Your Stomach and Digestive System Issues, Answered.

This month’s Ask the Doctor series features INTEGRIS gastroenterologist Dr. Abbas Raza, an expert in advanced interventional gastroenterology. Do you suffer from heartburn, gas, abdominal pain or irritable bowel syndrome? Does your esophagus burn from acid reflux? Do you have rectal bleeding or diarrhea? Do you have questions about getting a colonoscopy? Do you have other stomach and digestive system issues not listed here? Then a gastroenterologist is just the doctor for you!

Here are the questions submitted by our readers to Dr. Raza throughout the month.

(Disclaimer notice: The Ask the Doctor series with Dr. Raza is intended to provide general medical information and to support the promotion of health and wellness. The answers provided by Dr. Raza do not constitute medical advice and are not intended to be a substitute for medical care or advice provided by your physician or qualified provider.

Your participation in this article also does not create a physician/patient relationship, and if you have any specific questions about a personal medical matter, please consult your doctor or other professional health care provider).

1. I have chronic heartburn and reflux and have been on either Prilosec, Nexium, or Dexilant for many years. If I go without them, my heartburn is terrible as well as reflux during the night. I had bariatric surgery over 15 years ago, which definitely increases my reflux I think. I’ve heard that it is bad for your health to stay on proton pump inhibitors for a long period of time, but isn’t the risk of cancer from the reflux maybe worse for me?

Gastroesophageal reflux disease (GERD)  is a condition of symptoms and injury to the esophagus caused by percolation of stomach contents, including acid, into the esophagus. GERD is an extremely common condition. If left untreated, it can result in serious complications including esophageal ulcerations, difficulties with swallowing, bleeding, Barrett’s esophagus (a pre-cancerous condition) and esophageal cancer.

And yes, recently there have been concerns raised in several studies about the side effects of proton pump inhibitors. However, in treating this or any other disease, we have to assess the benefits versus side effects ratio. But first we need a definite diagnosis of GERD. In cases like this,  I often suggest the following tests to determine long-term treatment.

• upper endoscopy
• 48 hours of ambulatory esophageal pH monitoring
• a gastric emptying study to evaluate for gastroparesis (slowed gastric emptying). This condition is common in patients with a history of  bariatric surgery.

2. I have been taking prescription acid reflux medication for over 10 years. Should I be concerned about taking this medication for so long? When I don’t take it I get choked and vomit severely. Is there anything I can do other take a pill for the rest of my life?

In cases like this, the goals of treatment should be to alleviate symptoms, heal the esophageal damage caused by acid, and prevent occurrence of complications from acid reflux disease.

I would suggest making some lifestyle modifications, if applicable. These measures should include weight loss, smoking cessation, avoiding meals or eating within three hours of bedtime, and slightly elevating the head of the bed. Your doctor should review all your medications, since some medication side effects include acid reflux.

As for the long-term use of prescription acid medications, I would suggest a thorough evaluation by a physician to identify underlying issues. In cases like this, when one of my patients has a fairly severe symptomatic disease on a long-term basis, I would perform (at least) an upper endoscopy, with or without pH monitoring, to diagnose and then treat the disease.

3. I was on the acid blocker Omeprazole for seven years for heartburn. I also have chronic diarrhea. Could the two be related? If so, should I get off the Omeprazole? What else can I do for my chronic heartburn?

Yes, some proton pump inhibitors can cause diarrhea, but there are many other causes of diarrhea, too. Therefore you should be evaluated for other causes of diarrhea before attributing this symptom to the acid blocker drug. Depending on your age and other medical conditions it will be important to make the definite diagnosis by medical testing, including an upper endoscopy, with or without ambulatory pH monitoring, for acid reflux disease. Proper diagnosis is very important in cases like this where the patient has a long history of symptomatic disease, so that a long-term treatment plan can  be developed.

4. I have heartburn sometimes at night when I go to bed and my husband has it often. What should we do about it? We can’t eat in the evening or we get it for sure. Are there any natural remedies for heartburn that don’t require medication?

I think lifestyle modifications should be tried first. These would include weight loss ( if overweight), smoking cession, avoidance of meals within three hours of bedtime, avoidance of tight-fitting clothing, and some elevation of the head of the bed. Try to decrease consumption of alcohol, caffeine and aggravating foods, such as fried food, onions, and citrus- and tomato-based foods. In addition to these lifestyle modifications, over-the-counter medications for reflux, such as Prilosec OTC, are available.

In cases like these, if the symptoms don’t abate after lifestyle modifications, I would suggest a physician visit for further investigation. If you have any alarming symptoms, such as difficulty with swallowing, unexplained weight loss or anemia due to painful swallowing, you should see your doctor immediately for a referral to a specialist.

5. What exactly is an adenomatous polyp? Should I be worried if my mother has them, starting in her 60s? I am 45 years old. Do you recommend a colonoscopy for me?

Adenomatous polyps are precursors to colorectal cancer. These polyps are believed to develop in a stepwise fashion as a result of a series of genetic mutations. It is widely accepted in the medical community that adenomatous polyps lead to colon cancer. This is supported by several studies, including the National Polyp Study, which found that removal of adenomatous polyps resulted in significantly lower incidence of colon cancer.

In individuals with one first-degree relative with colon cancer or tubular adenoma diagnosed before the age of 60, the risk of developing colon cancer is increased to twice that of the general population. Therefore, in cases like this, I would be in favor of a patient having a colonoscopy at age 45 rather than waiting to turn 50 (which is the age at which everyone should start getting colonoscopies). However, please know that opinions and insurance coverage may vary, so be sure to check with your primary care provider to obtain authorization from your insurance company to have a colonoscopy at age 45.

6. I think I  have hemorrhoids but I’m not sure. How can I tell, and what are the treatments?

Hemorrhoids are normally sort of vascular cushions. When these vessels enlarge, they become symptomatic. The most common symptom is painless, bright red bleeding. There are many theories for causes of symptomatic hemorrhoids. These include pregnancy, diet, straining due to constipation or weight lifting, and heredity.

Treatment of hemorrhoids is dictated by the severity of symptoms and how chronic they are. Most patients require nothing but reassurance and modification of diet. Ointments and suppositories may have a limited role in treatment, but are still widely used. If conservative treatment does not help with symptoms, other available options include rubberband ligation of hemorrhoids, or even surgery by a rectal surgeon in selected cases. In your case I would suggest using stool softeners like Colace. If you are constipated, I would also advise using Miralax powder mixed with water.

In patients who are over the age of 40 and have a family history of colon cancer, and other symptoms like changes in bowel habits, anemia, diarrhea or abdominal pain, I would recommend they undergo thorough evaluation including a colonoscopy.

7. I have diagnosed myself with irritable bowel syndrome. I have loose, runny stools several times a week, and sometimes I have abdominal pain, too. Is this really IBS?

Irritable bowel syndrome is a functional gastrointestinal disorder characterized by chronic, recurrent abdominal pain or discomfort associated with disturbed bowel habits. Most patients with IBS continue to have symptoms for many years. Most population studies have shown prevalence of IBS in up to 15 percent of adults in the U.S. The cause of this disease is poorly understood, although it is probably what we like to call “multi-factorial,” because it likely involves visceral hypersensitivity and altered motility, immune activation, and stress response. Because IBS is known to cluster in families, there may be a genetic component as well.

This is one of the most difficult conditions to diagnose, even by specialists and experts. Therefore, it is not a good idea for you to diagnose this condition by yourself. There are several other diseases which may mimic irritable bowel syndrome. Most important of these conditions would be inflammatory bowel disease, celiac disease, endocrine disorders and cancer (if one has risk factors like age and family history) .
Therefore, I would advise a thorough diagnostic work-up before labeling and treating yourself for irritable bowel syndrome.

8. I worry that my bowel movements aren’t frequent enough. Usually I only have to go once every two or three days. Is this normal?

While it is difficult to define constipation precisely, generally one of these symptoms is sufficient to describe constipation: infrequent bowel movements, painful passage of stool, hard consistency of stool, or difficulty in evacuating stool. Your habit of going only once every two or three days is not normal.

There are numerous causes of constipation, including endocrine disease, diabetes, medications, muscle and nerve disease, and colon cancer. In addition to increasing liquids and fiber in the diet, in cases like these I would suggest setting up a regular, dedicated time for bowel movements, preferably twice a day. Using stool softeners and Miralax  powder with water would also be helpful.

However, the most important thing for you to do is see your doctor to determine the cause or causes of your constipation so that appropriate treatment can be started.

9. I know everyone passes gas and it’s a normal body function, but I think my husband has excessive gas. It’s pretty much a constant thing every night. Is it normal that it happens at a certain time of day? Is there anything he can do to treat this in the long-term?

Excessive gas production in the gastrointestinal tract is also called flatulence. In the majority of times, this symptom is caused by involuntary swallowing of air. However, sometimes this symptom can be due to carbohydrate malabsorption, artificial sweeteners, allergies to foods like gluten, bacterial overgrowth in the intestine, or slowed gastric emptying. Any obstruction of the GI tract can also cause one to have excessive gas.

Once we have excluded any disease, this symptom can be treated with dietary modifications and some lifestyle changes, including stress reduction techniques. Also, some antibiotics have been shown to reduce intestinal gas production.

Therefore, in cases like this, I would suggest a visit to the doctor to make sure there are no treatable conditions. Once this evaluation is complete I often recommend a visit to a dietitian who can help those who suffer from excessive gas make dietary changes to help reduce gas production.

10. As I get older, I have acid reflux that wakes me almost every night. What can I do about it? It’s much worse than standard heartburn, I think. Should I be worried?

Gastroesophageal reflux disease (GERD) is a very common disease. Classic symptoms are usually heartburn, and/or regurgitation of food. If this disease is not diagnosed and treated appropriately,  it can result in some serious problems, including esophageal ulcerations, difficulty with swallowing, Barrett’s esophagus (a pre-cancerous condition) and esophageal cancer. There are some extra gastrointestinal manifestations of this disease as well. These include chest pain, chronic cough, asthma, dental cavities, hoarseness of voice and chronic sinusitis.

In cases like this, I would suggest lifestyle modifications, including achievement of ideal BMI (body mass index), smoking cession if applicable, avoidance of meals within three hours of bedtime, and slight elevation of the head of the bed. Some medications can cause or make acid reflux worse, so I encourage patients to review their medications with their doctor. I also encourage my patients to decrease use of carbonated beverages, caffeine, citrus- and tomato-based foods, and (of course) fatty and large meals.

When a patient has symptoms of heartburn that are longstanding and worsening with advancing age, I would recommend a direct visualization by endoscopic examination to assess the severity of the disease, to exclude any complications and to formulate a long-term treatment goal. An upper endoscopy is a routine and safe procedure when performed by a well-trained and qualified physician specializing in gastroenterology.

11. What is diverticulitis, and how do you know if you have it? Is it preventable? How is it treated?

A diverticulum is a circumscribed pouch or sac that either occurs naturally or is created by herniation of the first mucosal lining of the GI tract through a defect in the muscle wall layer of the intestine. Multiple diverticulum are called diverticulosis. When these diverticula get infected it’s called “diverticulitis,” an acute, painful disease.

Although the specific cause of diverticulitis is unknown, the development likely involves mechanical, environmental and lifestyle factors. Contributing factors include age older than 50, obesity, sedentary lifestyle, corticosteroids, use of NSAIDs, smoking, constipation and excessive alcohol consumption. Therefore, this condition is partially preventable by modifying these factors (except for age). In western societies, 95 percent of diverticula are located on left side of the colon.

Mild diverticulitis is treated on an outpatient basis with clear liquids or a low-residue diet for a few weeks, as prescribed by your doctor. After complete resolution of the acute event, the colon should be evaluated by a colonoscopy, barium enema, or CT colography to ensure absence of other diseases of the colon, including cancer.

Moderate-to-severe disease is usually treated on an inpatient basis, with nothing by mouth, intravenous fluids, antibiotics, pain control and a CAT scan to assess for any local complications, such as abscess formation and/or perforation. In these complicated cases surgical intervention generally becomes necessary. Once again, after resolution of the severe episode, one should  have a colonoscopy, barium enema, or CT colography about four weeks later.

