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Use caution when tapering off your medicine for GERD

This week we have three very different questions. The first is from a member seeking a plan to taper off of his medicine for GERD. This should be done under the direction of a physician following a specific program to reduce any rebound effect. The second is an excellent question comparing silent reflux, or LPR, and acid reflux. Both result from the same problem, a damaged LES, but have very different symptoms. Finally, a member that just completed antireflux surgery has several questions about the recovery process. We asked our GERD specialist Dr. Dan Lister, who serves those suffering from acid reflux disease in Little Rock and the North Arkansas area, to respond to our member’s questions.

How do I taper off PPIs?
Member Question:

I have been taking Protonix as a medicine for GERD for 6 weeks (40 mgs, 2 times a day). How do I taper down at the end of this period?
Dr. Lister’s Response:
Acid rebound has been validated as a real response to withdrawal from daily PPI use. Dr. Chandrasoma wrote an interesting article discussing this titled Rebound Acid Secretion: What to expect if you reduce your PPI use . Since everyone is different, everyone will respond differently. I also recommend that you speak with your physician prior to starting this process to gain his input into and reduce your potential for any rebound effect. I have my patients take Ranitidine or Famotidine along with their PPI for five days prior to discontinuation of this powerful medicine for GERD. I then have them continue with H2 blockers for at least two weeks to allow their acid pumps to start working again. This also allows serum gastrin levels to return to normal to minimize the rebound effect due to overproduction of acid.

During this process be certain to eat several small meals every day, do not eat anything for at least three hours before you go to bed, and most importantly, avoid all trigger foods. Also, I encourage you to reduce your use of alcohol, or eliminate it all together, and stop smoking if you are a smoker. Keep your physician updated on your progress as well of any significant symptom reoccurrences that last for more than a few days.
Is silent reflux worse than acid reflux?
Member Question:
Is silent reflux worse than acid reflux?
Dr. Lister’s Response:
“Silent reflux,” also known as laryngopharyngel reflux, or LPR, and traditional acid reflux result from the same issue, a damaged lower esophageal sphincter; however, they tend to have very different symptoms. Acid reflux symptoms include heartburn, indigestion, abdominal and chest pain, and the sensation of food moving from the stomach into the esophagus (regurgitation). LPR, on the other hand, causes symptoms that include constant throat clearing, persistent coughing, and a hoarse voice.
LPR is a bit different in that it tends to be very short episodes of reflux reaching the vocal cords and typically only occurs in the upright position. It can affect the lungs and can cause serious problems including asthma and pulmonary fibrosis, so these symptoms should not be ignored.

Many people who suffer from LPR are not aware that their symptoms are a result of GERD. Traditional acid reflux, on the other hand, is typically more painful and thus, it could be considered “worse.” However, from a physician’s perspective, both are equally problematic and should be treated by a specialist.
How long do symptoms last after acid reflux surgery?
Member Question:
How long do you feel acid reflux and nausea after surgery? My surgeon said everyone is different. Please let me know. It’s been three weeks. Didn’t know I needed to be on a special diet.
Dr. Lister’s Response:
Your surgeon is correct. Everyone is different and each recovery from acid reflux surgery will be a bit different. It is important to remember that all antireflux procedures are significant surgeries, and as such, your body will need to recover from the intervention.
Like your surgeon, I put my patients on a strict “post-op” diet primarily to prevent any swallowing problems rather than to help with acid reflux symptoms. Reflux symptoms will go away rapidly after surgery in most cases since the procedure stops the refluxing of stomach contents into the esophagus. This difference will be noticeable within the first few days for the majority of patients. If symptoms are still occurring three weeks after surgery, I would be concerned that GERD was not the underlying driver of the symptoms. If antireflux surgical patients believe that they are still having reflux symptoms following surgery, I would request a 24-hour pH study to determine if the antireflux surgery was effective in eliminating any reflux. More importantly, situations like this illustrate why it is so important to do all of the proper diagnostic tests to accurately diagnose reflux and certainly prior to acid reflux surgery.

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