The Acid Reflux Topic

[Fat Guy]

For the first 35 years of my life, I could eat anything I wanted at any time in any quantity without any gastrointestinal repercussions.

I remember vividly, when our son was born in 2005, I was rushing to and fro around Mount Sinai hospital in New York City, subsisting on a diet of candy bars and bacon-and-egg sandwiches for several days while he was in the NICU (for, it later turned out when the test results came back, no actual reason other than to wait for the test results), at one point I got a burning, tightening, radiating pain sensation in my chest. I thought for sure it was my heart.

I guess that's a pretty common reaction. A couple of doctor's visits later and we had a diagnosis: GERD aka gastroesophageal reflux disease.

I started with Nexium, then Priolosec, then Protonix, based on whatever was the pill-du-jour that the insurance company would cover. Eventually, though, I decided the better move was lifestyle change.

Losing 100 pounds seemed out of the question but some better choices made a lot of difference. I guess the reflux thing presents in various ways for various people. I know some folks who take one bite of fried food and it triggers the burn. Not for me, though a while back when I was in Alabama and EVERYTHING was fried I got chronic heartburn after a couple of days.

For me, though, the primary important thing is to give myself plenty of time to digest after eating a meal. That means if I have to do any exertion, like walking to school with our son, I eat very little beforehand or I eat a couple of hours beforehand.

At the moment I'm drug free and not having any issues as long as I stick to the plan.

Are there any other sufferers out there? How are you coping? Drugs? Surgery? Lifestyle change?

[Shelby]

My husband takes Protonix for it and has no problems any more. Before he went to the doctor for it, I had to get dinner done fairly early --like 7:30--which during the summer, is very early for us what with work, garden etc. If it got past then, he was miserable.

I get reflux a lot during the summer because I eat tons and tons of fresh tomatoes from my garden. Usually, if I take an over-the-counter pill early in the afternoon, then I'm fine. But, if I'm stressed out or worried about something going on in my life, on top of eating something disagreeable, then those pills don't make a dent. So, I take one of my husband's pills and that knocks it out for at least 3 days.

[weinoo]

Yeah, getting old(er) sucks as that little doohickey that separates the stomach from the esophagus doesn't work as good any more.

Same issue for me - my first bout was a good 7 years ago and it was most definitely triggered by stress.

There are a lot of trigger foods that I like and still eat: coffee and booze and chocolate and spicy and...on and on.

I agree that you really can't and shouldn't do strenuous activity after a meal and you most certainly shouldn't lie down within a few hours of eating; by the way, don't bend over either.

So, I keep a supply of ranitidine 150mgs. at hand, try to be good. And if i get a bout that I feel needs clearing up, I'll put myself on a 14-day program of OTC omeprazole.

But I totally think it's all about lifestyle.

[rooftop1000]

My husband seems to have more problems in the winter which I feel is the weight gain (which we both seem to have).

He is a Rolaids kinda guy but I have gotten him to try a Gas-Ex (generic)which seems to work just as well as it relieves pressure in the stomach.

tracey

[feedmec00kies]

Ah yes, GERD. I'm only in my mid-20s but I first started having symptoms near the end of my spring semester of my junior year of college. I was under a lot of stress at the time. Along with other stressors, I was also working for a professor who was a very difficult boss and, here's probably the big trigger, I would be so worried about coming late or how she would react to me bringing food to work on Fridays (when I worked directly with her) that I would run to my job without eating, start at 12pm, and end at 4pm. So between that and the stress, in the last weeks of the semester, I started to get nauseous often and threw up on several occasions.

When I went home I continued to feel nauseous all the time, and after assuming it was some sort of dairy intolerance and not finding anything conclusive (it would get worse when I had milk, like in my cereal, but lactaid pills changed nothing), I went to my doctor. I was told it was "dyspepsia", and told to take Pepcid AC regularly for 2 weeks so my esophogus could heal properly.

The Pepcid helped a bit, but after 2 weeks my recovery was stagnant. I started losing weight, because I was so nauseous that I couldn't always eat. (My symptoms present as nausea, not heartburn, and were pretty constant because my triggers were either hunger or having just eaten.) Eventually, I went to a gastroenterologist and after some tests got my first diagnosis of GERD. Since then I've seen two more and gotten another endoscopy to check for ulcers and H. pylori, but nothing was found. Along with the first two doctors I took several PPIs, but they didn't seem to help and I would stop taking the medication and seeing the doctors. Sometimes the symptoms were bothersome, but sometimes I would be so nauseous I couldn't do anything or threw up (or wished I could, for relief). I also had to make sure to have food available at pretty much all times, because if the nausea gets too severe I'm unable to eat.