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Abbas Raza, M.D., is the director of the advanced diagnostic and interventional gastrointestinal endoscopy program at INTEGRIS Nazih Zuhdi Transplant Institute. He brings extensive training and experience in the gastroenterology field. Upon completion of his internal medicine residency at the University of Tennessee College of Medicine, Dr. Raza was selected as a gastroenterology/hepatology fellow at the University of Oklahoma Health Science Center in Oklahoma City. He continued his advanced gastroenterology training as a Fellow at Thomas Jefferson Medical College and University Hospital in Philadelphia. Dedicated to specialized training in advanced interventional endoscopies, his focus included therapeutic ERCP and endoscopic ultrasonography. His contributions in the field of gastrointestinal endoscopy have earned Dr. Raza the selection of Fellow of the American Society of Gastrointestinal Endoscopy.

Certified by the American Board of Internal Medicine and Gastroenterology, Dr. Raza’s professional interests and experience include:

• Early diagnosis, staging and treatment of pancreatic cancer
• Prevention, screening, diagnosis and staging of gastrointestinal cancer
• Diagnostic and therapeutic ERCPs
• General and interventional gastrointestinal endoscopy
• Endoscopic ultrasonography
• Capsule endoscopy

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Omeprazole: medicine to reduce stomach acid

It’s usual to take omeprazole once a day, first thing in the morning. It does not upset the stomach, so you can take it with or without food.

If you take omeprazole twice a day, take 1 dose in the morning and 1 dose in the evening.

Dosage

The usual dose to treat:

• indigestion is 10mg to 20mg a day
• heartburn and acid reflux is 20mg to 40mg a day
• stomach ulcers is 20mg to 40mg a day
• Zollinger-Ellison syndrome is 20mg to 120mg a day

Doses are usually lower for children and people with liver problems.

Tablets and capsules

Each tablet or capsule contains 10mg, 20mg or 40mg of omeprazole.

Swallow tablets and capsules whole with a glass of water or juice.

If you have problems swallowing capsules, you can open some brands of omeprazole capsules and mix the granules inside with a small amount of water or fruit juice, or sprinkle them on soft food, such as yoghurt or apple puree.

Do not open capsules that have a special coating (like those made by Dexel). Talk to your pharmacist if you’re not sure whether you can open your capsules.

Omeprazole also comes as a tablet that melts in your mouth.

You can buy omeprazole 10mg tablets and capsules from pharmacies.

They’re the same as omeprazole 10mg tablets and capsules that you get on prescription, but they’re meant to be taken only by adults, and only for up to 4 weeks.

Liquid omeprazole

Liquid omeprazole can be prescribed by a doctor and made to order for children and people who cannot swallow capsules or tablets.

It’ll come with a syringe or spoon to help you take the right amount. If you do not have a syringe or spoon, ask your pharmacist for one.

Do not use a kitchen teaspoon as it will not give the right amount.

Will my dose go up or down?

Sometimes your doctor will increase your dose of omeprazole if it is not working well enough.

Depending on the reason you take omeprazole, you may take a higher dose to begin with, usually for a few weeks.

After this, your doctor may recommend that you take a lower dose.

How long will I take it for?

If you bought the medicine yourself from a pharmacy, tell your doctor if you feel no better after taking omeprazole for 2 weeks.

They may want to do tests to find out what’s causing your symptoms or change you to a different medicine.

Depending on your illness or the reason you’re taking omeprazole, you may only need it for a few weeks or months.

Sometimes you might need to take it for longer, even for many years.

Some people do not need to take omeprazole every day and take it only when they have symptoms.

Once you feel better (often after a few days or weeks), you can stop taking it.

But taking omeprazole in this way is not suitable for everyone. Talk to your doctor about what’s best for you.

What if I forget to take it?

• If you usually take it once a day, take the missed dose as soon as you remember, unless it’s within 12 hours of your next dose, in which case skip the missed dose.
• If you usually take it twice a day, take the missed dose as soon as you remember, unless it’s within 4 hours of your next dose, in which case skip the missed dose.

Do not take a double dose to make up for a forgotten dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

It’s very unlikely that taking 1 or 2 extra doses by accident will cause any problems.

But you should check with your doctor if you have taken too much and have any of these symptoms:

• flushed skin
• feeling sweaty
• a fast heartbeat
• feeling sleepy
• blurred vision
• feeling confused or agitated

Gastrointestinal symptoms associated with gastroesophageal reflux disease, and their relapses after treatment with proton pump inhibitors: A systematic review

Abstract

Gastroesophageal reflux disease (GERD) is a common functional gastrointestinal disorder with significant effects on the quality of life. The burden of GERD is soaring in Asia. Preventing symptom relapse is a therapeutic goal in GERD patients. Since proton pump inhibitors (PPI) are the first-line treatment of GERD, drug failure has become a major problem in the treatment procedure. We reviewed the literature in order to find articles related to comorbidities and symptoms affecting GERD from 1980 to 2015 via PubMed and Google Scholar using keywords such as ‘Gastroesophageal reflux disease’, ‘Gastrointestinal symptoms’ and Boolean operators (such as AND, OR, NOT). Due to the cost of PPI therapy and the high rate of GERD relapse after PPI therapy, demand for continuing this type of treatment is decreasing. Thus, we need to discover new approaches to treat the disease and also investigate the relationship between the treatment of GERD and its comorbidities and symptoms such as functional constipation.

Keywords: Gastroesophageal reflux disease (GERD), Proton pump inhibitors (PPI), Comorbidities, Relapse

1.

Introduction

The chronic or recurrent gastrointestinal symptoms which cannot be explained through structural or biochemical abnormalities are referred to as functional gastrointestinal disorders (FGIDs). Such disorders are highly prevalent (1). GERD is a common FGID with a significant impact on the quality of life (2). Approximately 50% of infants younger than 3 months are affected by GERD (3). In this disorder, stomach acid or sporadic stomach content moves up from the stomach into the esophagus. It has been reported that permanent or temporary changes in the barrier between the stomach and the esophagus like abnormal movements of the lower esophageal sphincter and hiatal hernia are the major factors likely to lead to GERD. The burden of GERD is soaring in Asia and the majority of GERD patients are known to have non erosive reflux disease (NERD) (4). Proton pump inhibitors (PPI) and h3 receptor blockers or antacids are recognized as the first-line treatment of GERD. Preventing symptom relapse is a therapeutic goal in GERD patients (5). Therefore, PPI failure has turned into a major problem in the treatment procedure of GERD. Since there is a fair chance of GERD to be overlapped with other diseases, it is likely that the disease originates from the NERD phenotype leading to drug failure in GERD patients (6). As a result, we need to discover new approaches as to treat or prevent GERD. Several studies have focused on the treatment of GERD comorbidities and its associated symptoms such as FC in the face of treatment (7, 8). GERD and FC are the most common causes of referral to pediatricians within the first six months of life (2). Since a number of studies have indicated a significant relationship between GERD and FC, investigating the influence of these mechanisms on each other may lead us to a better understanding of the appropriate treatment for GERD. As such, the current systematic review aimed to answer the following questions:

1. What are the most common comorbidities in GERD patients?

2. What are the most frequent symptoms associated with GERD?

3. Is there a relationship between the changes in bowel function and reflux?

4. Is there a distinct relationship between GERD and FC?

5. Could PPI therapy act as the appropriate treatment for GERD?

6. What is the rate of symptom relapse in GERD after PPI treatment?

2.

Material and Methods

2.1. Literature search strategy

We reviewed the literature in order to find articles related to comorbidities and symptoms affecting GERD from 1980 to 2015 via PubMed and Google Scholar, using keywords such as ‘Gastroesophageal reflux disease’, ‘Gastrointestinal symptoms’ and Boolean operators (such as AND, OR, NOT), which are listed as follows: 1) Gastroesophageal reflux disease (GERD), 2) Gastric reflux disease, 3) Acid reflux disease 4) Functional gastrointestinal disorders (FGID), 5) Esophageal disease, 6) Functional constipation (FC), 7) Constipation, 8) Gastrointestinal symptoms, 9) Risk factors of gastroesophageal reflux disease, 10) Risk factors of gastrointestinal disease, 11) Gastrointestinal symptoms, 12) Esophageal disease, 13) Functional bowel disorders (FBD), GERD, 15) Gastrointestinal motility disorders, 16) Proton pump inhibitors (PPI), 17) Esophageal disease symptoms, 18) Gastroesophageal reflux disease symptoms, 19) GERD recurrence, 20) GERD relapse, and 21) h3 blocker.

2.2. Exclusion criteria

Expert opinions, consensus statements, case reports, editorials and letters, and qualitative studies were excluded from this review. The selected studies were published in English, but studies conducted in other languages were excluded.

2.3. Search strategy

Since a variety of different factors were assessed in the selected studies, the comparison between them could not be done in a straight forward manner and all the articles were evaluated in terms of the inclusion criteria in the present study. In total, 751 items found and 50 articles, which mainly focused on the comorbidities and the symptoms affecting GERD, PPI therapy and the rate of symptom relapse, were included in the current review. Ultimately, the findings of the selected articles were summarized in different subsections.

All the repetitive and irrelevant studies were removed from this systematic review. Moreover, the remaining articles were investigated as to discover the comorbidities and symptoms affecting GERD, the treatment procedure and the rate of symptom relapse in the GERD patients who were treated by PPI. These articles were evaluated in their full text after the screening step was complete, and the references were carefully organized during the next steps. The quality assessment of articles was based on two standards, CONSORT for clinical trials and PRISMA for review articles. The screening procedures are illustrated in the PRISMA flow diagram ().

PRISMA Flow Diagram: The screening process of articles in the current study

3. Results and discussion

3.1. The most common comorbidities in GERD patients

To the best of our knowledge, GERD is a prevalent type of FGID which exerts a negative effect on the quality of life. The study of Indrio et al. claimed that infantile colic, gastroesophageal reflux and constipation are the most common causes of referral to pediatricians within the first six months of life. It might result in the patient’s hospitalization, use of medications as well as anxiety and waste of time on behalf of parents (2). Digestive disorders associated with GERD have been assessed in many studies. According to the study of Rasmussen et al., which aimed to investigate the prevalence and overlap of GERD, functional dyspepsia (FD) and irritable bowel syndrome (IBS) in a Western population, the prevalence of GERD was reported to be 11.2%. Furthermore, the overlap between two or three of these disorders (GERD, FD, and IBS) was as much as 6.5%. Also, 30.7% of the patients who showed one or more of the factors of GERD, FD and IBS disorders, were found to have an overlap between two or all these disorders. Their study proved an overlap to be probable as well as frequent between these disorders (9). The results of De Vries et al.’s study indicated that FD and IBS were more prevalent in GERD patients compared to the general population (10). For this reason, the recognition of the diseases and the associated symptoms plays a major role in the treatment, elimination and prevention of this disease. Similar to Rasmussen et al and De Vries et al., the study of Pimentel et al. was indicative of a higher prevalence of IBS in the subjects with GERD compared with those without GERD. Another study conducted on a Korean population revealed that the overlaps between GERD, dyspepsia and IBS are frequent in the general population occurring in anxious people. In total, compared with GERD, dyspepsia, and IBS alone, a significant difference was detected between anxiety and GERD, dyspepsia and IBS overlap (11). The overlap between GERD and IBS was mentioned a lot (12–17). GERD is known as a psychosomatic disease which involves complex biopsychosocial problems (18) which have a negative effect on the individuals’ quality of life (19). According to the results of the aforementioned studies, IBS, among functional bowel disorders, is proven to be most significantly associated with GERD. Moreover, there seems to be an undeniable correlation between GERD and functional bowel disorders. Consequently, we attempted to reorganize the gastrointestinal and functional bowel disorder symptoms and their association with GERD (20–21). The most frequent comorbidities and the rate of overlap in GERD patients based on different studies are shown in .

