Gastroesophageal Reflux Disease (GERD) - What medicine do you take ? Does it help ?

[impulse]

1 hour ago, Ulysses G. said:

I found that sucking on one Tums or Rolaids - calcium carbonate - when I had it would usually make it go away.

 

Yeah, I haven't found a Calcium Carbonate based one in Thailand.  They all seem to be aluminum salts and with all the hoopla around aluminum and Alzheimers, I only take them when I'm miserable and can't find baking soda.  Why risk it? 

 

Last time I was in China, I found dirt cheap baking soda pills, so they're my new go-to for immediate but very short term relief.  Usually long enough to allow the Miracid to kick in, which can take hours, but then it's good all day.

[xylophone]

1 hour ago, impulse said:

 

Like you, I've been taking PPI's pretty much since they came on the market, and before that Famotidine and Cimetidine (H2 blockers I think).  Looking at the available literature, I'd amend your comment about side effects to indicate that the side effects are nowhere near bad enough to stop me from taking them.  I'd have thrown myself under a bus decades ago if there was no relief from the 24/7 heartburn.  But there are side effects, and some of them are insidious, sneaking up after years or decades.

 

That said, my heart guy recently had me try another alternative PPI that seemed to work a little bit better than the Miracid and doesn't interact with my heart meds like Omeprazole.  But I gave up on it simply because it wasn't as widely available, and Miracid can be purchased in every tiny pharmacy in Thailand.  Sorry I don't recall the name.  If anyone's interested, post back and I'll dig through my Samitivej receipts.

Hi impulse, thanks for your post, always helpful to get as much info as possible if one suffers from GERD, and as I still take the occasional Omeprazole, I would love to know the name of the "alternative PPI"............was it Nexium??

 

This has been marketed as the latest and best PPI, by the manufacturer of course, whereas others are sceptical. However it is expensive!

 

By the way, my Dr said that he had patients who had been on Omeprazole for decades, with no side effects, but there can be in rare cases apparently.

[impulse]

2 hours ago, xylophone said:

was it Nexium??

 

This has been marketed as the latest and best PPI, by the manufacturer of course, whereas others are sceptical. However it is expensive!

  

As I understand it, Nexium (esomeprazole) is a slight variation of Prilosec (omeprazole = Miracid), which the manufacturer introduced to keep the gravy train feeding in after Prilosec went off patent.  They change one or two molecular  bonds, or use a different ratio of ingredients and get another 20 years of obscene profits.

 

Doctors over the years have told me to stick with Omeprazole because Nexium doesn't provide any significant improvement, at least not one that justifies the huge cost difference, where Prilosec and its generics sell OTC at stores like WalMart, and Nexium still requires a prescription ($$$ just for a Doc visit in the USA) and then sells at many multiples the cost of the generic omeprazoles.  Generic, $5 OTC.    Nexium $150(+) all in.  Not a hard decision.  Probably a little closer race in Thailand where a script isn't required, but then you have to hunt down Nexium, where Miracid is ubiquitous.  I'd also mention that I have tried some other omeprazoles when the pharmacy was out of Miracid, and they were hit and miss.  Miracid works every time.

 

I'm going to have to dig a little deeper to find the name of the new one.  I'm getting a bunch of various refills tomorrow and I'll ask them to look up my history if I can't find the receipt in my jumble o' medical paperwork that's spread between BKK and China..

 

Edited December 7, 2017 by impulse

[xylophone]

1 hour ago, impulse said:

  

As I understand it, Nexium (esomeprazole) is a slight variation of Prilosec (omeprazole = Miracid), which the manufacturer introduced to keep the gravy train feeding in after Prilosec went off patent.  They change one or two molecular  bonds, or use a different ratio of ingredients and get another 20 years of obscene profits.

 

Doctors over the years have told me to stick with Omeprazole because Nexium doesn't provide any significant improvement, at least not one that justifies the huge cost difference, where Prilosec and its generics sell OTC at stores like WalMart, and Nexium still requires a prescription ($$$ just for a Doc visit in the USA) and then sells at many multiples the cost of the generic omeprazoles.  Generic, $5 OTC.    Nexium $150(+) all in.  Not a hard decision.  Probably a little closer race in Thailand where a script isn't required, but then you have to hunt down Nexium, where Miracid is ubiquitous.  I'd also mention that I have tried some other omeprazoles when the pharmacy was out of Miracid, and they were hit and miss.  Miracid works every time.

 

I'm going to have to dig a little deeper to find the name of the new one.  I'm getting a bunch of various refills tomorrow and I'll ask them to look up my history if I can't find the receipt in my jumble o' medical paperwork that's spread between BKK and China..

 

Like you I have followed the "Nexium" saga and as per your description (and the opinion of other physicians) believe it to be a rip-off.

 

My Dr also suggested Ranitidine as an alternative and suggested that it could be taken (at night) as well as omeprazole in extreme cases.

