Silent GERD & medication

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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echo
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Silent GERD & medication

Post by echo » Tue Apr 27, 2010 8:26 am

Hi everyone, I'm looking for some advice/feedback on going back on GERD medication. Short history:

- I've had on and off GERD (the non-silent kind) for years. When I watch what I eat, and have less abdominal fat, it seems to go away (ahem, i.e. when I lose weight). The GI specialist I went to last year said the same thing, that I need to lose weight. He also said I need to exercise 2 hours a day most days of the week.
- Even when I had less fat around my belly, I still sometimes woke up with that bad taste in my mouth
- Last year after my endoscopy (it was clear thankfully though with indications of GERD) the doctor gave me a few weeks' supply of medication to take for the reflux. After that he said to keep taking it if the reflux didn't go away. Well it seemed to go away and I also didn't have the bad taste in my mouth in the mornings, but who knows for sure?
- BUT lately it seems to have come back, at least the silent type. Last few weeks (also corresponding to gaining a few kg's again) I keep waking up with a bad taste in my mouth, so I think it's back.

I'm realllyyyyyy paranoid about taking GERD medication my whole life. My dad had/died from esophagael cancer from GERD even though he took Prilosec for years (unfortunately his GP never ordered an endoscopy and we had no idea how bad GERD could get). Well I'm getting the 5-yearly endoscopies now, but I'm still not comfortable with continuously reducing my stomach acid with meds (since I don't think that's the real cause of the reflux anyway). I'm just not doing very well controlling my weight or my food intake at the moment (less carbs/fats).

But in the meantime, until I can lose some weight and get back on track with a better eating strategy again, I think I need to go back on the meds. Right?

Assuming the meds work in the interim, and eventually I do lose weight again, how do I know that the silent GERD is no longer a problem? Is the lack of a bad taste in my mouth in the mornings sufficient? Or is the endoscopy the only way to know for sure??

I just feel like I'll be battling this for the rest of my life, and I definitely don't want my sleep (and my esophagus) to suffer from silent GERD. I also don't want to take these meds for the rest of my life, probably a subconscious fear based on my dad's experience, even though logic tells me the endoscopies will catch any changes.

Thanks, I just need to gripe. I know what I need to do, just you know?
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LSAT
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Re: Silent GERD & medication

Post by LSAT » Tue Apr 27, 2010 8:57 am

echo....
I can relate...I had the Nissen Fundoplication surgery 8 years ago. Most GERD is the result of a malfunctioning lower esophageal sphincter (LES) valve. The surgery completely stopped any acid related symptoms for me. From what you indicated, the only thing you are doing is taking meds and watching your eating habits...that's fine, but in addition, elevate the head of your bed or get a bed wedge, avoid sleeping on your right side and do not eat within 3 hours of bedtime. I would think reflux at night would be at a minimum because your CPAP is blowing down the esophagus and should prevent most reflux from coming up. You don't indicate any throat symptoms but, you might have an ENT do a mini scope in the office to see if there is any indication of acid in the throat or vocal chords. Continue with the periodic endoscopy.

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KatieW
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Re: Silent GERD & medication

Post by KatieW » Tue Apr 27, 2010 9:05 am

Who can exercise 2 hours every day? That's unrealistic advice to be giving out. Echo, it's a dilemma, and as you say, you know what to do.

Just wanted to say hi, and that I've been enjoying your posts.

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Re: Silent GERD & medication

Post by jnk » Tue Apr 27, 2010 9:13 am

LSAT wrote: . . . do not eat within 3 hours of bedtime . . .
Excellent advice! My understanding is that following that advice may be enough to solve the problem for some.

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BlackSpinner
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Re: Silent GERD & medication

Post by BlackSpinner » Tue Apr 27, 2010 9:33 am

I'm realllyyyyyy paranoid about taking GERD medication my whole life. My dad had/died from esophagael cancer from GERD even though he took Prilosec for years (unfortunately his GP never ordered an endoscopy and we had no idea how bad GERD could get).
The medication didn't cause it and might have kept it from developing much earlier. You are more aware of the issues and taking steps to keep up with it therefore taking the medication should be a Good Thing. It doesn't solve everything but it does reduce the effect of the reflux.

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Re: Silent GERD & medication

Post by GERDfree » Tue Apr 27, 2010 4:17 pm

Hi

I have had similar issues and concerns. A few things helped for me:

1. Not eating 2 hours before sleep.
2. Watching what I eat before sleep, some foods tended to give me far more problems
3. Raising the bed head.
4. Somac - one 40 mg tablet a day worked wonders.
5. Losing weight.

But the biggest change was getting a CPAP. I think sleep apnea was probably the main cause for my GERD.