Table 1

The most common comorbidities in GERD patients

Ref. no.	Country	Comorbidities, Diseases and Disorders	Results and Rate of Overlap
9	Denmark	Functional dyspepsia (FD) and irritable bowel syndrome (IBS)	The overlap between GERD, FD, and IBS was 6.5%. 30.7% of the patients with one or more of the GERD, FD and IBS criteria had overlap between two or all three disorders.
16	UK	Increased prevalence of GERD and IBS symptoms was associated with coeliac disease and IBD	Odds ratio of coeliac disease and IBD were 6.8% and 2.2% in GERD patients with severe symptoms.
20	USA	IBS	71% of GERD patients had IBS and there was a higher prevalence of IBS in subjects with GERD compared with non-GERD subjects.
10	Netherlands	FD, IBS and both FD and IBS	25%, 35%, and 5% of GERD patients had FD (14% in general population), IBS (0.6–6% in general population), and both FD and IBS, respectively.
11	Korea	GERD, dyspepsia and IBS	Overlaps between GERD, dyspepsia and IBS were observed in 2.3% and 2%. Overlaps between dyspepsia and IBS were observed in 2% and 1.3% of the population.
12	Iran	IBS, GERD and dyspepsia	74.7% and 77.9% of IBS patients simultaneously suffered from GERD and dyspepsia symptoms. Also 66% of GERD patients had dyspepsia.
17	Italy	IBS and Functional heartburn (FH)	Possible concomitance of GERD or FH with IBS and the pathophysiological relationships between these disorders.
14	Iran	IBS and functional symptoms	63.6% of IBS subjects and 34.7% of non-IBS patients suffered from GERD (p<0.05). 33.9% of GERD patients compared to 13.5% of non-GERD patients had Rome criteria.
13	Singapore	Dyspepsia and IBS	Dyspepsia and irritable bowel syndrome are co-existing disorders with GERD.
8	China	Chronic abdominal pain/bloating, chronic diarrhea/constipation, FBD, IBS and functional constipation	25.2%, 14%, 10.3%, and 7.5% of GERD patients had chronic bloating, chronic constipation, IBS and FC and the rate of these symptoms was higher in GERD patients than non-GERD patients. In total, the rate of GERD combined with chronic bloating and constipation had overlaps with IBS and FC.

3.2. The relationship between changes of bowel function, constipation and GERD

The findings of epidemiological studies in the adult population are suggestive of a significant overlap between the functional disorders of the digestive system. As such, two major and integral components of childhood functional gastrointestinal disorders are FC and GERD (22–25). Reorganization of GERD symptoms as well as the causes of its association with FC are paramount due to their remarkable impact on the patient’s quality of life. For this reason, we also attempted to investigate the correlation between GERD and FC. Evidently, there is a relationship between GERD disorder and functional bowel diseases (FBD). Since FC is one of the most prominent symptoms of FBD, there might also be comorbidity between the GERD disorder and FC. This finding has been confirmed by several studies. In this regard, the study of Zeitoun et al. showed that 84% of the patients with Ehlers-Danlos syndrome (EDS) also suffered from FBD. Overall, a significant correlation was found between FBD and GERD (23–24). Jiang et al. aimed to assess the prevalence of common symptoms of gastrointestinal and GERD combined with functional bowel disorders (FBD). The frequency and severity of GERD symptoms were measured by a Chinese Reflux Disease Questionnaire (RDQ). Approximately 10% of the patients, who showed symptoms of GERD, were really diagnosed with this disease (8). Another study was performed by Baran et al. to evaluate the frequency of GERD in children with FC. According to the results of that study, delayed gastric emptying symptoms were more prevalent in the patients with FC. In addition, pyrosis, hiccups and belching were observed to be common in FC patients with and without acid reflux (22).

3.3. Treatment of GERD symptoms with proton pump inhibitors (PPI)

Proton pump inhibitors (PPI) and h3 receptor blockers or antacids are the first-line treatment of GERD. In patients with certain conditions or the ones who do not show signs of improvement, surgery might be optional to treatment. Normally, it occurs in 10–20% of the population in Western countries. Due to the fact that there is evidence of overlap in GERD, IBS and FD patients, and also because of the lack of major pharmacological breakthrough in the treatment of this overlap, the study of Monnikes et al. was performed in order to evaluate the stability of GERD healing process and determine whether the effects of PPI treatment on the GERD would also apply to symptoms of IBS and FD. According to their findings, pantoprazole decreased the prevalence of GERD combined with FD, IBS or reflux symptoms. After discontinuing the medication, the rates of FD and IBS were stabilized at a relatively low level. However, reflux symptoms increased again after the cessation of the medication (26). Another study which was performed in Pakistan in order to evaluate the rate of PPI use in GERD patients with typical symptoms, showed that the omeprazole was the medication of choice (16). The study of Yamaji et al. was conducted in order to determine whether the symptoms of GERD would improve by the prokinetic activity of mosapride combined with PPI. According to their results, no additional improvements of reflux symptoms were observed in the patients who used mosapride combined with PPI compared to those who only received PPI (27). In the study of Remes-Troche et al, the severity of GERD symptoms decreased by at least 80% from the baseline after the treatment with pantoprazole magnesium (28). The study of Moraes-Filho et al. was designed to compare the efficacy of pantoprazole and esomeprazole in GERD patients. According to the results of that study, no significant differences were found in the improvement of GERD patients in four weeks. At week 8, GERD symptom had shown a more noticeable improvement in the patients who used pantoprazole (91.6%) compared to the patients who had used esomeprazole (86.0%) (p=0.0370) (29). Another study which was performed to evaluate the safety and efficacy of esomeprazole combined with flupentixol/melitracen for the treatment of GERD patients with emotional disorders, proved the combination therapy to be more effective and safer in the treatment of patients who had gastroesophageal reflux (30). The study of Chiu et al. aimed to investigate the efficacy and safety of sodium alginate suspension compared to omeprazole NERD patients. According to their study, sodium alginate was as effective as omeprazole for symptomatic relief in patients with non-erosive reflux disease (4). Similar to the study of Chiu et al. (4), omeprazole 20 mg was used for the treatment of reflux symptoms in the study of Abbasinazari et al. Omeprazole plus SR (Sustained Release) baclofen was administered versus omeprazole 20 mg/d plus placebo. The results of the study revealed that SR baclofen plus omeprazole is more effective than omeprazole alone in the treatment of reflux symptoms (heartburn and regurgitation) (31). Another study which was conducted to compare the effects of single-dose morning versus nighttime once-daily omeprazole/sodium bicarbonate (Zegerid (®) (IR-OME) in patients with esophagitis and symptoms of gastroesophageal reflux, showed that the reflux esophagitis and GERD symptoms improved after taking IR-OME (32–33). According to the study of Kim et al., poor response to PPI treatment is a result of psychological factors, sleep dysfunction and BMI lower 23kg/m in patients with GERD symptoms (34). The study of De Milliano et al. aimed to determine the effects of a mixture of probiotics in the treatment of constipation during pregnancy (35). According to the study of Perry et al., in western societies, 10% of the population is affected by GERD (36). The disease is known to have cost the United States healthcare system over 9 billion dollars per year (37). Drug failure is experienced by 30–40 % of the patients who receive PPI therapy. The recent findings are indicative of the fact that the risk of complications is increasing among these patients. Regarding the diverse number of patients who experience medically inappropriate treatments and the number of surgeries, there is a substantial therapeutic gap in the management of GERD (36). For this reason, we need to discover new approaches to treat or prevent GERD. Several studies have focused on diet therapy (1, 38, 39) while some others have emphasized on the treatment of GERD comorbidities such as IBS and the associated symptoms like FC (7,8) for the treatment, elimination or prevention of GERD.

3.4. Relapse of GERD symptoms after PPI and h3 blocker therapy

As we know, GERD treatment is highly costly. In some studies, step-down from PPI is used in order to obtain a less expensive therapy. In the study of Inadomi et al., a total of 117 subjects received treatment from step-down to single-dose PPI. The majority of the patients did not report recurrent symptoms of reflux symptom during the 6 months and their quality of life did not alter significantly. However, the rate of dyspepsia was observed to increase (40–43).

In a study performed by Yoshida et al., it was suggested that rebamipide plus lansoprazole could be effective in preventing the symptom relapse of GERD in the long run, and it could also be used as a maintenance treatment for this disorder (5). According to another study, the recurrence rate was 25%, 30.8%, and 4.4% in the patients receiving treatment with omeprazole, lansoprazole, and rabeprazole, respectively (44). In the other study on the same subject, Omeprazole was more effective than cimetidine in preventing the recurrence of GERD-associated heartburn (45). The study of Usai et al. emphasized the role of a gluten-free diet (GFD) in diminishing GERD symptoms as well as in preventing the recurrence of these symptoms (46). The study of Miyake et al was performed to assess the effects of famotidine to prevent the recurrence of reflux esophagitis. According to their results, improvements were observed within seven days (47). The study of Caro et al. showed that PPIs were found to be effective in the recovery of erosive esophagitis and decreasing relapse rates compared to ranitidine and placebo (48). The rates of GERD symptom relapse after PPI orh3 blocker therapy are shown in .

Table 2

The rate of GERD symptom relapse after PPI or h3 blocker therapy

Ref. no.	Country	Number/Dosage	Rate symptom relapse
43	USA	117 subjects were treated with step-down to single-dose PPI	79.5% of the patients did not report recurrent symptoms of reflux during the 6 months
5	Japan	41 patients treated by15 mg/d of lansoprazole or 15 mg of lansoprazole and 300 mg/d rebamipide for 8 weeks	After 12 months, 52.4% and 20% of the patients were treated by lansoprazole and lansoprazole plus rebamipide experienced recurrence of symptoms (p<0.05)
44	Japan	99 patients treated by rabeprazole (10mg/day), omeprazole (20mg/day) or lansoprazole (15mg/day).	After 6 months, the recurrence rate was 25%, 30.8%, and 4.4% in patients who were treated by omeprazole, lansoprazole, and rabeprazole, respectively.
46	Italy	105 patients treated by proton-pump inhibitor (PPI) for 8 weeks	Recurrence of GERD-rs was observed in about 20% of patients. This was found out after 12, 18, and 24 months
47	Japan	17 handicapped children; Famotidine 1 to 2 mg/kg, twice a day>10kg three times a day<10 kg.	Reduction of vomiting or hematemesis (or both) within two weeks in 70% of cases and within three weeks in 94%. Famotidine was effective in 29% and moderately effective in 41%; no side effects were observed
45	UK	156 patients; Omeprazole (20mg/d) and cimetidine (400mg qds) prescribed for 4 weeks	The median time to symptomatic relapse was longer in patients receiving omeprazole (169 vs. 15 days) (p=0.0001)

4. Conclusions

GERD has a negative impact on the individuals’ quality of life. Moreover, an undeniable connection seems to exist between GERD and other GI disorders. Therefore, investigating the relationship between the treatment of GERD and its comorbidities and symptoms such as FC is of paramount importance. Due to the cost of PPI therapy and the high rate of GERD relapse after PPI therapy, demand for continuing this type of treatment is decreasing. Thus, we need to discover new approaches as to treat or prevent GERD bridging the therapeutic gap in the management of this disease.

Footnotes

iThenticate screening: January 24, 2017, English editing: February 10, 2017, Quality control: April 14, 2017

Conflict of Interest:

There is no conflict of interest to be declared.

Authors’ contributions:

All authors contributed to this project and article equally. All authors read and approved the final manuscript.

Baby Acid Reflux Medications; What You Need To Know

There are various baby acid reflux medications available and health care professionals are able to prescribe them to your baby if they suspect your baby has acid reflux, also known as gastro-oesophagus reflux disease (GERD).

Most parents implicitly trust health care professionals that these medications are appropriate, but we are not given much information about them. What are these medications that are being given to our babies? Here I explain the common baby acid reflux medications and the issues surrounding them.

Gaviscon

Gaviscon is often the first medication offered to babies who present with reflux symptoms. It is an alginate which reacts with stomach contents. It creates a gel like layer and thickens the milk in the stomach to prevent it from flowing back up the oesophagus. You dissolve it in the milk if your baby is formula fed or given to baby before a feed if your baby is breast fed.

Although many parents feel that it helps reduce the amount
of milk being regurgitated, it has been widely reported that it causes
constipation. This is because it is more difficult for the milk to be digested
due to it being thicker. Constipation itself can cause many difficulties such
as wind, bloating and stomach cramps.

Omeprazole    

This is a proton pump inhibitor (PPI) and is used as an acid suppressant. This reduces how much acid the stomach makes by inhibiting the enzymes that produce the stomach acid. It can help a baby who is suffering from acid reflux. This can often present as ‘silent reflux’ when the baby does not regurgitate milk but is very uncomfortable and it is believed that stomach acid is washing back up.

However, advice is not to give this to infants under the age of 12 months. Yet it is widely prescribed by health care professionals to babies under this age. It has a lot of side effects such as nausea, headaches, stomach cramps and constipation. A baby can’t tell you that they are suffering from a headache, they just cry. This is probably why many parents report that their baby continues to cry whilst taking this drug.

