Constant Acid, nothing works!

Omeprazole 80Mg per day, taken at the same time as mebeverine, I have cut out just about everything I used to eat, Porridge really starts me off badly, so that has now gone. I have tried different varities of bread and even cut it out and still have problems.

There is a prescription of Gaviscon liquid in my kit, apart from making me feel sick, it mellows the acid down but does not remove it entirely.

I cannot see why I have to take a multitude of tablets when they are not having any effect, it seems to be just hiding the real problem which still has not been found. As far as eating is concerned, I have done all you have suggested and more over the last 18 months and is why I am at the end of my tether with it, I have also lost 4 stone in the process.

Another reason for coming on is to see if I could find out anything else about what actually causes these things, I was fine before I had the H Pylori, it has all been downhill since.

 

You may find fundoplication surgery may be an alternative to consider.

NICE have produced an Option Grid for patients to discuss with their doctors the pros and cons of lifetime medication or surgery.

You may find it if you visit the DownWithAcid org uk site and select "NICE Option Grid" from the appndix listed at the bottom of the Contents list.

Some people have a malfunctioning LES, this is the ring of muscle between your stomach and oesophagus.  The LES opens when you swallow food, or liquid, and then closes.  The ONLY other time it should be open is if you need to belch, or vomit, the rest of the time it should be tight shut, to prevent the stomach contents from refluxing into the unprotected oesophagus.  I have suffered with reflux problems for many years but now, at 60, it has got much worse and NOTHING is helping. I am worse on a morning, after I have been lying down.  My gp has suggested it may be a faulty LES, worsened due to age, hasn't said what could be done to help though! I know there is a test to check for this but nothing has been suggested, AllI get told is all the usual stuff, which I do anyway. They just prescribe various PPIs, Ranitadine, Gaviscon and send me for periodic endoscopies, and I just carry on feeling non stop crap!  I am well and truly sick of it!  Don't know if it helps to know you are not alone?  Good luck!

The oesophagus cannot protect itself from acid, this is the reason reflux causes pain. The stomach has a mucous lining to prevent the acid digesting the stomach, the oesophagus does not, because it does not need it, as acid should not be in the esophagus!  When the LES, the muscle at the top of the stomach, does not close properly (and remain tightly closed until you next eat, drink, or belch), it allows the reflux of acid etc into the oesophagus and, because the oesophagus has no protection, it hurts! This is what reflux is: contents of the stomach splashing up through the malfunctioning LES into the unprotected esophagus, and  burning it, causing pain. It is not due to too much stomach acid, it is due to acid in the wrong place, too much stomach acid is extremely rare. The ideal treatment would be to help the LES to keep tightly closed, but there is not a 100% effective, cost effective, side affect free way of doing that at the moment, so the approach is to get rid of the acid, so, that when reflux occurs, it doesn't hurt.  Only problem is some folk have bile in their stomachs, and we all have peptin too, both are corrosive, so some do not find relief from PPIs.  At this moment in time there is nothing available to "neutralise" bile, or peptin. Most reflux occurs at night, whilst lying down, (through the day gravity helps keep acid etc down in the stomach) the burning and pain from this can be felt all the next day. People with ulcers feel pain because part of the protective covering of the stomach has gone, and that unprotected area is "eaten" by the acid. Most people with reflux feel the pain right at the top of the stomach, under the sternum (breastbone) and it can go through into the back.  They also tend to have the burning sensation  there on a morning when they wake up.  Lying on your back, or right hand side can make this worse. People should try to sleep with the upper body elevated, and try not to eat acid causing foods (although I found the latter did not help much, whether a teaspoon, or a cup full, refluxes, it still hurts!) There seems to be a light at the end of the tunnel (hopefully) a small ring of magnetic beads, which is placed around the LES and keeps it shut, is being tested. The results so far seem quite promising.

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The oesophagus does protect itself with mucous produced in the mucosallayer of the epithelium. However, unlike the stomach, it is lined with squamous cells rather than acid-resistant columnar cells.

The problem with back-washing acid is that it can wash the mucous away. The acid can then burn and scars the mucosal layer producing inflammation: oesophagitis.

Bile acts like detergent to permit fats (such as animal tissue) and water based acid to interact; bile can help the acid to start breaking down the mucosal layer.

As a protection, the squamous cells may be replaced with columnar cells resulting in the condition known as Barrett's Oesophagus which in some people can mutate to cancer.

Ther are many ways to prevent this. Acid suppressant medication can take acid out of the equation or reflux reduction surgery can take reflux out of the equation. LINX is one of the newer ways of doing this with an mpanted device.

Nissen fundoplication, however, is the gold standard . Actually superior to  LINX, it has been performed for 60 years, the last 20 of which laparoscopically (minimally invasive keyhole surgery). 

The DownWithAcid org uk book looks at 8 variations of fiundoplication and 11 articial treatment devices for anyone wishing to find more information on reflux reduction tretament.