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roster
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Re: Silent GERD & medication

Post by roster » Tue Apr 27, 2010 4:36 pm

echo, It's good to see you active here again. I thought of this earlier when you were telling a newbie how important data is. It's a simple basic requirement but the medical profession rarely tells newbies, so it is good to have you telling them.

GERDfree has given you some good advice that is basically what I did to cure my silent GERD. I used Prilosec for a few weeks to speed up the process but, like you, I did not want to use a GERD drug longterm.

My chronic symptom was a slightly hoarse throat when I talked a lot (basically all day ). I also had bad sleep disturbances if I ate a very spicy dinner. Fortunately that has gone away.

Elevating the head of the bed four to five inches is a must IMO. Be careful with wedges. Most of them are fairly short and cause you to bend at the stomach area which can actually worsen reflux. MedSlant makes one which is long enough that you bend at the hips. However, it is comfortable in the backsleeping position only, so my MedSlant languishes in the closet while I use four-inch risers under the bedfeet at the head.

In a few minutes I will start a new threat about an article on sleep apnea and reflux that you should read.

Ciao.

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Re: Silent GERD & medication

Post by PST » Tue Apr 27, 2010 7:37 pm

I have GERD and take a proton pump inhibitor -- in my case Prevacid, but I think they all work similarly. Although I didn't like the idea of taking a pill every day, this has worked so well for me that I don't object any more. The different approaches to acid reflux depend on whether you are working on the acid part or the reflux part. The pills don't prevent reflux, they just ensure that what comes up into the esophagus isn't excessively acidic. It is largely the acid that causes Barrett's esophagus, the precursor to esophageal cancer. Posture changes and surgery work on the reflux. The methods complement one another.

I agree with Blackspinner that antacid medication does not contribute to the development of esophageal cancer. I started on the advice of a gastroenterologist, who cited a reduction in cancer risk as a reason to take it.

And might I add that it's good to see you posting, Rooster. You seemed to be missing for a few days, and I began to worry that perhaps you were lying low as a precaution until the Sue Lowden kerfuffle passes and barnyard fowl are safe again.

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Re: Silent GERD & medication

Post by mars » Tue Apr 27, 2010 8:07 pm

echo wrote:

Assuming the meds work in the interim, and eventually I do lose weight again, how do I know that the silent GERD is no longer a problem? Is the lack of a bad taste in my mouth in the mornings sufficient? Or is the endoscopy the only way to know for sure??


Hi Echo

I have an endoscopy every year, to check if Barretts Esophagus has turned into cancer. This is caused by Gastroesophagal Reflux Disease, and unless you have an endoscopy every year, you will not know whether or not GERDS has caused Barretts Esophagus, (unless cancer arrives).

5 yearly endoscopies is really bad advice, bordering on the incompetent. IMHO!
Rooster wrote -
However, it is comfortable in the backsleeping position only, so my MedSlant languishes in the closet while I use four-inch risers under the bedfeet at the head.


The medslant wedge is a good idea, and I find it very comfortable to use it sleeping on my side. Obviously, comfort is a personal issue.

cheers

Mars
for an an easier, cheaper and travel-easy sleep apnea treatment :D

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Re: Silent GERD & medication

Post by roster » Wed Apr 28, 2010 5:15 am

PST wrote:
And might I add that it's good to see you posting, Rooster. You seemed to be missing for a few days, and I began to worry that perhaps you were lying low as a precaution until the Sue Lowden kerfuffle passes and barnyard fowl are safe again.

"But this one's eating my popcorn!"

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Re: Silent GERD & medication

Post by Country4ever » Wed Apr 28, 2010 5:45 am

Hi Echo,
Have you tried any supplements, like digestive enzymes or slippery elm, etc.?

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Re: Silent GERD & medication

Post by Didi needs a nap » Wed Apr 28, 2010 5:52 am

I am also overweight, but I found that eliminating Carrageenan from my diet cured my GERD. I haven't had an attack since.

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echo
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Re: Silent GERD & medication

Post by echo » Wed Apr 28, 2010 4:46 pm

Thanks for all the feedback everyone, and thank you Rooster for that other post, it really hit home.

So first things first I will make an appt with the doctor to get some meds again. I do realize that the medication itself doesn't cause the cancer (or the Barrett's esophagus), believe me we learned a LOT after GERD and Barrett's esophagus and cancer after he was diagnosed. My concern was that even though he was on medication it still developed into cancer. Although you can argue that many ways: the lesions may have already been present before he started the meds (he took them 20+ years and died at age 54), they weren't strong enough, no endoscopy was ever done, etc... anyway, it's one of my 'irrational fears' about the future.