Also, it is worth noting that omeprazole is designed to be a short term resolution as we need stomach acid to keep bacteria and other pathogens at bay. Another of the side effects is bacteria overgrowth due to the lack of stomach acid. Unfortunately, not many parents are given advice on when and how to wean their babies off this medication.

Ranitidine

This medication is known as a h3 blocker or a Histamine 2 Receptor. Similar to a PPI, it reduces stomach acid. This is done by stopping the histamine-2 response in the stomach which stimulates gastric acid production. You may know this medication as Zantac or Pepcid. It is now much more difficult to be prescribed this medication due to it’s recall. Tests found that it contained cancer causing chemicals, therefore there has been a move away from this drug.

Educating parents

Reflux is very difficult and of course you want to help your baby as much as you possibly can. This is why we turn to health care professionals to provide us with a solution. This article isn’t intended to advise you against baby acid reflux medications. It’s purpose is to educate parents on the medications that are being prescribed because knowledge is the best defence against colic and reflux.

For more information on how I can help you with your baby and discover the underlying cause of your baby’s distress click here https://colicsos.com/colic-services/ or book your free 15 minute call.

Conditions, Symptoms, and Treatments – KnowYourOTCs.org

Whether eating a greasy cheeseburger or an apple, your digestive system is designed to turn the food you eat into the nutrients your body needs for energy, growth, and cell repair. The digestive tract (or gastrointestinal tract) is a long twisting tube that starts at your mouth and ends at your anus. Along the way are a series of muscles that coordinate how food moves through your body and other cells that produce enzymes and hormones to aid in the breakdown of food.

When the process works as it should, you’re happily unaware. But when there’s a problem, the signs are easy to recognize – diarrhea, bloating, constipation, heartburn, and belly pain. Keep reading to learn more about common tummy troubles and how to treat them.

Heartburn

Also referred to as acid reflux, heartburn is an uncomfortable, painful, or burning feeling in your chest or throat that may begin after a meal and last a few minutes to many hours. It happens when stomach acid backs up into your esophagus, the tube that carries food from your mouth to your stomach. Other symptoms may include a hot, sour, or acidic fluid felt in the back of your throat, as well as a cough that lasts for a while, sore throat, or hoarse voice.

If you experience heartburn, you know it’s more than just uncomfortable or painful – it can affect your daily life. It can also disrupt sleep, productivity at work, and social occasions. It’s important not to ignore your symptoms. Even a small amount of stomach acid can cause significant pain or discomfort. If left untreated, the stomach acid that causes heartburn can even damage your esophagus and teeth.

Heartburn Treatments

When deciding how to treat your heartburn symptoms, there are many options to consider. Occasional and frequent heartburn is relatively common and can be managed with lifestyle changes as well as with certain over-the-counter (OTC) medicines. There are also several lifestyle changes that you can make to help reduce or avoid the symptoms of heartburn including, maintaining a healthy weight, not smoking, and/or practicing relaxation techniques.

More chronic or severe cases of heartburn can result from a diagnosed condition called gastroesophageal reflux disease (GERD) and may require more intensive medical care such as using prescription (Rx) medicines or even surgery. For more information about safely treating your heartburn symptoms, check out this advice from one of our medical experts.

Antacids

These medicines provide quick heartburn relief by neutralizing or weakening the stomach acid. They usually come as a liquid, chewable gummy or tablet, or a tablet that you dissolve in water to drink. While antacids are quick and convenient, they don’t prevent future episodes of heartburn.

OTC antacids:

h3 Blockers

These medicines are named after the receptor they block, the h3 receptor, which reduces the amount of acid your stomach makes. Symptom relief from h3 blockers tends to last longer than antacids, but it also takes longer for them to start working. One h3 blocker tablet can be taken before a meal to prevent heartburn or after a meal to relieve heartburn. Typically, you should not take more than two tablets in a 24-hour period.

OTC h3 blockers:

Proton Pump Inhibitors (PPIs)

These medicines are used to treat frequent heartburn (occurs two or more days a week) by blocking the production of stomach acid at its source. OTC PPIs should be taken once a day (in the morning before a meal) for 14 days, up to three times per year, unless directed by a doctor. They take one to four days to work.

OTC proton pump inhibitors (PPIs):

!

Safe use tips for heartburn medicines

Always read the Drug Facts label carefully. The label tells you everything you need to know about the medicine, including the ingredients, what you are supposed to use it for, how much you should take, and when you should not take the product.

Talk to your healthcare provider if you still experience heartburn symptoms after taking these medicines. Persistent heartburn symptoms may be a sign of a more serious underlying condition.

Unless directed by your doctor, do not take heartburn medicines more often than directed on the label.

Heartburn medicines can interact with other medicines, so tell your pharmacist or healthcare provider about all medicines you are taking.

Infants and children can experience heartburn. Treatment for heartburn in children is determine by a healthcare provider based on the child’s age, overall health and medical history, and severity of symptoms.

Keep all medicines out of the reach and sight of children.

Diarrhea

We’ve all been there. You know it’s diarrhea when you pass loose, watery stools that leave you making several urgent trips to the bathroom in a short period of time. You may also experience cramping, abdominal pain, bloating, nausea, fever, and/or vomiting. In most cases, diarrhea lasts 2-3 days and can be treated with over-the-counter (OTC) medicines. For mild cases, the most important things you can do is to stay hydrated as the diarrhea runs its course and avoid foods that will make your symptoms worse.

For more serious cases, when diarrhea lasts more than three days, or a child has been experiencing symptoms for more than 24 hours, it’s important to consult your healthcare provider.

Diarrhea Treatments

While most of the time minor bouts of diarrhea do not need to be treated, there are some OTC medicines that can help you find fast relief.

Antidiarrheals

These medicines can help to slow or stop loose, watery stools. But you shouldn’t take them for very long. You should also see your doctor if you find that you rely on these medicines often. They may help you find temporary relief, but it’s important to find out what is causing your diarrhea in the first place.

OTC antidiarrheals:

!

Safe use tips for antidirrheal medicines

Always read the Drug Facts label carefully. The label tells you everything you need to know about the medicine, including the ingredients, what you are supposed to use it for, how much you should take, and when you should not take the product.

You should never take more medicine or for a longer period of time than what the Drug Facts label says.

You should drink plenty of clear fluids to help prevent dehydration caused by diarrhea.

Constipation

Constipation, or occasional irregularity, is a fairly common condition that is defined as infrequent bowel movements accompanied by hard, dry stool that is difficult or painful to pass. While normal bowel frequency varies from person to person, you may be suffering from constipation if you have to strain excessively, pass less than three stools in a week, and have a “blocked” feeling in your rectal area.

There are many reasons why you may become irregular, including poor diet, dehydration, and lack of exercise. The root cause of constipation is when the muscle contractions in the colon become sluggish or the colon absorbs too much water, which makes the stool become hard and dry and move too slowly through the colon.

Constipation Treatments

Laxatives, like all over-the-counter (OTC) medicines, contain certain active ingredients that make the products work in the human body. There are six basic types of OTC laxatives, listed below. Depending on the product type, laxatives can be taken orally or inserted into the rectum. Some laxatives may contain more than one active ingredient.

Bulk-forming Laxatives

These medicines increase bulk volume and water content of the stool which promotes a bowel movement. These OTC products are for oral use and must be taken with plenty of fluid. Bulk-forming laxatives generally product a bowel movement within 12 to 72 hours.

OTC bulk-forming laxatives:

Hyperosmotic Laxatives

These medicines attract water into the stool which promotes bowel movement. OTC hyperosmotic laxatives in suppository form are intended to be inserted into the rectum and generally product a bowel movement within 15 minutes to one hour. If taken orally, they generally product a bowel movement in one to three days.

OTC hyperosmotic laxatives:

• Glycerin
• Polyethylene glycol 3350
  MiraLAX^®

Lubricant Laxatives

These medicines coat the intestinal tract and soften the stool which helps to lessen straining and promote a bowel movement. OTC lubricant laxatives that are taken orally, they generally product a bowel movement within six to eight hours. Those that are used rectally generally produce a bowel movement within two to 15 minutes.

OTC lubricant laxatives:

Saline Laxatives

These medicines draw water into the colon which promotes bowel movement. OTC saline laxatives that are taken orally generally produce a bowel movement within six to 12 hours. Those that are used rectally generally produce a bowel movement within two to 15 minutes.

OTC saline laxatives:

• Dibasic sodium phosphate
• Magnesium hydroxide
• Monobasic sodium phosphate

Stimulant Laxatives

These medicines cause rhythmic muscle contractions in the intestines which promote bowel movement. OTC stimulant laxatives that are taken orally generally produce a bowel movement within 12 to 72 hours. Those that are used rectally generally produce a bowel movement within two to 15 minutes.

OTC stimulant laxatives:

Stool Softener Laxatives

These medicines penetrate and moisten the stool which prevents dryness and promotes a bowel movement. OTC stool softeners that are taken orally generally produce a bowel movement within 12 to 72 hours. Those that are used rectally generally produce a bowel movement within two to 15 minutes.

OTC stool softener laxatives:

!

Safe use tips for laxative medicines

Always read the Drug Facts label carefully. The label tells you everything you need to know about the medicine, including the ingredients, what you are supposed to use it for, how much you should take, and when you should not take the product.

Ask a healthcare provider before using a laxative if you have abdominal pain, nausea, vomiting, or have noticed a sudden change in bowel habits lasting for two weeks.

Stop using a laxative and contact your healthcare provider if you have rectal bleeding or no bowel movement after use. These could be signs of a serious condition.

When using an enema, be careful not to use force when inserting the product’s tip into the rectum.

If you are pregnant or nursing, talk to a doctor before using a laxative.

Talk to a healthcare provider before using a suppository on a child under the age of two.

Discontinue use of a suppository on a child if you encounter resistance. Forcing product insertion may cause injury.

OTC laxatives are available in different dosage strengths. Do not give any medicine to a child that is only intended for use in an adult.

Gas

As you digest food, gas is a normal result of the process. But while it’s an ordinary occurrence, it can be painful and embarrassing at times.

Gas Treatments

In addition to making changes to your diet and ensuring you chew food properly, there are also over-the-counter (OTC) medicines available to temporarily find relief.

Antiflatulents

These medicines work by changing the surface tension of gas bubbles in the stomach and intestines. They usually come in the form of a tablet, chewable tablet, capsule, or a liquid.

OTC antiflatulents:

!

Safe use tips for antiflatulents medicines

Always read the Drug Facts label carefully. The label tells you everything you need to know about the medicine, including the ingredients, what you are supposed to use it for, how much you should take, and when you should not take the product.

You should never take more medicine or for a longer period of time than what the Drug Facts label says.

Homeopathic Products

Homeopathic digestive health products are derived from plants, minerals, and animal substances that are known for their pharmacological or biological actions. For safety, read all instructions and warnings on the product label before taking any homeopathic product and follow all dosing instructions.

OTC homeopathic digestive medicines include:

• Antimonium crudum
• Arsenicum album
• Chelidonium majus
• Colocynthis
• Nux vomica

Understanding How Antacids Work – Revere Health

Are you among the 15 million Americans who experience heartburn symptoms on a daily basis? Perhaps you count yourself among the 60 million people who endure the burning pain of acid indigestion at least once a month. Although more common among pregnant women and the elderly, anyone can find themselves racing to the medicine chest in search of over-the-counter (OTC) relief.
You’ve got several choices when it comes to non-prescription antacids, but not all acid reducers are created equal. As we review some of the most popular OTC medications used to quell heartburn, it’s important that you never use more than one antacid or acid reducer at a time without first consulting your gastroenterologist.

Types of antacids

Antacids are neutralizing, absorbing agents taken to relieve heartburn or indigestion caused by excess stomach acid. They typically contain salts of magnesium, aluminum, calcium and sodium. Antacids work by raising the gastric pH and are also used to provide symptomatic relief from peptic ulcers. Sodium bicarbonate antacids, including Alka-Seltzer and Bromo Seltzer, contain baking soda. Pregnant women, individuals with high blood pressure and those on salt-restricted diets should avoid this type of antacid.