The last doctor I saw told me to start sleeping on an incline and prescribed Zegerid to me, which is omeprazole (Prilosec) and sodium bicarbonate (good ol' baking soda), which seems to help me the most of anything. At this point I take it once a day and try to avoid things, particularly when I'm not feeling well (when I won't be able to contemplate eating it anyway). But that's about as much as I can do. I'm not overweight, so I can't use weight loss as a tactic. I can't (or won't) restrict my diet too strictly because I psychologically cannot bring myself to eat much if everything is bland, but I have cut down trigger foods... if only because I can't contemplate consuming them when I am symptomatic. This includes large amounts of caffeine, tannins, spicy foods, acid, sugar, alcohol, and fat. I get around tannins with tea by drinking tea with milk (the proteins or something else in milk binds to the tannins in the tea). I seem to have no problem drinking lambic and other similar lower alcohol sour beers despite the acid (ironically, tasting something sour is sometimes one thing that makes me feel better), even though the smell of hops makes me nauseous. The thing is, when I've tried to cut out all triggers I don't seem to do significantly better, and my gastroenterologist does not seem to feel I should have to cut out these foods altogether, either.

So I'm kind of stuck in place right now, unfortunately. I'd like to go off meds, but I don't seem to have any hope of that right now. My PCP mentioned that there is surgery, but I don't think I'm ready for that route, either (and I haven't talked to my gastro about it).

[feedmec00kies]

Oh dear, my post was long!

I wanted to mention that Pepto Bismol pills have worked well for me when Zegerid isn't enough.

[Marlene]

I take prescription strength Zantac on an as needed basis. As soon as I feel it coming on, I take one. Seems to work.

[Mjx]

I have a self-induced hiatal hernia (essentially, a prolapse of 'that little doohickey that separates the stomach from the esophagus', or the 'lower esophageal sphincter'(LES)) because I indulged in the full spectrum of eating disorders while I was a teenager. Since my 20s, I've had acid reflux issues when I'm not careful.

I know stress can aggravate this, but to a large extent, I can manage it by just dealing with the physical end of it:

Drinking enough water, not eating more at a single go than will fit in my two cupped hands, and keeping my weight at a reasonable level (healthy hip:waist ratio) have helped a lot (I researched this extensively while I was still reading biomed., and my stomach began giving me all sorts of hell, so spent a lot of time at the AAM library at 105th Street). The 'weight at a reasonable level' thing really makes a difference, because if fat deposits in the abdomenal area get large enough, they do impinge on the area occupied by your stomach, more so when you fill it.

If I've eaten more than the two-handsful I know I can safely accommodate, and the meal contains a significant amount of acid or booze (e.g. two or more glasses of wine), these things will make the reflux more painful (in general, because I trashed my LES, I can't drink anything stronger than 15% alcohol, or it feels like I've swilled Drano).

Although I love both, I've cut wheat and and potatoes from my diet, and keep other starches to a minimum. I'm not allergic, but I don't seem to handle them very well (potatoes also make my joints swell, and wheat makes me sleepy and weak, and gives me a runny nose).

If acid reflux does kick in, standing/walking, and taking occasional small sips of water(if/when it gets really painful) help; sitting puts more pressure on the stomach, and laying down seems to aggravate reflux. I usually take a stroll, and breathe deeply.

I've never tried any medication for this, although at one point, when things got really bad, and I couldn't keep down food (which makes the whole thing worse) I was prescribed an anti-anxiety med. (which I was too scared to take; I was a afraid I'd turn into a junkie). I was prescribed Zantac for my duodenal ulcer when I was about 20, but I stopped taking it after a while, which is when the acid reflux business really bared its teeth (I think the ulcer med. probably masked the LES issue).

Edited February 2, 2011 by Mjx (log)

[andiesenji]

I was diagnosed with GERD and Barrett's Esophagus six years ago and was given various medications, advised to lose weight (which I have been doing), and have an upper endoscopy every two years and avoid eating certain foods late in the day. I also have to sleep with my upper body elevated.

My regular routine is one Ranitidine 150 mg 1 hour before eating in the morning for 4 months and then a 2 week course of Omeprazole and then back to the Ranitidine alone.

I was instructed to keep the volume of my meals below a certain point, which various with each person, and to "balance" the meal so there is a lower ratio of fatty foods to non-fatty and to keep the greasy foods generally to a lower percentage in my diet. I can have French fries OR a hamburger, but not both at the same meal.