[Blue bruce]

i have on and off periods of GERD , as suggested i take omeprazole. brand name Prilosec. I have been taking it for years no ill effects

[jamieoutlook]

6 hours ago, impulse said:

 

Like you, I've been taking PPI's pretty much since they came on the market, and before that Famotidine and Cimetidine (H2 blockers I think).  Looking at the available literature, I'd amend your comment about side effects to indicate that the side effects are nowhere near bad enough to stop me from taking them.  I'd have thrown myself under a bus decades ago if there was no relief from the 24/7 heartburn.  But there are side effects, and some of them are insidious, sneaking up after years or decades.

 

That said, my heart guy recently had me try another alternative PPI that seemed to work a little bit better than the Miracid and doesn't interact with my heart meds like Omeprazole.  But I gave up on it simply because it wasn't as widely available, and Miracid can be purchased in every tiny pharmacy in Thailand.  Sorry I don't recall the name.  If anyone's interested, post back and I'll dig through my Samitivej receipts.

Thanks for the info and advice,and i was the same regarding 24/7 acid high in the stomach..bend down and it would be in my mouth, absolutely horrible!

No doubt that like all meds there are possible/probable side effects, but, in my case, as i said, after 30 years of one a day i, myself have had no ill effects.

Possibly because i take absolutely no other meds to mix and cause problems, i don't know.

We are all different.

[impulse]

5 hours ago, Blue bruce said:

i have on and off periods of GERD , as suggested i take omeprazole. brand name Prilosec. I have been taking it for years no ill effects

 

The issue with Prilosec in Thailand is that it's hard to find (usually at hospitals) and it costs many multiples of the price of the generic equivalent (Miracid), which is made by Berlin Pharm, located  in Thailand.  Miracid costs about 60-80 baht for 14 days of the 20mg pills.  (Except in the airport where it's 120 baht +/- per 14 pills)  That's on par with what you'd pay for OTC Prilosec at a WalMart or other discount chain store back home since it went off patent and is now offered without a script.  But chain stores in Thailand don't sell it.  They generally don't sell any meds except the ones promoted to whiten skin or make you smart. 

 

If you want Prilosec, you'll be limited to buying it at a tiny fraction of the pharmacies on every street corner (95% will have Miracid). And you'll pay through the nose for it.  7 years of perusing these GERD threads has never shown me anyone who felt better on Prilosec (or any other brand of omeprazole) than they did on Miracid.  There are some other generics that seem to be hit and miss, but not the Miracid.

 

Edited December 7, 2017 by impulse

[wpcoe]

What can be taken after a particularly painful episode of acid reflux to kill the throat pain?  I have occasional reflux while I sleep and sometimes the pain (burning) is really intense, while usually it's rather mild.  Water does nothing.  I thought milk or yogurt would help, but no.  Any quick "band-aid" fixes for those sudden middle-of-the-night flashes of pain?

[ClutchClark]

I have not read through all these pages but I hope sme members have been able to suggest Probiotics and provided you with a good source. 

 

Good luck with your future health.

[impulse]

6 hours ago, wpcoe said:

What can be taken after a particularly painful episode of acid reflux to kill the throat pain?  I have occasional reflux while I sleep and sometimes the pain (burning) is really intense, while usually it's rather mild.  Water does nothing.  I thought milk or yogurt would help, but no.  Any quick "band-aid" fixes for those sudden middle-of-the-night flashes of pain?

 

Drinking baking soda in warm water works for me to neutralize the acid immediately.  That relief usually lasts long enough for the longer duration relief offered up by PPI's (like Omeprazole) or H2 Blockers (like Famotidine or Cimetidine). They usually take an hour to 4 hours to kick in, so they're more of a preventative than a relief.

 

[xylophone]

6 hours ago, wpcoe said:

What can be taken after a particularly painful episode of acid reflux to kill the throat pain?  I have occasional reflux while I sleep and sometimes the pain (burning) is really intense, while usually it's rather mild.  Water does nothing.  I thought milk or yogurt would help, but no.  Any quick "band-aid" fixes for those sudden middle-of-the-night flashes of pain?

A spoonful or two of Gaviscon works for me, with a little water if necessary (remember to shake the bottle before opening).

[Sheryl]

7 hours ago, wpcoe said:

What can be taken after a particularly painful episode of acid reflux to kill the throat pain?  I have occasional reflux while I sleep and sometimes the pain (burning) is really intense, while usually it's rather mild.  Water does nothing.  I thought milk or yogurt would help, but no.  Any quick "band-aid" fixes for those sudden middle-of-the-night flashes of pain?

Have you tried gaviscon?

 

The liquid form will act quickest though pretty icky tasting

 

Should also elevate the head of your bed if you haven't already

 

 

[wpcoe]

Thanks for the replies.  I'll try baking soda first, since I have some.  If it doesn't do the trick, I'll look into Gaviscon.  I assume Gaviscon is common at pharmacies in Thailand?

[Sheryl]

Yes, all pharmacies have it.

[jamieoutlook]

27 minutes ago, Sheryl said:

Yes, all pharmacies have it.

As a well respected adviser on things medical, i think it would be appropriate to amend your incorrect post on the workings of PPI's earlier in this thread if you will.

Some people don't bother reading a thread in its entirity and could be mislead by your words.

Thanks.