Calcium carbonate antacids such as Tums and aluminum-based antacids like Amphojel may cause constipation. Some individuals experience diarrhea when using magnesium compounds such as Phillips’ Milk of Magnesia. For these reasons, many people prefer combination aluminum-magnesium antacids like Maalox and Mylanta that are less likely to cause constipation or diarrhea. Some of these formulas contain simethicone, an anti-foaming agent that helps reduce bloating by breaking down gas bubbles in your stomach.

Always take your antacid with food. This allows you up to three hours of relief. When ingested on an empty stomach, an antacid leaves your stomach too quickly and can only neutralize acid for 30 to 60 minutes.

It’s important to consult your doctor or pharmacist before you take an antacid if you’re on other medications to prevent interactions. Individuals with kidney or liver problems should never begin the use of antacids without speaking with their physician in order to avoid drug build-up.

Acid reducers

Acid reducers help to relieve heartburn by decreasing the amount of acid produced by the stomach.

OTC h3 blockers, such as Zantac and Pepcid, usually start to work within an hour and relieve symptoms for a longer period of time than antacids.

OTC proton pump inhibitors include Prilosec and Prevacid 24HR. These medications are recommended for people who have heartburn more than two days a week that don’t find relief in the other choices. Proton pump inhibitors are not as fast acting as antacids and h3 blockers, but the relief lasts longer.

Consult with your gastroenterologist before taking a proton pump inhibitor if:

• You are elderly or have a compromised immune system. These medicines may increase your risk for pneumonia.
• You are a postmenopausal woman. Proton pump inhibitors reduce calcium absorption and may increase your risk for osteoporosis.
• You have been treated for a Clostridium difficile infection. Proton pump inhibitors may put you at an increased risk for a return of the infection.

Short-term fix, not a long-term solution

Antacids are great for providing fast, short-term relief, but they don’t correct the underlying problem causing your symptoms. If after two weeks of self-treatment with OTC medicines you still suffer from heartburn and excess stomach acid—it’s time to see your doctor. Frequent and persistent symptoms can indicate a more serious problem such as gastroesophageal reflux, or GERD, advises the American College of Gastroenterology:

“When GERD is not treated, serious complications can occur, such as severe chest pain that can mimic a heart attack, esophageal stricture (a narrowing or obstruction of the esophagus), bleeding, or a pre-malignant change in the lining of the esophagus called Barrett’s esophagus.”

Studies show that patients with chronic, longstanding, untreated heartburn are at substantially greater risk for esophageal cancer – a rapidly growing and highly fatal cancer in the United States.

Don’t ignore persistent symptoms of heartburn or reflux. It’s fine to try an OTC solution for a week or two, but if discomfort persists, book an appointment with your gastroenterologist. Seeing your doctor early helps you get immediate treatment to avoid far more serious problems down the line.
Do you or a loved one struggle with frequent bouts of heartburn? Revere Health’s gastroenterologists diagnose and treat a wide variety of disorders of the gastrointestinal tract, including acid reflux, ulcers and Barrett’s esophagus. We offer compassionate, patient-centered care in multiple Utah locations and work with you to develop a treatment plan based on your individual needs and goals.

Revere Health’s experienced gastroenterology professionals offer comprehensive prevention, diagnosis and treatment of digestive disorders. We will work with you to develop a treatment plan based on your individual needs and goals.

 

Sources

 

Omeprazole | Health Navigator NZ

Omeprazole is used to treat problems affecting the stomach and gut, such as indigestion, reflux and ulcers. Find out how to take it safely and possible side effects. Omeprazole is also called Losec.

The colour of omeprazole capsules will be changing
From 1 August 2021, the colour and packaging for omeprazole capsules will be changing. They are still made by the same company (Actavis) and the formulation remains the same. Omeprazole 10 mg and 20 mg: the capsules and bottles for are changing. Omeprazole 40 mg: the capsules remain the same, but the bottles will have a new look.

What is omeprazole?

Omeprazole reduces the amount of acid produced in your stomach. It belongs to a group of medicines known as proton pump inhibitors (PPIs). They are used to treat a number of conditions associated with high stomach acid affecting your stomach and gut, such as indigestion, reflux and ulcers. Omeprazole can prevent ulcers from forming or help the healing process where damage has already occurred.

Omeprazole can be given together with antibiotics to get rid of Helicobacter pylori, a bacteria found in your stomach that can cause ulcers. 

Omeprazole can be used to prevent ulcers caused by medicines such as non-steroidal anti-inflammatory drugs (NSAIDs). Examples of NSAIDs are diclofenac, ibuprofen, naproxen.

In New Zealand omeprazole is available as capsules and can be given as an injection in the hospital.  

Dose

• The usual dose of omeprazole is 20 mg a day.
• For some people, 10 mg a day is enough; others may need a higher dose of 40 mg a day.
• It is best to take the lowest effective dose, for the shortest possible time.
• Your doctor will advise you how long to take omeprazole for (usually for 4 to 8 weeks). Some people may need to take it for longer.
• The pharmacy label on your medicine will tell you how much omeprazole to take, how often to take it, and any special instructions. 

How to take omeprazole

• Timing: Take omeprazole at the same time each day, usually in the morning. Omeprazole is usually taken once a day, but some people may need to take it twice a day. Your doctor will tell you how often to take it. Omeprazole can be taken before or after food, although taking it before food is best.
• Swallow the capsule whole with a glass of water. Do not crush or chew – the medicine doesn’t work properly if the capsule is crushed or chewed. If you have difficulty swallowing the capsule, you can open it and sprinkle the pellets over some fruit juice or yoghurt and swallow the pellets without chewing.
• Missed dose: If you forget to take your dose, take it as soon as you remember. But, if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.

Avoid long-term use of omeprazole

If you don’t need them, PPIs like omeprazole should not be taken long term, because of the possible side effects. There may be a small increased risk of bone fractures, chest infections, kidney problems and nutrient deficiencies such as low magnesium and vitamin B12. If you’ve been taking omeprazole for reflux for longer than 4 to 8 weeks, and your symptoms seem to be well managed, it’s a good idea to talk to your healthcare provider about reviewing your medicine. They may recommend stepping down your treatment. This could include:

• reducing your daily dose of omeprazole
• taking omeprazole only when you experience the symptoms of heartburn and reflux (also known as on-demand therapy)
• stopping treatment completely, as your symptoms may not return. It may be best to reduce the dose over a few weeks before stopping.

Read more about PPIs for heartburn and reflux Choosing Wisely, NZ 

Precautions before starting omeprazole

• Are you pregnant, planning a pregnancy or breastfeeding?
• Do you have problems with your liver?
• Are taking any other medicines? This includes any medicines you are taking that you can buy without a prescription, as well as herbal and complementary medicines.

If so, it’s important that you tell your doctor or pharmacist before you start omeprazole. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Side effects

Like all medicines omeprazole can cause side effects, although not everyone gets them. Often side effects improve as your body adjusts to the new medicine.

Rebound acid secretion

When omeprazole is stopped, a common side effect is rebound acid secretion, where the acid secretion in your stomach increases significantly. This should return to normal within 2 weeks. Because the symptoms of rebound acid secretion are the same as for reflux (such as indigestion, discomfort and pain in your upper stomach and chest, feeling sick and an acid taste in your mouth), it can form an ongoing loop where stopping omeprazole treatment creates the need to start it again.

Rather than restart omeprazole, your doctor may advise you to use medicines that contain both an antacid and an anti-foaming agent, such as Acidex oral liquid or Gaviscon Double Strength tablets. Alternatively, ranitidine tablets could be used. These can be effective for treating rebound acid secretion. You can use these medicines to relieve the symptoms when they occur.

Talk to your doctor or pharmacist about how to manage rebound acid secretion.

Other side effects

Side effects	What should I do?
Stomach upset, feeling sick Feeling bloated, gas in your abdomen (tummy) Loose stool (mild diarrhoea) Constipation	These are quite common when you first start taking omeprazole. Tell your doctor if troublesome.
Signs of low magnesium, such as muscle cramps, weakness, tiredness, feeling irritable and changes in heartbeat	Increase your intake of magnesium-rich foods such as wholegrain cereals, green leafy vegetables (spinach, parsley, cabbage), peas, lean meats, nuts, seeds and bananas. Tell your doctor if troublesome – you may need a magnesium supplement.
Severe diarrhoea (loose, watery, frequent stools)	Omeprazole can increase the chance of getting severe diarrhoea (which may be caused by bacteria called clostridium difficle). Stop omeprazole and tell your doctor immediately.
Signs of an allergic reaction such as rash, fever, painful joints	Tell your doctor immediately or ring HealthLine 0800 611 116.
Worsening stomach problems, such as really bad stomach pain, blood in your stool or black stools, vomiting blood or dark-coloured vomit	Tell your doctor immediately or ring HealthLine 0800 611 116.

Interactions

Omeprazole may interact with a few medications and herbal supplements, so check with your doctor or pharmacist before starting omeprazole or before starting any new medicines.

Learn more

The following links have more information on omeprazole:

Omeprazole (Māori) New Zealand Formulary Patient Information
Losec, Omezol Relief Medsafe Consumer Information Sheets

References

1. Stopping proton pump inhibitors in older people BPAC, NZ 2019
2. Proton pump inhibitors: When is enough, enough? BPAC, NZ, 2014
3. Proton pump inhibitors and the risk of acute kidney injury. BPAC, NZ, 2016
4. Omeprazole New Zealand Formulary

90,000 NEXIUM AGAINST THE ADDITIONAL – DIFFERENCE AND COMPARISON – HEALTH

Health 2021

Nexium and Prilosets are heartburn medications, more specifically proton pump inhibitors (PPIs), manufactured by AtraZeneca Pharmaceutical. Nexium, the active ingredient of which is esomeprazole, about

Contents:

Nexium and Prilosec are heartburn medications, specifically proton pump inhibitors (PPIs), manufactured by AstraZeneca Pharmaceuticals. Nexium , of which esomeprazole is the active ingredient, is a prescription drug primarily used for the treatment of GERD and Zollinger-Ellison syndrome. Prilocyan , in which Omeprazole is the active ingredient, is available over the counter and is cheaper than Nexium. Both drugs can be used in children, but only Nexium is approved for babies.

Comparison table

Comparison table Nexium and Prilosek

	Nexium	Priloser
	Current rating 2.85/5 (39 ratings)	current rating 2.98 / 5 (287 ratings)
Active ingredient	Esomeprazole	Omeprazole.
Treatment conditions	GERD, Zollinger-Ellison syndrome, ulcers, heartburn.	Duodenal ulcers, stomach ulcers, GERD and erosive esophagitis, initially Zollinger-Ellison syndrome.
Drug type	PPI (Protein Pump Inhibitor)	Proton Pump Inhibitors (PPI).
Prescription	Prescription Required	Over-the-counter or over-the-counter.
General version	Not available	Available.
Side effects	Headache, diarrhea, nausea, risk of bone fractures, inflammation of the stomach lining	Headache, diarrhea, nausea, risk of bone fractures, inflammation of the stomach lining.
Dose	As Prescribed	Twice daily for 10 days; 1 time per day for 18 days in the presence of an ulcer.
Pregnancy category	B (US): Safe during pregnancy	C (US): Not safe during pregnancy, but potential benefits may warrant use in pregnant women despite potential risks.
Delayed return	yes	Yes.

What are proton pump inhibitors?

Heartburn can be treated in three different ways: with antacids, h3 blockers, and proton pump inhibitors (PPIs).There are tiny pumps in the stomach that produce acid to break down the food you eat. If acid is produced in excess and returned to the esophagus, it causes heartburn. Proton pump inhibitors shut off pumps in the stomach to reduce acid production to a level sufficient for digestion. While antacids and h3 blockers provide temporary relief for several hours, proton pump inhibitors such as Nexium and Prilosec may provide longer-term relief.

This video explains how PPIs work:

Active Ingredients

The active ingredient in Nexium is esomeprazole, the S-enantiomer of omeprazole, the active ingredient in Prilosec.

Esomeprazole is used primarily for gastroesophageal reflux disease, treatment and maintenance of erosive esophagitis, treatment of H. pylori-induced duodenal ulcers, prevention of gastric ulcers in persons receiving chronic NSAID therapy, and treatment of gastrointestinal ulcers associated with Crohn’s disease …Omeprazole is used to treat gastroesophageal reflux disease, stomach and duodenal ulcers, and gastritis.

People who are allergic to esmeprazole should avoid taking Nexium, and those who are allergic to omeprazole should not take Prilosec.

