestions?

Hi Community,

I'm a 42 year old female.  A year ago I started having chest pain and hard to breath episodes out of the blue.  I thought it was my asthma, although medication didn't help. I went to my PCP and they thought it was reflux, even though I don't notice heartburn.  I was sent to a GI and scoped, stating esophagitis and small hiatal hernia.  I was placed on Protonix once a day.  I felt better, so went off, only to have a year of on and off again chest pain/breathing issues and on/off PPI medication.  During this year, I have also had a full cardiac workup and full pulmonary function test, both of which were perfect.  A few months ago I was sent back to the GI and he wanted another scope.  This time he said GERD and to stay on medication.  I have tried herbal, lifestyle modifications, etc and nothing except the PPI's help.  I've tried Zantac twice a day and that takes most of the edge off, but Protonix is better.  I exercise daily, am 5'7 120 lbs, eat healthy, etc.  I do not like taking the Protonix because also have chronic hepatitis b (that has been lifelong but stable), although I have been told by 2 PCP's, my liver specialist, and my GI doctor that this medication is safe long term for my liver.  My questions are, does anyone have any suggestions on what more can be done to not take PPI's daily forever?  It seems like such a silly thing to take medication for possibly the rest of my life, but is such a lifesaver on the other hand.  It's also odd to me that a year ago out of the blue this came up.  I still don't know if it really is GERD but know nothing else has come up.  My PCP says I have been to every specialist related to my issues and everything has been ruled out except for GI, and just to take the medication indefinably.  Thanks for your help or at least being able to relate.  
6 Responses
620923 tn?1452915648

  Hi and welcome to the GERD forum.

A few questions....do you smoke, drink coffee, tea or alcohol....eat spicy, acidic  or greasy foods? Chocolate?...there are many foods, bevs and even lifestyle choices that can also trigger our symptoms to flare....eating b4 bed...we need to allow 3 to 4 hrs b4 laying down...reduce stress as it is also a trigger....exercise is great!....

When you look back to a yr ago when this started, did you have stress, or an illness like the flu....

Allergies or just someone that over produces histamines can develop reflux due to the PND.....something else to consider and rule out.
Silent reflux or LPR do not always have heartburn but that does not mean you do not have reflux....

Look to the meds you are on for your other condition to see if it could be a reason for your symptoms.
Avatar universal
Thanks for your help.  The only other medication I am on is Advair for my asthma, and this has been for probably close to 15 years.  In fact, after the pulmonary tests I was able to effectively lower my dosage from the 500 to the 100.  So, at least that was a plus.

I have tried cutting out all of the food triggers and coffee and it doesn't do anything.  In fact, when I feel the chest pain it occurs all day long.  When I take the Zantac I would say my chest symptoms are 90% better, but the Protonix is best for me.  With that said, my doctor said if I can manage on the Zantac either once or twice a day to do that, since Zantac has less side effects. Chewing gum during the day helps me a lot too.

No stress, but a year ago when this started my whole family did get a cold, and this is when I thought it was asthma, but it wasn't.  I had a GI scope about 3 months before this and was on the Protonix but was off by the time I had this first episode of chest issues.  My GI said my chest issues are from going off the Protonix and with my lung/allergy issues the reflux backs up into my lungs?  When this occurs and I have what I call a flare the first thing in the morning my lungs feel so awful!

The only thing that I can really think that brought this on was a couple years ago I was diagnosed with h pylori.  I did successfully get rid of it by taking PPI's and strong antibiotics for a few weeks.  I remember after this is when I started to have bouts of reflux, which lead to the first scope and prescription for Protonix.  It almost seemed like I felt better when I had that bad bacteria living in my stomach!  I do take daily probiotics, which I do not see a difference taking.

If my symptoms are 90% better with twice daily Zantac do you all feel this is the safer way to go?  Also, has anyone tried a foam wedge to sleep on at night?  It seems like when I wake up even on the PPI's or Zantac my throat is sore, even though I don't notice reflux.  Thanks again for all your help!
Avatar universal
I do not smoke, drink alcohol, drink tea.  I do drink 2 cups of coffee a day.  I have tried quitting for months and the symptoms are not better.  I'm not a big chocolate or spicy food eater.  I also have been stopping all eating at 6 pm and this too I don't notice anything.  Like I said, my issues are chest pain but my doctors feel it's silent GERD?  What is PND?
620923 tn?1452915648

  H. Pylori can come back and take several rounds of anti biotics to get rid of....my father had a tough time clearing it up.

As for pro biotics...not all are LIVE...and you should talk to your Dr about getting the type you need a  RX for and keep in the fridge....it is better then OTC pro biotics...especially if  you have on going issues  and the others do not help.

PDN = Post nasal drip.

Silent reflux you still need to avoid the same foods.....etc...and the caffeine in coffee will not help you calm down your symptoms....and in a flare , water can trigger symptoms....so even tho you stopped your coffee for a few months it may not have been long enuff to really see the benefits.

Have you tried 6 small meals instead of 3 larger ones?

Also elevate the head of your bed...this can be helpful....

Have they retested for H. Pylori to make sure it has not come back?
Avatar universal
Thanks Selma.  Yes, I did the breath test and my 2 scopes revealed no h pylori.  I've been taking the prescription 150 mg Zantac twice a day and for 3 nights slept with a wedge pillow and have felt great each day, no waking up with a sore throat!  I eat small meals and always have, eating a small something every 2-3 hours and stop at 6pm.  The main change is the wedge, which so far is a noticeable difference.  If the wedge continues to take care of my daily/nightly symptoms should I still stay on the Zantac or try lowering to the 75 mg, or just take at night, etc?

Initially, my gastro doctor said to stay on Protonix but my PCP said to wean off that to the Zantac, and try to get to taking at night only.  I've only been on the Zantac a week and a half, so don't know if it's too soon to either half the doses or just take at night?  
620923 tn?1452915648

  Talk this over with your Dr as to how to manage this condition with your meds....these meds are not easy to stop taking as you can have rebound effect....basically the symptoms worsen when the meds are stopped...so it is best to only alter meds under the direction of your Dr.

  I am glad to hear the wedge is working for you.
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