Well I never knew that! Thanks for sharing.  I am not a medical person, so can only go on what I have been told, or read, over the years. Mind you, I have had conflicting information from different doctors.  Since my gallbladder was removed the PPIs no longer work (they used to, brilliantly!) but my current GP seems reluctant to say I have bile reflux, he told me that there is nothing that can be prescribed for bile reflux, but that anything that helps acid reflux will help bile reflux.  How, I know no,t as one is acid and the other is alkaline! I think the only cure is something which helps the LES to close properly, but in the UK they seem very reluctant to operate, perhaps because it is too expensive for the NHS?!

Depends who you talk to. I haven't found a reluctance to operate. GPs may be reluctant to refer patients. Since they hold the purse strings, they don't like to refer if they don't think it's necessary. Usually you'd be refered to a gastroenterologist, a medic, who'd like to try and manage the condition medically rather than surgically. I had to ask for my fundoplication and the protocol meant the gastroenterologist had to write to the surgeon to ask him to see me to assess my suitability - which includes diagnostic testing (pH 24 hr manometry and a surgical (assessment) endosopy.

A fundoplication may actually be a cheaper option than a lifetime prescription for acid suppressants. I was on 80mg omeprazole daily (costing NHS nearly £7 a month - and that's the cheapest PPI, it would have been £74 a month if I'd been on esomeprazole) and had a Laparoscopic Nissen Fundoplication costing NHS about £3000 (ie 400 months' worth. Though I may not live another 30 years, other prospective recipients of surgery probably would.)

Using those figures, a fundoplication could well pay for itself in as little as 3 years in some cases.

There is a NICE produced Option Grid at the back of the Down With Acid book (Appendix 2) of pros and cons of lifetime PPIs vs surgery to discuss with your doctor.

PPIs reduces acid. Fundoplication reduces reflux. Nothing reduces bile. You really only need to control one of the three elements which boils down to whether your problems are mainly excess acid or excess reflux.

That's very informative, thank you. I am sure you are right that GPs are reluctant to refer people due to the cost, also  a low dose, (15 mg Lansoprazole),  controlled my reflux (which was obviously then acid) for many years, so an operation was not needed then.

My reflux has only become uncontrolled since 2013 (post gallbladder removal), which, I suppose, is quite recently. The fact that it is recent, and the fact that I am 60, is probably making my GP decide to take a "wait and see" approach, whilst keeping a check on the severity with regular endoscopies, blood tests etc.

At least I am healthier because of this: I have stopped smoking, drinking alcohol, cut out caffeine, and my diet is just fish, vegetables, whole grains, and very low fat.  In fact, if I didn't feel so crap due to the reflux, I'd be the healthiest person I know! 

Take care, and thanks again!

 

You sound just like me about 25 years ago. It would be like a flame thrower down my throat. Whatever I ate or drank set it off. Sitting up for a couple of hours in the middle of the night swigging far too much gaviscon from the bottle. And, like you, I found ice cream was the only thing that helped. I still have ice cream to end my evening meal. A helping of cheap plain vanilla - the cheap stuff doesn't have much cream in it unlike Cornish ice cream which could cause a problem itself.

A high dose of PPIs did slowly reduce the oesophagitis and made that apect of my reflux bearable. 

One thing that did help me a little was giving up caffeine.  Even having one caffeinated coffee when I go to my friend's house  can start my stomach burning.  I notice you said you drink hot chocolate, as far as I know chocolate contains caffeine too. Caffeine can cause excess acid production. I also read that eating a large meal can cause excess acid, I eat my evening meal in two small portions with about 2 hours between each one. I tend to think that stopping smoking did not help, and, whilst it is true that it has not cured me, I must admit that it does not hurt as much as it did. Also watch milk, at one time milk was considered safe, even good, for people with our problem, but recent research has shown that initially it soothes the stomach but later causes more acid to be produced.  I know it's easier said than done but try not to get anxious, hard I know when you feel crap! But anxiety and stress cause excess acid too. Also are you on any other drugs?  I have been on Tramadol for years but my GP told me recently that they can irritate the stomach.  I do hope you can get some relief soon, feeling like you do all the time is awful, I know.

If you are on omeprazole, it should be used continuously, not on and off. It is not an antacid but an acid supporessant that is taken pre-emptively. If taken intermittantly it can actually make the symptoms worse. When active, it stops the stomach making so many acid producing cells which the stomach tries harder to achieve. If you then stop, it's like opening the floodgates and an excessive number of these proton pumps are created producing a rebound effect.

Although alcohol is a muscle relaxant which we may feel intuitively may exacerbate reflux, recent research papers have found no link between alcohol and acid reflux.

Hi thanks for that. When I said about the omeprazole on and off. I had a

period where I was continually on them for four months. Have you had these symptoms that every time you eat, you belch and then your mouth burns with the acid. Regards.

I used to, many years ago, but I managed to tame my acid with a very high dose of PPI (80mg omeprazole) and then opted for reflux reduction surgery. I still burp but it doesn't bring up acid.