Treatment

Nexium and Prilosek are used to reduce stomach acid, which causes frequent heartburn and related conditions.

Nexium is mainly used to treat GERD (gastroesophageal reflux disease) and Zollinger-Ellison syndrome, which leads to the formation of tumors that secrete excess stomach acid.Nexium can also be used to treat duodenal ulcers, stomach ulcers and stress-induced ulcers.

Prilosek in combination with other medicines can be used to treat or prevent ulcers of the duodenum, stomach, GERD and erosive esophagitis. It can also be prescribed in the initial stages of patients with Zollinger-Ellison syndrome. Both drugs can be used to treat ulcers caused by NSAIDs. (NSAIDs are a class of anti-inflammatory drugs that contain acetaminophen, ibuprofen, or aspirin, among others.)

Prilosec can be used for both adults and children, while Nexium is prescribed only for adult patients.

Efficacy

In a study by the NIH, esomeprazole (Nexium) was found to be more beneficial and safer for patients with gastroesophageal reflux disease (GERD). Esomeprazole was superior to omeprazole on all secondary measures and had a similar safety profile.

Esomeprazole 40 mg is also considered to be more effective in controlling acid in patients with GERD than a double dose of omeprazole (Prilosec).

Side effects

Common side effects

Both Nexium and Prilosec have similar side effects. Common side effects include headache, diarrhea, nausea, gas, and abdominal pain. In addition, Nexium can cause constipation, dry mouth and drowsiness; Prilosek may induce vomiting.

In children, Nexium can cause headache, diarrhea, abdominal pain, nausea. Prilosek, in addition to the side effects listed above, can also cause breathing problems and fever.

Prilosek is not recommended for babies. Nexium can be given to babies between the ages of 1 month and 1 year, but it can cause side effects such as abdominal pain, regurgitation, and heart palpitations.

Serious side effects

With long-term use, both drugs can cause the risk of bone fractures, inflammation of the stomach lining and reduce magnesium levels in the body. In addition to this, both can cause seizures, dizziness, seizures, spasm of the vocal apparatus, muscle weakness, tremors, and heart palpitations.

Health expert and radio talk show host Dr. Tom Rosel talks about the dangers of proton pump inhibitors such as Nexium and Prilosec:

Availability and cost

Nexium is a prescription drug with no generic equivalent. Prilosec is much cheaper and because it does not require a prescription, it can be bought over the counter, even in generic form (omeprazole).

90,000 Generic Prilosec: uses, doses and side effects

Disclaimer

If you have any medical questions or concerns, please contact your doctor.Articles in the Health Guide are based on peer-reviewed research and information gleaned from medical societies and government agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

How penis enlargement pills work

If you have frequent heartburn or are living with a chronic condition such as GERD (gastroesophageal reflux disease), you know that daily antacids do not always help.

For chronic heartburn, your healthcare provider may recommend over-the-counter (OTC) medications or prescription medications that include proton pump inhibitors (PPIs) such as Prilosec or H2 antagonists such as Zantac, one of the first medications developed for the treatment of peptic ulcer disease (Nugent, 2020).

Vitals

• Prilosec is a medicine commonly used to treat conditions caused or aggravated by high stomach acid levels, including frequent heartburn, gastroesophageal reflux disease (GERD), esophagitis, and peptic ulcers.
• Prilosec is a proton pump inhibitor (PPI) that reduces stomach acid production and prevents heartburn.
• The active ingredient in Prilosec is omeprazole, which is also available in generic form.
• Both generic omeprazole and the brand name Prilosec are available in the same dosage and have the same effect and safety profile.

Prilosec and its generic drug, omeprazole, are PPIs that are effective for treating certain gastrointestinal conditions and are available both over the counter and prescription. Here’s what you need to know about Prilosec, what it is used for, its potential side effects, and versus a generic alternative.

What is Priloby?

Prilosec, known in its generic form as omeprazole, is a drug commonly used to treat chronic digestive conditions such as GERD.Although the prevalence of GERD varies, studies show that approximately 23% of adults in North America live with the condition (El-Serag, 2014). Prilosec was originally only available as a prescription drug before the US Food and Drug Administration (FDA). approved the OTC version in 2015 (FDA, 2015).

Prilosec is available as a delayed-release capsule or as an oral suspension that can be mixed with applesauce for those who have trouble swallowing tablets.Recommended dosages are 10 mg, 20 mg, 40 mg, and 60 mg, depending on which condition you are using it for (FDA, 2018). Your age and weight can also affect your dosage. Although Prilosec starts working right away, it can take up to four days before you feel the full effect. Do not take Prilosec OTC for more than 14 consecutive days without consulting a doctor (Prilosec, 2019).

Like other PPIs, Prilosek helps treat conditions caused by high stomach acid levels.Research has also shown that it plays a preventive role in patients at risk of upper gastrointestinal bleeding or those taking medications that may increase the risk of upper gastrointestinal bleeding, such as non-steroidal anti-inflammatory drugs (NSAIDs) (Khan, 2018) … Here are the main uses of Prilosec (NLM, 2019):

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GERD

Although almost everyone experiences heartburn sometimes, if it occurs more frequently, it can be a sign of GERD, a digestive system disorder that causes irritation and inflammation of the esophagus (the tube that leads from the mouth to the stomach) due to leaving acid. your stomach. Symptoms vary, but people with GERD often experience recurrent heartburn, regurgitation, difficulty swallowing, belching, coughing, or a bad taste in the mouth (Sandhu, 2017).PPIs like Prilosek are effective treatments for GERD and work by reducing the amount of acid in the stomach.

Esophagitis

Conditions such as GERD can lead to esophagitis when the esophagus becomes irritated or inflamed due to frequent acid reflux. Esophagitis symptoms may include heartburn, regurgitation, and difficulty swallowing. If left untreated, this can cause permanent damage to the esophagus. A potentially precancerous condition called Barrett’s esophagus can also develop when the lining of the esophagus becomes tissue similar to that of the stomach (Wang, 2015).With proper treatment, these changes are reversible. But if not diagnosed, Barrett’s esophagus can cause serious health problems.

Duodenal and gastric ulcers

Peptic ulcers – lesions that develop in the stomach or small intestine as a result of damage to the lining of these organs – are also treated with PPIs, which help relieve symptoms and help ulcers heal. Some things can cause peptic ulcers, but the most common culprits are Helicobacter pylori stomach infections and frequent use of NSAIDs (such as aspirin, Advil, or Motrin) (ACG, 2012).

Zollinger-Ellison Syndrome

Zollinger-Ellison Syndrome is a very rare condition that results in the release of excess gastrin, a hormone that stimulates the secretion of acid in the stomach (NORD, n.d.). This acid can cause heartburn or ulcers in the stomach or small intestine.

Both Prilosec and generic omeprazole, which we will discuss in more detail below, are relatively inexpensive in terms of drugs, although prices may vary depending on whether or not you have health insurance coverage.

What is Generic Prilosec?

Omeprazole is a generic form of Prilosec that is as effective as a brand name product. Another brand name for omeprazole is Losec. Omeprazole works by blocking proton pumps (specialized mechanisms in the body that produce stomach acid), thereby lowering stomach acid levels (FDA, 2018).

In addition to omeprazole, there are other types of PPIs such as pantoprazole and lansoprazole that work in the same way.Most of these drugs are considered safe and effective (IFFGD, 2020).

Possible side effects of Prilosek

The side effects of Prilosek vary with the most common symptoms, including headaches, dizziness, nausea, diarrhea, rash, cough and constipation. Less common side effects include loss of appetite, hair loss, and taste changes (Casciaro, 2019).

Prilosec may also cause less common side effects associated with underlying medical conditions such as bone fractures and chronic stomach inflammation.Serious side effects are rare but may include pancreatitis, kidney inflammation, and liver damage (FDA, 2018).

Who Should Not Use Prilosec?

Priloser is safe for many people. However, some people may need a lower dose and some should avoid taking the drug altogether.

There is no solid scientific research on the effects of omeprazole on pregnant women, making it difficult to predict any side effects or risk to the fetus (FDA, 2018).Negative effects for breastfeeding mothers, although there is evidence that omeprazole passes into breast milk (NLM, 2019).

Prilosec can be administered to children under the guidance of a healthcare professional, although there is insufficient research to determine if it is safe for babies (FDA, 2018). Check with your pediatrician before giving this medicine to a child.

Even if you are only taking the over-the-counter Prilosek, it is important to talk to your healthcare professional first.Also keep in mind that this drug is intended to treat frequent heartburn – not to immediately relieve symptoms or for occasional heartburn (FDA, 2015).

If you are allergic (or suspect you are allergic) to medicines like omeprazole, or if you are taking certain antiretroviral drugs (medicines that help treat HIV), do not take this drug (NLM, 2019).

Prilosec can interact with many other medications.Some interactions can be mild and some are severe. Here are some of the most important medications to remember when taking omeprazole (FDA, 2018):

• Antiretrovirals: Prilosec may decrease the effectiveness of some antiretroviral drugs used to treat HIV. Examples of these drugs include rilpivirine, atazanavir, nelfinavir, and saquinavir.
• Warfarin: Warfarin is an anticoagulant that prevents blood clots.When combined with warfarin, omeprazole may increase the risk of bleeding.
• Methotrexate: A therapeutic drug used to treat arthritis and certain cancers that combines omeprazole with methotrexate can lead to toxic levels of methotrexate in the blood.
• Clopidogrel: Taking blood thinners such as clopidogrel with Prilosek may reduce its effectiveness and increase the likelihood of blood clot formation. This is due to the effect of this medication on the liver.Other drugs that omeprazole affects include citalopram, cilostazol, phenytoin, diazepam, and a heart drug known as digoxin.
• Tacrolimus: Tacrolimus is a medicine used to prevent organ rejection after transplantation. PPIs like Prilosek can increase the level of tacrolimus in the body.

This does not include all possible drug interactions with Prilosek. Talk to your doctor before taking PPIs, especially if you have a medical condition or are taking any other medications.For more information on side effects, safety, and prescribing of medications, read the FDA-approved Prilosek Prescribing Information.

Recommendations

1. Ali Khan, M., & Howden, C.W. (2018). The role of proton pump inhibitors in the treatment of diseases of the upper gastrointestinal tract. Gastroenterology and Hepatology, 14 (3), 169-175. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29928161/
2. American College of Gastroenterology (ACG) – Stomach Ulcer (2012).Retrieved 23 September 2020 from: https://gi.org/topics/peptic-ulcer-disease/
3. Antunes, K., Alim, A., & Curtis, S.A. (2020). Gastroesophageal reflux disease. StatPearls. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK441938/
4. Kasharo, M., Navarra, M., Inferrera, G., Liotta, M., Gangemi, S., and Minchiullo , P. L. (2019). PPI Adverse Reactions: A Retrospective Study. Clinical and Molecular Allergy, 17 (1). two: https://doi.org/10.1186/s12948-019-0104-4
5. El Serag, H.B., Sweet, S., Winchester, C.S., & Dent, J. (2014). Updating the epidemiology of gastroesophageal reflux disease: a systematic review. Gut, 63 (6), 871-880. Doi: 10.1136 / gutjnl-2012-304269. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23853213/
6. International Foundation for Gastrointestinal Disorders (IFFGD) – Proton Pump Inhibitors (PPI) (2020, March 16). Retrieved on August 10, 2020 from https://www.aboutgerd.org/medications/proton-pump-inhibitors-ppis.html
7. Kinoshita Yu., Ishimura N. and Ishihara S. (2018). Advantages and disadvantages of long-term use of proton pump inhibitors. Journal of Neurogastroenterology and Motility, 24 (2), 182-196. Doi: 10.5056 / jnm18001. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29605975/
8. National Organization for Rare Diseases (NORD) – Zollinger-Ellison Syndrome (NA). Retrieved September 23, 2020, from: https://rarediseases.org/rare-diseases/zollinger-ellison-syndrome/
9. Nugent, K.K., Falxon, S.R., Terrell, J.M. (2020). h3 blockers. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK525994/
10. Monograph on the OTC product Prilosets. (2019, September 30). Procter & Gamble. https://prilosecotc.com/en-us/article/product-monograph
11. Sandhu, D.S., & Fass, R. (2018). Current trends in the treatment of gastroesophageal reflux disease. Intestine and Liver, 12 (1), 7-16. https://doi.org/10.5009/gnl16615
12. US Food and Drug Administration (FDA) – Prescribing Essentials, PRILOSEC (June 2018)). Retrieved on August 21, 2020 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/022056s022lbl.pdf
13. US National Library of Medicine (NLM) – PRILOSEC- omesaprole magnesium granules, delayed release (2019, 27 November). Retrieved on August 11, 2020 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b6761f84-53ac-4745-a8c8-1e5427d7e179
14. FDA ( FDA) – Questions and Answers About Prilosec OTC (Omeprazole) (November 27, 2015)). Retrieved on August 8, 2020 from https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/questions-and-answers-prilosec-otc-omeprazole
15. Van R.H . (2015). From reflux esophagitis to Barrett’s esophagus and esophageal adenocarcinoma. World Journal of Gastroenterology, 21 (17), 5210-5219. https://doi.org/10.3748/wjg.v21.i17.5210

Learn more
90,024 90,000% d0% Bf% d0% b8% d1% 89% d0% b5% d0% b2% d0% b0% d1% 80% d0% b8% d1% 82% d0% b5% d0% bb% d1% 8c % d0% bd% d0% be% d0% b9 – English translation – Linguee

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What are proton pump inhibitors?

