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Tags: acid, aciphex, antacid, danger, gerd, heartburn, low, nexium, prevacid, prilosec, stomach, suppressing, tagamet, zantac
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Well, I am pleased to report that after almost two weeks off PPI meds (Aciphex, after years of Nexium) I am mostly asymptomatic. A few flare-ups here and there but nothing like the disabling OMFG-kill-me-now pain I had years ago when I first went on Nexium. Thanks for the scientific ammo my brain needed to get off this stuff.
I’m aware that it may take a long time for my gizzard to recover from the PPI onslaught. -
Hi Chris,
I have really enjoyed your articles. I have been on a low carb diet for a long time and have seen great results but I am not completely symptom free yet. How long is this process generally? I have not taken HCL partly because I thought is this just another pill I will have to take forever, I do take probiotics. Do you find that eventually people can stop taking HCL and not have symptoms return? I was on prilosec for seven years! I was also wondering do you find the other symptoms (asthma) that come with reflux go away once the relux is resolved? -
You’ve done a very solid review of the evidence. I wish I had never taken PPIs but now I have Barrett’s esophagus, with the result that the conseqeunces of being wrong are greater than just a flare up of heartburn… There is not conclusive proof that PPIs prevent cancer in those with BE, but most evidence suggests they so. Thus, for people with BE, PPIs may not be elective.
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I think, in principal, controlling reflux should be superior than taking a PPI for cancer prevention in people with BE. That said, if reflux is recalcitrant (e.g., on account of severe hiatal hernia), skipping the PPIs may be harmful. Cancer progression in BE seems to be mediated by inflammation and associated oxidative damage. Acid supression reduces certain markers of inflammation (but not others…) and may have a role in supressing ROS formation (and may have a role in causing ROs formation…). The best evidence seems to be that the cancer progression rate used to be about 1% per year and now it is .5% per year. It could just be measurment error, but acid suppression (at minimum) doesn’t seem to hurt (much) as progression to cancer among people with BE on long-term acid suppression is about 0.3% per year according to a 2006 UK study. Turns out, antioxidants and nitrite scavengers, like vit C and vit E (and melatonin & NAC are promitting too) may do more to prevent cancer than PPIs, at least if the animal and limited human case report evidence is to be trusted.
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Excellent points. It is a dilemma!
The vit C, nitrite thing is complicated. There was a very recent mechanistic study that in the presence of 10% fat (almost any meal), vit C actually produces more nitrites in conditions that simulate the stomach. The idea was that vit C prevents nitrite formation but causes nitric oxide (NO) to be formed which dissolves in fat and then (I think because the NO is insulated from the water-soluble vit C) forms nitrosamines… Perhaps vit E would help…
In any case, it’s not clear how much nitrites are involved in the progression to gastric cancer. This guys thesis is 2 years old but very itneresting. http://theses.gla.ac.uk/394/01/2008patersonphd.pdf -
Also, h pylori (which lowers stoach acid) seems to protect against esophageal cancer in people with BE.
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Agreed. And, thank you for this series. It is pretty damn good.
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