The gastroenterologist suggested I have 5 smaller meals instead of the three regular type and this worked quite well even while I was still working. This is also beneficial for my diabetes.

I also have to walk for a minimum of 15 minutes after each meal, possibly one of the reasons I have slowly but steadily lost weight.

This is not strenuous activity but he says it contributes to stimulating the stomach to emptying more rapidly. I am absolutely forbidden to recline immediately after a meal, if I must sit it has to be on an upright chair.

I am due for another upper endoscopy in a few weeks, an event to which I am not looking forward, but it is necessary.

I can still eat almost all the things I used to eat, just juggled them a bit to fit into my routine and I had to give up the super-hot types of peppers and have to use less of some spices.

Edited February 2, 2011 by andiesenji (log)

[Mjx]

. . . .

I am due for another upper endoscopy in a few weeks, an event to which I am not looking forward, but it is necessary.

. . . .

Oh no! Those are lousy, I'm really sorry to hear that. I had just one, and that was plenty (the images were kind of cool, though, and I still wish I'd had the courage to ask the doctor for copies).

[SaltySnack]

I was pretty much living on Tums there for a while with heartburn. I was never on prilosec long enough to give it a go. But all that changed when I went gluten-free. All symptoms gone. Now the only time I get hearburn/reflux is when I drink a lot of carbonated beverages or funnily enough a migraine as it is now a symptom of a migraine for me.

I really suggest going gluten-free. it is amazing how many problems it cleared up for me and how I had no idea of how bad I was feeling before going gluten-free.

[Mjx]

feedmec00kies, is there any chance you're intolerant of something? It can take several weeks to figure it out, but even when you do find out, you don't have to avoid the problem items altogether, it just gives you some control over your condition. Also, have you been tested for celiac disease (or any other food allergy)? a lot of people go on with celiac for years, I believe many are not diagnosed until their 50s.

[Darienne]

I was with my husband and two dogs, two hours out in a canyon in Utah (thus five hours from any help at all) when I thought I was stricken by a heart attack and was going to die. The pain was excruciating. I did not tell Ed. What would have been the point? I made my peace with the fact that at least I was dying in my favorite place in the world.

Needless to say, I did not die. I suffered my first attack of GERD and nothing like it since. Prevacid was my drug of choice and I took it for a couple of months. That was 8 years ago, making me 61 at the time. Before that day I had NEVER EVER suffered any heartburnish upsets in my entire life. Never a Tums, never a Pepcid. Nada. I ate nails: I spit rust.

Mostly I can get by by taking nothing, but just monitoring my foods. I can eat spicy, hot, acidic...what I can't eat is meat and legumes together. The day of my non-death, I had eaten a 'Cowboy Lunch' at a local Moab watering hole. However, having said that, I am currently on an obsessive Mexican kick which is giving me some trouble, so I have a trusty vial of Raniditine at hand for difficult times.

Interesting enough, there is apparently no connection between legumes and GERD. Except for me.

Borrowing from the British playwright, John Mortimer, 'I am still clinging to the wreckage'.

[OnigiriFB]

Omg me too! But after meds for fibro and then gallbladder removal it got worse.

[Pierogi]

Tums was my best friend while I was working (in a very high stress field), and I was the office source for it. Anyone needing a Tums knew to come to my desk, I had the industrial size container. My co-workers, staff and I used to laugh that coffee and Tums was the official meal of the department.

About 10 years ago I was diagnosed with rheumatoid arthritis, and as part of the treatment take a handful of nasty anti-inflammatory pills every day. They are notorious for eating your stomach up. I went on the proton-pump inhibitor treatment (lik FG, whichever the insurance would cover at the moment). I got good results from the OTC Prilosec, but now am on Nexxium. As soon as I went on the PPI treatment, I stopped needing Tums. I'm sure their stock took a hit from the loss of revenue.

[qrn]

Prilosec, every morning, for years, takes care of all problems..may be luck, but that is what plays for me..I forget for two days and I notice the difference..

Bud

[feedmec00kies]

Mjx, when I first got blood tests done (I actually went to the medical center at school somewhere in there) I asked them to test for Celiac disease, because I knew it was a possibility, but it came back negative (fortunately). Otherwise, it doesn't appear that a food allergy or intolerance is at fault, but I haven't been as good as I could have been at trying to figure that out.