Proton pump inhibitors (PPIs) can also be called antacids, although they are a specific type of antacid that helps block stomach cells from producing acid in the form of hydrogen ions.Not all antacids are created equal, and PPIs are often compared to another type of acid reducing agent called an H2 blocker. H2 blockers affect another mechanism and decrease the histamine response that signals the stomach to release more acid. H2 blockers are usually more effective with short and shorter durations, but they need to be taken more frequently. PPIs, by contrast, tend to work more efficiently for longer periods of time, but they may need to be taken for several days before they start working well.

Either an H2 blocker or PPI can be used to treat gastroesophageal reflux disease (GERD), but PPIs are recommended for conditions such as acid damage to the esophagus or ulcers. Another indication for the use of proton pump inhibitors is when a person has Zollinger-Ellison syndrome. This causes an overproduction of acid from tumor formation.

There are several proton pump inhibitors available and some require a doctor’s prescription.Omeprazole, known as Prilosec®, is available over the counter in many regions. Other PPIs include lansoprazole (Prevacid®), pantoprazole (Protonix®), dexlansoprazole (Kapidex®), raberprazole (Aciphex®), and esomeprazole (Nexium®). Some of these drugs are widely advertised and well known to consumers.

Familiarity does not mean superiority, and most drugs in this class are considered equally effective. There may be reasons why doctors choose to prescribe one proton pump inhibitor to another.Such reasons may include the patient’s medical history and the various medications or conditions being taken that may make a particular drug the best choice. For example, someone who regularly takes Valium® or warfarin may stop using Prilosec® because it raises the level of these drugs in the blood. On the other hand, the dosage of Valium® or warfarin may be adjusted to accommodate Prilosec®.

Because each of the proton pump inhibitors is slightly different, the expected side effects are difficult to discuss.In general, people taking PPIs may experience some minor or major experience of conditions such as diarrhea, constipation, or other stomach upsets such as nausea. Another common side effect of PPIs is headache. Many people do not report side effects from PPI use or find that early side effects go away with continued use.

Many times physicians have set out to take PPIs on a long-term basis to treat current conditions.Another advantage of these drugs over h3 inhibitors for treating chronic problems is that they can often be taken once a day instead of two or more times a day. They are not really intended to treat an occasional heartburn episode, nor will they effectively stop an active case of heartburn. An h3 inhibitor or other antacid is recommended instead. If the frequency of heartburn is frequent and chronic, people may want to discuss the potential benefits of proton pump inhibitors with their doctors.

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# esophagitis Instagram posts – Gramho.com

🕉Today we will consider some of the asanas that are recommended for women in the book “Yoga for Women” by Gita Iyengar.

🕉Why did I decide to bring this up? Because taking care of our body and its health also depends on physical activity, and I think yoga is a great way to balance mind and body.SARVANGASANA – CANDLE POSITION🕯
Sarvangasana is one of the most important asanas for women’s health. It soothes the nervous system, strengthens the muscles of the thighs, abdomen, shoulders, back, strengthens the spine, is effective in the treatment of varicose veins, has a beneficial effect on the female genital organs, and helps to normalize digestion.

BADDHA KONASANA – RELATED ANGLE POSITION
Baddha Konasana increases the mobility of the hip joints, relieves tension in the pelvis, stimulates and normalizes ovarian function, positively affects the menstrual cycle, positively affects the kidneys and bladder, relieves spasms.⠀
BALASANA – BABY POSITION🚼
This calming asana helps to gently increase the mobility of the hip joints while relieving tension in the lower back.

UTHITA TRIKONASANA – TRIANGLE POSITION
It relieves stiffness in the hip joints, has a positive psycho-emotional effect in stress, depression and brings relief in case of menstrual irregularities.

VIRASANA – HERO POSITION🕉
Virasana increases the flexibility of the muscles of the thighs and perineum and improves digestion. The asana helps improve posture, stretches the ankles, and helps lower blood pressure.PASCHIMOTTANASANA – BUTT EXTENSION POSITION
Regular practice of this asana relaxes the hip joints and helps to remove fat from the abdominal area. It also tones all the abdominal organs, helps to activate the kidneys, liver, adrenal glands and pancreas; it also tones the pelvic organs, which makes it especially effective in eliminating disorders of the female reproductive system.

‼ ️IMPORTANT
It is recommended to completely abandon the practice during the menstrual cycle. This is especially true for inverted asanas.Perform these asanas under the guidance of an experienced instructor, according to your level of training.

🙏🏻Your attitude towards her? Have you tried to borrow?

90,000 Why does the stomach hurt from potatoes

Why the stomach hurts from potatoes

Treatment of gastritis is based on adherence to a strict diet. That is why, when drawing up the menu, you should adhere to the recommendations of a nutritionist. Potatoes for gastritis are healthy foods, but you just need to know how to cook it correctly.

Benefits of potatoes

Potatoes have a unique natural composition that has a beneficial effect on the functioning of the gastrointestinal tract. It contains a balanced complex of amino acids, minerals and vitamins. The benefit of a vegetable for gastritis lies in the fact that the fiber contained in it is not an irritant for the inflamed mucous membrane.

In addition, the presence of starch in the composition provides enveloping properties. This minimizes the effect of aggressive factors on the gastric mucosa when various foods are consumed.The popular vegetable also benefits from the following:

• In lowering cholesterol levels, which strengthens the blood vessels of the circulatory system.
• In improving metabolism, which allows you to remove toxins and toxins, and, therefore, enhance the body’s defenses.

You can use potatoes for gastritis boiled, stewed and baked. But at the same time, it is believed that the maximum amount of nutrients and vitamins is preserved if you boil potatoes in uniforms.Potato juice can be used as a remedy for gastritis.

Is it possible to have potatoes for gastritis

For gastritis, patients are prescribed a special diet. As a rule, it includes a large number of potato dishes. This is already the answer to the question of whether it is possible to eat potatoes with gastritis. But at the same time, you need to remember about the high calorie content of the vegetable, so you cannot abuse dishes from it.

Advice! Fried potatoes are a harmful dish for diseases of the gastrointestinal tract, so they should be completely abandoned.

Raw potatoes can be used as a remedy for gastritis with high acidity. The juice also helps to stabilize the condition. Treatment with this remedy should be carried out exclusively in consultation with the doctor.

Cooking methods

To prepare potatoes, certain rules must be followed. This will allow you to keep the maximum amount of nutrients in it. Any recipe for a potato dish provides for the use of high-quality tubers, without any damage.A vegetable can be cooked properly if its:

• Cook.
• Bake.
• Simmer.

Tip! It is not allowed to include fried potato dishes in the diet. They overload the digestive organ and can provoke an exacerbation of the disease.

Home potatoes should be preferred. Shop vegetables can contain harmful substances if they were grown by unscrupulous agricultural producers. The quality of the tubers should be taken very seriously if you plan to take raw potatoes or juice as a remedy.

Baked potatoes

Baked potatoes for gastritis are considered a very healthy dish. It is very simple to prepare it, you should:

• Wash the selected tubers thoroughly under running water.
• Wrap each potato in foil.
• Bake until tender.
• Cut the finished tuber in half and carefully remove the pulp.

Tip! To enhance the taste, you can make mashed potatoes from a baked vegetable with a little milk and butter.

Mashed potatoes

Mashed potatoes for gastritis is one of the main dishes. To prepare it, you should use tubers grown in home gardens or in proven farms. Young vegetables are not suitable for mashing.

White varieties are considered the best option for a dish. The cooking process is very simple, to prepare the dish you should:

• Thoroughly peel the selected tubers and rinse under running water.
• Put tubers in a saucepan and pour hot water 1-2 cm higher.
• Cook over high heat until tender.
• Drain the water, add butter and milk, then mash the tubers.

When cooking a dish during an exacerbation of gastritis, the water is not completely drained. No butter and milk are added to the puree, and its consistency should be semi-liquid. It is necessary to eat mashed potatoes for gastritis in a warm form.

Stewed potatoes

Stewed potatoes can be cooked in combination with various vegetables such as carrots, cabbage or asparagus.This dish allows you to diversify the menu during remission. It is important to simmer all vegetables individually until half cooked.

After that, they should be mixed and brought to full readiness. It is best to cook such a dish in a multicooker in the “Stew” mode. To enhance the taste, it is allowed to add a little vegetable oil to the finished stew.

Boiled potatoes

Boiled potatoes in slices will allow you to diversify the menu in some way. But it should only be remembered that during an exacerbation it is better to give preference to mashed potatoes.Boiled potatoes cannot be fried, but you can season them with a little vegetable oil and sprinkle with dill.

Advice! Boil the potatoes by pouring hot water over it. This will allow you to keep the maximum amount of nutrients in the vegetable.

Contraindications

There are practically no contraindications to the inclusion of potato dishes in the diet for gastritis. Nutritionists recommend consuming less of this vegetable in the spring, since by this time it has lost many of its beneficial properties.In addition, it is forbidden to use a fried vegetable for any form of gastritis. The following dishes should not be present on the menu:

• French fries.
• Chips.
• Zrazy.
• Potato pancakes.

You should also not include a stewed vegetable with fatty meats in the diet. The restrictions on treatment with juice and raw potatoes relate to the disease, which proceeds against a background of low acidity.

It is very important when treating gastritis to remember that the menu should be composed in such a way as not to overload the stomach.Potatoes are a high-calorie dish, so you need to eat them in small quantities.

Why does my stomach hurt after eating?

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Overview

Are your eyes bigger than your belly? Almost everyone abused at one time or another, resulting in an upset stomach, fullness and nausea. But if you experience stomach pain with your usual amount of food, it could be a sign of a problem.

Most causes of stomach pain and indigestion are not serious and do not require medical attention. Mild indigestion can usually be treated at home with over-the-counter (OTC) medications.

But if your pain is moderate or severe, you should talk to your doctor. Your symptoms could be a sign of a serious underlying medical condition.

There are many reasons why you may have stomach pain after eating. Read on to find out more.

There are many different types of abdominal pain and disorder. You’ve probably encountered many of them before.

Some common symptoms of indigestion include:

If you or someone you know is experiencing severe stabbing pain, this may be a medical emergency. You should talk to your doctor right away.

Dehydration is also a medical emergency. If you cannot drink fluids without vomiting, or if you have severe and persistent diarrhea, you may need to go to the emergency room for intravenous (IV) fluids.

There are several potential causes of stomach pain after eating. These include:

Food allergy

A food allergy occurs when your body mistakes a certain food for a harmful foreign invader and your immune system makes antibodies to fight it. This immune response can cause a variety of symptoms, including stomach pain. Common food allergies include:

Read about basic first aid for allergic reactions.

Food intolerances

Food sensitivities or intolerances are when your body’s digestive system does not agree with a particular food. Food intolerances do not trigger an immune response. If you have a food intolerance, your digestive system is either irritated by the food or cannot digest it properly.

Many people are lactose intolerant, which means that milk and other dairy products are causing them symptoms of indigestion.

Celiac disease

Celiac disease is the body’s immune response to gluten, a protein found in wheat, barley and rye. Causes damage to the mucous membrane of the small intestine with repeated exposure. This causes symptoms of indigestion and can lead to other serious complications.

