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stomach acid, ppi timing questions

Posted , 4 users are following.

peterm8
peterm8

I am wondering about the timing of PPI effectiveness and what it feels like when it wears off for the dosage.

I have been off and on PPIs for around the last year and the first few times I stopped, I stopped cold turkey and didn't seem to have any immediate effects. Typically trouble in the form of burping would start about 2 weeks later but also seemed to coincide with bad eating so I don't know if it was rebound or diet or both. 

For the first 10 of the 12 last months I never had any heartburn or even sign of LPR other than burping. I did get a bit of a warm feeling in my stomach early on before taking PPIs when I ate certain foods.

The last 2 months I ended up with a lot more severe problems (see my other post  here if you want all the sad details:

https://patient.info/forums/discuss/help-figuring-out-what-to-do-gerd-lpr-ibs-etc-symptoms--656798

Anyways, one thing that happened when I started to have all my stomach pains and issues was that about a week or so into it, while on 60mg of dexilant I actually felt some reflux while eating some ribs. Since then I have a lot more noticeable signs of some kind of acid related problems. Right now here is what it looks like:

I take my 60 mg of dexilant at 5:30PM because I wanted to maximize night time protection since I seemed to be having some pains after dinner and bad sleep..

My day usually goes like this now that all my other gut pains have drastically decreased in intensity and frequency.

Wake up feeling fine. Sometimes a bit of a metallic taste in my mouth. Sometimes not.

Drink a big cup of water and have breakfast 15-20 mins later.

Typically OK till about 3PM. Sometime between 3 and 5PM I typically notice a slight burning feeling in my stomach. I thought it was from food I was eating but it doesn't matter what I eat or if I ate recently, it comes on. It often also comes with a slight feeling of pressure in my throat and I start getting an occasional dry cough. This feel lasts 30-60 minutes and then seems to calm down a bit with or without taking a PPI. I usually am drinking some water throughout this time though.

I take my 5:30PM PPI and usually things feel a little better. I have dinner around 6:15 to 6:30PM. After dinner, I often have a cough and a slight feeling of having a harder time taking in a deep breath. When I go to bed around 10:45 to 11PM I feel fine when I lay down (on my left and head elevated on a medcline pillow). This includes breathing in which feels totally fine..

So my questions are:

Does this sound like LPR?

Is the slight burning feeling that comes on around 3PM or so my stomach starting to produce or over produce acid because the daily dosage of dexilant has worn off enough? If so, should I do something to protect myself from reflux for this short period? Like take gaviscon or something at 2:30 or 3PM? Or make sure my stomach has something in it? (and if so, what?)

Does this mean I definitely have a reflux problem that would exist even without the PPIs or is there a chance that it is acid hypersecretion and weening off the PPIs would eventually produce less acid? I am scared to ween off at this point because I don't want to aggravate any other issues that I had but I am also worried that the PPIs are the cause of some of the other issues..

For reference some of the issues I have that I am wondering if they are caused by PPIs or the acid are:

- greatly increased sensitivity to foods. It's almost like I have oral allergy syndrome as things are starting to irritate my throat shortly after eating them that didn't even 2 weeks ago. Bananas, cantaloupe, etc..

- I used to be able to handle dairy fine but tested high lactose intolerant about 6 months ago. This was after being on PPIS for about 4 months

- I seem to have digestive problems. Possibly gluten sensitivity (tested negative for celiac though) and I get full pretty easily and it takes more than 3 or 4 hours to not feel full. (slow emptying?)

Any thoughts would be appreciated. My GI doc didn't have much to offer at this point but I have an endoscope schedule for next month. I am seeing a new family doc on Friday and will see what she says as well.

Thanks

0 likes, 5 replies

5 Replies

  • pippa58442
    pippa58442 peterm8

    Posted

    Food sensitivity may suggest gastritis which an endoscopy would pick up.
    • peterm8
      peterm8 pippa58442

      Posted

      That would be interesting and concerning. I seemed to start having food sensitivities start more in late 2017. So if I had gastritis that long I would be worried about what damage it has caused. Most of my issues started when trying to go off PPIs for a couple of weeks at a time in Feb and March. Basically I was fine for a week or two but then frequent and somewhat uncomfortable burping and throat pressure started. It was in early april that I started getting intestinal pains and stuff.

       

    • pippa58442
      pippa58442 peterm8

      Posted

      If your symptoms continue or get worse, I would ask for an endoscopy.
  • stoneoakgi
    stoneoakgi peterm8

    Posted

    you are taking PPIs on demand, it’s best to anticipate that a meal may be a problem and take it before that meal. It takes over an hour for a PPI to take effect, so if you wait until you already have heartburn to take the GERD medication, you could be waiting a while for relief. In that situation a topical medication is best (Maalox, Tums, etc.) since they work right away. One interesting PPI, Zegerid, is different and can provide relief after heartburn strikes. Zegerid contains a PPI (omeprazole, which is the same active ingredient in Prilosec) and sodium bicarbonate (similar to Tums). The bicarbonate works right away to neutralize existing stomach acid while waiting for the omeprazole to kick in and reduce acid production.
    • peterm8
      peterm8 stoneoakgi

      Posted

      Interesting. I take my PPIs now at the same time every day which is usually about an hour before supper. I only have the stomach burning around 1-2 hours before I have to take my pill so it seems that it doesn't quite last long enough. What the PPI doesn't seem to help with is things like throat pressure starting after a meal if I eat too much or have something that creates too much bloating. It doesn't seem to take much to cause that so I am wondering if have a slow emptying problem or something else making things worse.

      I will look more into Zegerid.

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