Darienne, we have a friend (a year older than me) that was diagnosed with GERD after having the same kind of heart attack panic 2 or 3 years ago. Even called an ambulance.

[Paul Bacino]

I had no luck with Prilosec, did have some success with Axid, but the best result for me has been Aciphex.. which my docter said has the ability to help repair the irritation rather than control.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001068

Best I have felt in yrs.

Cheers Paul

Edited February 2, 2011 by Paul Bacino (log)

[Darienne]

Gosh, all our friends are here.

[Peter the eater]

I take acid reflux meds for dental reasons, and to avoid the occasional burn. Constant low-level acidity was eroding my teeth enamel from the back like you might see with a bulimic, which I certainly am not. Rabeprazole works for me.

<Edit to add Rabeprazole = Aciphex as in Paul Bacino's link above>

Edited February 3, 2011 by Peter the eater (log)

[acautrell]

I don't have the chest pain or burning. I was diagnosed after having daily stomach pain for a couple of months and after the ulcer test came back negative, they decided on something resembling GERD. Daily omeprazole has done wonders for me. I haven't changed my diet a whole lot. I can eat a lot of the trigger foods and not notice any difference. I eat tons of citrus fruit and tomatoes, and spicy food. I do notice issues when I go overboard on sodas, coffee or chocolate, so it seems the caffeine and carbonation is my main trigger. My stomach also seems to get irritated when I eat too often. I do better if I don't snack and stick to 3 meals that aren't huge. It's been about a year since I started on the meds, and as long as I'm diligent there and on the coffee front I've been pretty much pain free.

[andiesenji]

Tums was my best friend while I was working (in a very high stress field), and I was the office source for it. Anyone needing a Tums knew to come to my desk, I had the industrial size container. My co-workers, staff and I used to laugh that coffee and Tums was the official meal of the department.

About 10 years ago I was diagnosed with rheumatoid arthritis, and as part of the treatment take a handful of nasty anti-inflammatory pills every day. They are notorious for eating your stomach up. I went on the proton-pump inhibitor treatment (lik FG, whichever the insurance would cover at the moment). I got good results from the OTC Prilosec, but now am on Nexxium. As soon as I went on the PPI treatment, I stopped needing Tums. I'm sure their stock took a hit from the loss of revenue.

I don't have rheumatoid arthritis but have had traumatic osteoarthritis, especially in my knees for many years and took a lot of NSAIDS until I had GI bleeding and my internist said that was the root cause of my stomach and esophagus problems as well as the GI symptoms, an "incipient ulcer". I can't even take aspirin now, much less Naproxyn or Ibuprofen and unfortunately I'm allergic to codeine. Oddly enough, while I still have some pain, I can mostly ignore it but I to have an electrical devise, something like an TENS unit to use but only rarely. If I keep my mind busy with reading or working and playing on the computer, I'm really unaware of the pain.

[gfweb]

If you are prone to GERD taking H2 blockers eg pepcid on an as needed basis is a mistake. It is much better to take them at least nightly before bed. You get a much better protection against Barret's and against agita.

Whether proton pump inhibitors are better than H2 blockers for the average patient is not clear (to me at least).

[feedmec00kies]

Some more random things:

Question for everyone: do you find that your symptoms are worse during certain times of the year? I'm wondering because this topic coincides with one of the two times of year that I tend to see an increase in severity (the other time is around August/September), and my doctor (internist) actually asked if it seemed to be seasonal. She said she's noticed this trend in patients, but can't draw any sort of conclusion from it.

Mjx: I forgot you had said a doctor prescribed anti-anxiety meds to you. One of the only times I didn't have any symptoms at all was when I was taking one for a few days. My husband had to get brain surgery for a benign tumor, and I started having panic attacks in the weeks between the diagnosis and the surgery. My doctor decided to give me a prescription for Lorazepam (Ativan). And you know what? Even though I was still heavily stressed out by the experience despite the medication (I started tearing up when they were doing his intake paperwork, and I burst into tears when we first got to see him after the surgery) those few days I didn't have any symptoms AT ALL. I did not think about needing to eat, feeling nauseous, or anything GERD-related. Of course you can't take anti-anxiety meds without developing tolerance for them, though, so sadly that wasn't a viable long-term option. It made it brutally clear how much of a trigger stress is for me, though (I can always tell how much I'm worrying about things by how bad my symptoms are).

[gfweb]

Anxiety absolutely provokes acid secretion, but treating anxiety is not the usual way to approach GERD...unless the primary issue is anxiety and GERD is just a secondary thing.