As for the eating before bed guilty as charged. It's all tied in with my biorhythm too, as well as my previously very demanding job and the 3 hours of commuting - I wake up late, my eating schedule gets shifted, breakfast is skipped, dinner gets eaten late, vicious cycle continues. I will try to be more careful with this. Although with me, 3 hours before bedtim isn't enough. My digestive system is horribly slow (hello hypothyroidism?), but seems to have improved a bit with the thyroid meds. I'm actually hungry when I wake up now!

I frequently use a digestive enzyme complex, usually with dinner and if I don't forget with breakfast/lunch too. I'm thinking about starting drinking Aloe again, that seemed to help before.

Spicey foods don't seem to affect me negatively, but wine and chocolate do (aw gawd what a life without those things!).

Malfunctioning lower esophageal sphincter makes a lot of sense, and would explain why my dad, my sister, and I all have the reflux problem. I never though about surgery. I'm also curious to see what my sister's doctor says - she had the 48-esophageal pill implant last month and had the strange result that the times when she felt the reflux in her throat, the pH was actually alkaline, not acidic. The meds seem to help her a lot.

The bed issue . I guess I didn't realize how important that was (I always thought of it as an interim solution). I've slept in my parents' bed quite a few times - the head of their bed is raised (mattress isn't bent, but straight, so the whole bed is raised basically??), and I could never get comfortable sleeping on it. It feels so unnatural, I always feel like I'm falling off the bed, and basically I can only sleep on my back in that bed. So I'm very reluctant to do this at home.

Throat hoarseness - yes I have that too actually, and the annoying cough sometimes. And the mucous formation which I've read is the body's way of protecting the throat. I have a whole bunch of other symptoms too, you want it in novel form or cliff's notes? I guess lately the other main symptom has been the unrelenting congestion, nose is clear when I go to bed (hh in passover mode) and in the morning, bam! All stuffed up. It's not allergies as it only comes at night, the cpap filters are cleaned/replaced weekly or as necessary, only distilled water that's rinsed out weekly, etc.

I thought they checked the throat too, during the endoscopy? At least they did the first time I had one in 2001. Not sure if they did this time.

Mars -- the doctors that treated my dad said that even 10-yearly endoscopies are OK, but if it was someone in THEIR family they would recommend it every 5 years. The reasoning is that it takes a long time for the cells to become dysplastic and even longer to turn into cancer, so every 5 years is sufficient, in their opinion.

Well, let's start the GERD battle (again)! Thanks all for the responses! and sorry again for my usually long-winded posts
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echo
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Re: Silent GERD & medication

Post by echo » Thu Apr 29, 2010 5:56 pm

Went to the doc today, got the prescription for pantomed (pantoprazole), 20mg, which is what they gave me last year after the endoscopy because I had some small scarring in the esophagus. Apparently it's a "mild" proton pump inhibitor??

So tonight: NO food 5 hours before bedtime, which is in a few minutes, and now I've got the worst daytime reflux I've had in ages. Took the med about an hour ago (no food afterwards, maybe that was my problem??) . auuuurgh!

You win some, you lose some. Let's hope it gets better after a few days.... Thanks again everyone.
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Re: Silent GERD & medication

Post by frh » Thu Apr 29, 2010 9:36 pm

echo wrote:Went to the doc today, got the prescription for pantomed (pantoprazole), 20mg, which is what they gave me last year after the endoscopy because I had some small scarring in the esophagus. Apparently it's a "mild" proton pump inhibitor??
echo, I was on zantac (rantodine) for more than 20 years, but it stopped working. The doc had me try Prevacid OTC (lansoprazole). It didn't seem to work. They put me on 40 mg Protonix (pantoprazole) about 3 months ago. A couple of weeks ago (after my endoscopy) they upped it to twice a day (1/2 hour before I eat in the evening and again in the morning), plus Carafate 1 gm tablets 4 times a day. The doc assured me pantoprazole will be safe to take the rest of my life.

I never remember to take the pills before I eat, so I started taking them when I go to bed and as soon as I roll out of bed in the morning. Truth is, I think CPAP makes more difference than the pills do. It seems to keep reflux from happening when I sleep. Regardless, a lot of my esophagus discomfort has gone away in the last couple of weeks. As soon as I can get the money, I plan to order a Mediwedge http://www.mediwedge.com/index.html, but I can't quite decide between the 4" and 6" size.

Last night was my second night on the S9. It's set for a minimum pressure of 5 and a maximum pressure of 10. The first night it reported an AHI of 2.9 with an average pressure of 6.8. Last night it said 1.0, but I did not take the card out to check the pressure. Last night was also the first night in years that I got 7 hours of unbroken sleep. I would probably have slept another hour or two, but two dogs woke me at 6 am.

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