GERD

Gastroesophageal reflux disease (GERD) is a chronic (long-term) digestive disorder in which stomach acid returns back to the esophagus.This acid reflux irritates the lining of the esophagus and can damage it.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common chronic disease that affects the large intestine. This can cause:

• abdominal pain
• cramping
• bloating
• diarrhea
• constipation
• gas

This usually requires long-term treatment.

Crohn’s disease

Crohn’s disease is a serious chronic inflammatory bowel disease (IBD). It causes inflammation in various parts of the digestive tract, which can lead to severe pain, diarrhea, bloody stools, and other symptoms. It is a serious medical condition with potentially life-threatening complications.

Peptic ulcers

Peptic ulcers are ulcers that develop on the inside of the stomach and in the upper part of the small intestine (duodenum).The most common symptom of an ulcer is a burning pain in the abdomen. This pain can be aggravated by spicy food.

Sugar alcohols

Sugar alcohols, which are oddly sugar-free and alcohol-free, are artificial sweeteners used in many sugar-free gum and candy. Sugar alcohols such as sorbitol are food additives that are regulated United States Food and Drug Administration (FDA). Some people believe they cause digestive upset.The FDA warns that excessive consumption of sorbitol can have a “laxative effect.”

Constipation

Constipation occurs when stool moves too slowly through the digestive tract and cannot be relieved in the usual way. Chronic constipation – several weeks with three or fewer bowel movements – can cause stomach pain and bloating. After eating, as your body tries to digest new food, your symptoms may worsen.

Your doctor can diagnose the cause of your stomach pain simply by listening to you describe your symptoms.However, sometimes more invasive tests may be required. This can include:

If you suspect you have a food intolerance, trial and error is often the best way to determine it. You can keep a food diary to keep track of your symptoms. Your doctor may also recommend an elimination diet.

If you have stomach pain after eating, you may already have tried several home remedies. If you didn’t find anything that works, you may not have provided the correct reason.

Ultimately, treatment for stomach pain will depend on what is causing it. If you suspect that you have a food allergy, you should be examined by an allergist for a correct diagnosis. If you have food intolerances, you should avoid food as much as possible.

A lactose-free diet may seem unappealing at first, but there are ways to make it work. You might want to see a dietitian or get a lactose-free cookbook.If you think you have a gluten problem, don’t give up gluten until you’ve been seen by a gastroenterologist to rule out celiac disease. Screening for celiac disease should be done on a diet that contains gluten.

Many of the unpleasant symptoms of stomach pain after eating can be controlled with over-the-counter medications. As always, check with your doctor before starting any new medication, even if it does not require a prescription.

Here are some treatment options that you can find at your local pharmacy:

• Simethicone (Gas-X) helps reduce unpleasant bloating.
• Antacids (Alka-Seltzer, Rolaids, Tums) neutralize stomach acid, reducing the burning sensation.
• Acid pests (Pepcid) reduce gastric acid production for up to 12 hours.
• Beano helps prevent gassing.
• Antidiarrheal agents (Imodium) stop diarrhea and associated symptoms.
• Lansoprazole and omeprazole (Prevacid, Prilosec) block acid production and promote esophageal healing when taken daily.
• Pepto-Bismol coats the lining of the esophagus to reduce burning sensation and treat nausea and diarrhea.
• Diphenhydramine (Benadryl) fights symptoms associated with an allergic immune response and helps treat nausea and vomiting.
• Laxatives and stool softeners relieve occasional constipation and associated bloating.
• Acetaminophen (Tylenol) relieves pain without irritating the stomach like aspirin, ibuprofen and naproxen.
• Probiotics contribute to overall digestive health by introducing more beneficial bacteria into the body.
• Fiber supplements (Metamucil, Benefiber) promote normal bowel movements and prevent constipation, although they can cause gas and bloating.

Antacid shop.

Probiotic store.

Laxative store.

Potential complications depend on what is causing the abdominal pain. Food allergies can lead to a serious allergic reaction known as anaphylaxis, which can stop breathing.Anaphylaxis is a medical emergency.

GERD can damage the esophagus, making it difficult to swallow. Peptic ulcers can lead to internal bleeding and serious infections. Chronic constipation can lead, among other things, to hemorrhoids and fissures in the anus.

Crohn’s disease is associated with the most serious complications, including bowel obstruction and fistula, requiring surgery, and may increase the risk of colon cancer.

There are several ways to prevent stomach pain after eating.

There are many reasons why your stomach may hurt after eating. It is likely that you have the usual upset stomach or heartburn, and over-the-counter medications will help. But if your symptoms persist for several weeks, you may have a chronic illness and you should consult your doctor as soon as possible.

.

Why does the stomach hurt?

Problems with the tummy are a common reason for visiting a doctor.When patients complain of “abdominal pain”, they sometimes describe pain that is all over the abdomen and may not be directly related to an organ known as the stomach.

Doctors first try to determine if the patient’s abdominal pain is due to a structural or functional problem.

Occasionally the digestive tract does not function properly due to a malformation of the organ. Medical imaging will show that the organ does not look normal and is not working properly.

Functional problems, also called motor impairments, are conditions that result from poor nerve and muscle function in the digestive tract. Organs that are part of the gastrointestinal tract usually look normal on medical images, such as a CT scan or MRI, but the organs do not work as they should.

“The gastrointestinal system has its own nervous system that controls the muscle contractions that digest the food you eat,” says Dr. Linda Lee.“Functional disorders can be difficult to diagnose because we cannot easily see problems with nerves or muscles in the gastrointestinal tract. “

Some of the conditions that can cause stomach pain:

5 causes of stomach pain

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Why does stomach pain? 17 possible causes of stomach pain

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What causes stomach rumbling?

Sounds familiar? You are sitting in a classroom in the middle of the morning. It’s been a couple of hours since you had breakfast. It’s still a long way to lunch. You try to focus, but your stomach starts to distract you.

In fact, this can start to distract the entire class. When your belly starts to rumble, it can be loud enough for the whole class to hear! Has your belly ever started rumbling so loudly that it seemed like it wanted to ask the teacher a question? Perhaps he wanted to ask: “When is lunch?”

What’s with that? You probably already knew you were hungry.Do you really need to have your stomach choked with groans and strange noises? Probably no! So why is he doing this?

Don’t be embarrassed. Everyone has a humming, gurgling, humming or humming stomach from time to time. This is just a friendly reminder that your body is always working to keep you in top shape.

While it may sound like a growl from your throat, this rumbling and grunting you hear comes from your stomach and small intestine. And it happens anytime – not just when you’re hungry!

As the muscles in your digestive system push food through the digestion process, the food is broken down for your body to use.Also, gas and air bubbles get into the mixture.

It is these pockets of gas and air that produce the sounds known as stomach rumblings. They are not as loud when there is food in the stomach. This is because food absorbs some of the sound.

However, when your stomach is empty, these sounds are much easier to hear. This is probably why rumbling in the stomach is associated with hunger. A couple of hours after eating, your stomach sends signals to your brain to get the muscles in your digestive system to work again.

This process removes all previously skipped products. The contractions of the abdominal muscles also help satisfy hunger, so you eat more food than your body needs. Since your stomach is empty, these gas and air pockets make much more noise than you hear the rumbling in your stomach.

There is actually a scientific word for the noises your stomach makes. It is called “bourboigm” after the Greek word ( borborygmus ), which is onomatopoeia: a word that imitates the sound of what it describes!

Are you tired of tummy grumbles? Eat several small meals each day, not several large ones.Keeping more food in your stomach throughout the day can help calm those annoying sounds!

Standards: NGSS.LS1.C, NGSS.LS1.D, CCRA.L.3, CCRA.L.6, CCRA.R.1, CCRA.R.2, CCRA.R.4, CCRA. R.10, CCRA .SL.1, CCRA.SL.1

.

Achlorhydria: symptoms, causes, diagnosis, treatment – Health

Achlorhydria is the absence of hydrochloric acid in gastric juice produced in the stomach. This disease does not usually occur on its own, but is a secondary result of some other condition

Contents

Achlorhydria is the absence of hydrochloric acid in gastric juice produced in the stomach.This disease does not usually occur on its own, but is a secondary result of some other condition or circumstance, such as H. pylori infection or hypothyroidism. Regardless of the cause, achlorhydria can cause a variety of gastrointestinal symptoms, from pain to constipation to heartburn.

Hydrochloric acid, which is produced by the parietal cells of the stomach wall, helps maintain the pH level in gastric juice so that enzymes that help break down food into easily digestible substances can do their job.It also helps maintain the correct acidic environment to prevent illness and disease.

Symptoms

Given that achlorhydria occurs for different reasons, symptoms can vary, but usually include one or more of the following:

• Pain in the upper abdomen below the ribs and above the abdomen (epigastric region)
• Weight loss
• Heartburn
• Nausea
• Abdominal distention
• Diarrhea
• Acid regurgitation

satiety, usually after eating )

• Vomiting
• Constipation
• Difficulty swallowing (dysphagia)

Causes

Long-term use of proton pump inhibitors (PPIs), such as Prilosec (omeprazole) and Prevacid (lansoprazole), can cause hypochlorhydria or decreased hydrochloric acid production and can lead to achlorhydria.Your doctor will monitor your medications and investigate based on symptoms.

In addition, diseases can interfere with the functioning of parietal cells, resulting in low or no acid production.

This includes:

• Helicobacter pylori (H. pylori) infection: a bacterial infection of the stomach that can cause gastritis, peptic ulcer and stomach cancer.
• Hypothyroidism: Low thyroid hormone levels can negatively affect the production of hydrochloric acid.
• Autoimmune diseases in which the parietal cells of the stomach become enemies and attack them, for example, autoimmune atrophic gastritis. This type of gastritis may be a precursor to pernicious anemia, another autoimmune condition that affects parietal cells.
• Gastric bypass procedures in which the largest acid-producing parts of the stomach are removed or associated this state.

  Diagnostics

  If any of the possible causes apply to you, your doctor may perform several tests. However, these tests are generally designed to diagnose the suspected primary health condition, not achlorhydria itself.

  Some tests your doctor may consider include:

  • An intrinsic factor antibody test , a blood panel that measures levels of intrinsic factor antibodies: intrinsic factor is a protein made by parietal cells and pernicious anemia can cause the body to produce antibodies that attack parietal cells and suppress the production of intrinsic factor.
  • Gastric biopsy: During endoscopy, a flexible endoscope is inserted into the stomach through the mouth (the patient is sedated) to obtain a sample of stomach tissue. The examination can detect gastritis, H. pylori infection, and stomach cancer. An increased bacterial count may indicate a low acid level.
  • H. pylori test: H. pylori bacterial infection can be detected by blood tests, urea breath test (inhalation into a collection bag), stool test, or endoscopy.
  • Stomach acid test: The patient is injected with gastrin, a hormone that stimulates the production of acid. A tube is then inserted through the nose or mouth into the stomach to take a sample for analysis. Achlorhydria causes abnormal gastric volume and pH levels.
  • Serum Pepsinogen Test: Low levels of pepsinogen, a substance secreted in the stomach and converted to the enzyme pepsin by stomach acid, may indicate achlorhydria. This blood test can also be used as an early screening for stomach cancer.
  • Serum Gastrin Test: High serum gastrin levels may signal achlorhydria.

  Complications

  In addition to complications (eg, stomach cancer) that can arise from ignoring symptoms or not treating underlying conditions, most complications of achlorhydria are due to nutritional deficiencies.

  In the case of autoimmune conditions that attack parietal cells, an abnormal digestive environment can cause absorption problems, resulting in iron and vitamin B12 deficiencies.

  Achlorhydria is also associated with vitamin D and calcium deficiencies, so weak bones can be an unintended complication, which can lead to fractures, especially of the hip.

  Could you be B12 deficient?

  Treatment

  The cause of your achlorhydria will determine your treatment path. For example, if chronic use of PPIs has led to this condition, your doctor may stop these medications in the first place.

  If achlorhydria is caused by another disorder, treating the condition will usually alleviate low acid stomach problems.Thus, individualized treatment for pernicious anemia, H. pylori infection, or even stomach cancer will be the standard treatment for achlorhydria.

  May also require dietary supplements such as B12, iron, calcium, and vitamin D.

  Try these natural remedies for hypochlorhydria and achlorhydria

  A word from Verywell

  As with most cases, the sooner achlorhydria is found, the better your long-term prognosis, especially in the case of gastric cancer and its precursors such as H.