Bile Reflux and Antacid therapy

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Hi there, I have heard that using only PPIs is not be good when you have bile reflux. If you have both acid and bile reflux, ... ummm, not sure... things can be different... Ask your doctor if he can give you Domperidone, Ursodeoxycholic acid or other drugs for your bile reflux. Yet I'm not sure.

Does anybody have any ideas? I have also read that acid suppression therapy can make things worse when you have bile reflux. Not sure when you have both acid and bile.

 

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  • Posted

    PPIs are good at reducing acid. They do not reduce bile nor reflux.

    All three elements together are required to produce Barrett's Oesophagus which can mutate to cancer. There are no drugs that effectively reduce bile nor prevent reflux.

    Bile will only enter the stomach when called upon to help digest foods (eg animal fats) that don't break down in acid alone. (It acts as an emulsifier.)

    Domperidone and metaclopramide are drugs that can help peristalsis in some cases. They are anti-emetics but not very good at controlling reflux.

    Ursodeoxycholic acid is used to help break down gall stones. It's not that useful for controlling bile.

    No evidence to supoort the theory PPIs exacerbate bile reflux.

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    • Posted

      Trying to strike up a discussion with you but, for reason my texts are being investigated
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    • Posted

      Having swallowing issues, naseau and back pain. I think it's Barretts or the big c. Had and endoscopy a yr ago, some gastritis. Scared
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    • Posted

      Hi, do not be scared. Just do an endoscopy and recieve good treatment. Trouble swallowing may also be a sign of reflux, I think.
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    • Posted

      Do you have pain swallowing or difficulty swallowing? They may be different but I do not know. It might not be cancer or Barrett's at all. Do an endoscope to find out.
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    • Posted

      Yes I do have pain when swallowing. It has subsided a little, but the naseau is major. Just not feeling myself lately. I am going for another endoscopy as I text. I pray it all comes out well.
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    • Posted

      Hi, I had I am having an endoscopy today. Yes I had pain swallowing, it subsided a little, but the naseau is major
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    • Posted

      Hi. Excuse me, could you please be so kind as to answer my questions?

      1. I have heard that the combination of acid and bile is less toxic to the esophagus is that true?

      2. How about the SSRIs (such as Citalopram) some doctors prescribe for patients with bile reflux which is caused by stress?

      3. please be so kind as to tell me how long it takes for a bile reflux sufferrer to develop Barrett's esophagus? My brother has constant and heavy bile reflux. I'm worried he might develop cancer. Is it enough if we do an endoscope every 6 months?

      4. Please tell me what you did to prevent Barrett's from turning to cancer?

      5. Do you still suffer reflux? Acid or bile? How hard is your reflux?

      Please answer me. Thanks so much.

       

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    • Posted

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    • Posted

      Please be so kind as to answer my questions:

      1. I have heard that the combination of acid and bile is less toxic to the esophagus is that true?

      2. How about the SSRIs (such as Citalopram) some doctors prescribe for patients with bile reflux which is caused by stress?

      3. please be so kind as to tell me how long it takes for a bile reflux sufferrer to develop Barrett's esophagus? My brother has constant and heavy bile reflux. I'm worried he might develop cancer. Is it enough if we do an endoscope every 6 months?

      4. Please tell me what you did to prevent Barrett's from turning to cancer?

      5. Do you still suffer reflux? Acid or bile? How hard is your reflux?

      Please answer me. Thanks so much.

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    • Posted

      1. On the contrary: development of Barrett's requires both acid and bile. A research study a couple of years ago found both elements were required and neither by itself created Barrett's. It's like removing grease from a plate: detergent and water seperately are ineefective but together they work. Similarly for the acid to start dissolving the tissue (resulting in the protective mechanism of replacing squamous celss with columnar ones) the bile acts as a detergent to let the molecules adhere.

      (Bile Acid at Low pH Reduces Squamous Differentiation and Activates EGFR Signaling in Esophageal Squamous Cells in 3-D Culture.

      "Results suggest that bile at low pH, but not bile or low pH alone, promotes loss of differentiation status of stratified squamous esophageal epithelium in vitro, possibly by initiating a mucosal repair response through epidermal growth factor activation." - Journal of Gastrointestinal Surgery 7 August 2013)  (also supported by other research papers)

      2. SSRIs reduce stress, they do not reduce reflux of bile. In relaxing the muscles, they may actually exacerbate reflux. (I was actually reading an abstract of a just published article about SSRI use for reflux this morning but cannot find it in the history.)

      3. How long is a piece of string? Not everyone who refluxes acid and bile develops Barrett's. Regular surveillance endoscopy every couple of years should be sufficient to show any oesophageal changes.

      4. For the great majority of those with Barrett's, they will never progress from "normal" (non-dysplastic) Barrett's to anything worse. However, some will progress through the stages of low grade dysplasia, high grade dysplasia and thence, possibly, cancer. If at an endoscopy dysplasia is identified, there are various ablation therapies that may be considered. The usual route is firstly to remove the "lumps and bumps" with endoscopic mucosal resection and then to use Radio Frequency Ablation to burn away the smoother areas of Barrett's. At completion of treatment (which may take several sessions), new suamous epithelium forma and no Barrett's remains. However, because the patient developed Barretts initially, they are liekly to develop it again so lifetime PPIs and regular surveillance is still required.

      See the www BarrettsWessex org uk site pages on the Journey (pages 22 onwards include videos of the procedures.)

      RFA may also be used with T1 cancer but anything higher requires oesophagectomy. Caught early enough, the cancer is removed from the body.

      5. I had reflux reduction surgery 8 years ago. Following 5 hours violent retching from norovirus the wrap loosened and I had revision surgery a couple of years ago. I get no regular reflux but am careful about not over eating etc and still have my bed head raised.

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    • Posted

      Thanks so much. I have heard that the nature of this cancer is aggressive. Does this aggressiveness start from early stages of the disease or it's just for the end stage and the metastasis stage? Is it impossible to do surgery because of the delicate heart structures, etc. around the esophagus, even in early stages? Thanks.
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    • Posted

      The rate of progress is like an exponential curve.

      Any progression along the metaplasia - dysplasia - neoplasia line is slow initially (IF it is going to happen) but once the cancer establishes, it takes off rapidly with typical prognosis of just 6 weeks on diagnosis even as a T1 adenocarcinoma. Of course surgery is difficult but even a T4 patient may be saved by oesophagectomy. (But there's only a 15% survival rate. )

      Of course, oesophagectomy cannot help if the disease has metastaciesd considerably even with readio and chemo therapies to treat the affected areas.

      I do know a number of oesophagectomy survivors and the Oesophageal Patients Association (Patients helping patients) is a great help to many.

      In the www DownWithAcid org uk book, you may read about the different oesophagectomy procedures by scrolling down the menu to the Treatments section to find the chapter on oesophagectomy.

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