[Once Bitten]

I suffered for years with Reflux acid and in the end decided to have  Laparoscopic Nissens Fundoplication surgery.
 
This was paid for by my private health insurers  , that was over 15 years ago and it was the best thing I have ever done , within three months after the surgery I was still taking a lower does of Nexium and within six months I stopped all medication. After  the surgery right up to now I have never had a relapse of the reflux acid and life has been far better .   May be I had a good surgeon and was lucky .
 

[Sheryl]

As a well respected adviser on things medical, i think it would be appropriate to amend your incorrect post on the workings of PPI's earlier in this thread if you will.
Some people don't bother reading a thread in its entirity and could be mislead by your words.
Thanks.

If you are referring to my statement that PPIs reduce the acidity of gastric juices, thereby rendering reflux less uncomfortanle, they do. Nothing to correct.

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[jamieoutlook]

1 hour ago, Sheryl said:

 

If you are referring to my statement that PPIs reduce the acidity of gastric juices, thereby rendering reflux less uncomfortanle, they do. Nothing to correct.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

 

This is what you stated in part "they just render it less uncomfortable by making the gastric fluid less acidic."

PPI's do not make the fluid less acidic , they DO reduce the amount of acid made.

 

Well, there goes your credibility i guess.

Dozens of pages of info telling it how it is.;

Here, just a few;

https://medlineplus.gov/ency/patientinstructions/000381.htm

Proton pump inhibitors (PPIs) are medicines that work by reducing the amount of stomach acid made by glands in the lining of your stomach.

https://patient.info/health/proton-pump-inhibitors

PPIs are a group (class) of medicines that work on the cells that line the stomach, reducing the production of acid. 

https://www.drugwatch.com/proton-pump-inhibitors/

Proton pump inhibitors (PPIs) are medications designed to treat certain gastrointestinal disorders. They work by reducing the amount of acid in the stomach by shutting down many of the stomach pumps that produce it

Edited December 8, 2017 by jamieoutlook

[ClutchClark]

Just curious but isn't anyone using probiotics for thiese types of health issues?  I keep hearing about treating the symptoms with medication but no responses that actually attack the issue itself. 

 

Modification of diet.

 

Just a glass of Kefir a day can make a real positive difference.

[Sheryl]

2 hours ago, jamieoutlook said:

This is what you stated in part "they just render it less uncomfortable by making the gastric fluid less acidic."

PPI's do not make the fluid less acidic , they DO reduce the amount of acid made.

 

Well, there goes your credibility i guess.

Dozens of pages of info telling it how it is.;

Here, just a few;

https://medlineplus.gov/ency/patientinstructions/000381.htm

Proton pump inhibitors (PPIs) are medicines that work by reducing the amount of stomach acid made by glands in the lining of your stomach.

https://patient.info/health/proton-pump-inhibitors

PPIs are a group (class) of medicines that work on the cells that line the stomach, reducing the production of acid. 

https://www.drugwatch.com/proton-pump-inhibitors/

Proton pump inhibitors (PPIs) are medications designed to treat certain gastrointestinal disorders. They work by reducing the amount of acid in the stomach by shutting down many of the stomach pumps that produce it

I am well aware if the mode of action of PPIs. I just I really don't understand what sort of point you are trying to make since what you have said and what I have said are nto in any way at odds.

 

PPIs reduce the secretion of gastric acid. This in turn makes the gastric fluid -- which is a mixture of water, HCL (gastric acid) and enzymes -- less acidic.

 

It is this effect of reducing acidity that accounts for their therapuetic effect in GERD, ulcer disease etc.

[Rhys]

Well...hmm.. the section is for information and possibly a referral to the MD...it is not a site for self-prescribing information... see the MD...  Happy Holidays.

[balo]

3 hours ago, ClutchClark said:

Modification of diet.

 

Just a glass of Kefir a day can make a real positive difference.

I agree , but when the doctor diagnoses you with GERD it is too late for a diet change I think . At least that's what my brother told me , he tried some changes in the diet as well. 

 

  

[jamieoutlook]

4 hours ago, Sheryl said:

I am well aware if the mode of action of PPIs. I just I really don't understand what sort of point you are trying to make since what you have said and what I have said are nto in any way at odds.

 

PPIs reduce the secretion of gastric acid. This in turn makes the gastric fluid -- which is a mixture of water, HCL (gastric acid) and enzymes -- less acidic.

 

It is this effect of reducing acidity that accounts for their therapuetic effect in GERD, ulcer disease etc.

Okay, now i get it where we are differing as  it appears you have mistakenly thought that the secretion of gastric acid makes gastric fluid. This is incorrect.

The reason you are incorrect is because gastric acid is just another name for gastric fluid and also stomach acid; ie all three names are used by different people to describe the same thing.

 

So to reiterate,as i have said earlier that PPI's simply and only , reduce the amount of secretion [by volume from the gastric glands] of the gastric acid AKA gastric fluid AKA stomach acid so that there is less volume present, the mixture itself is not at all diluted or as you say, less acidic.

 

You are however  correct in your description of the basic make up of this liquid.

 HCI [hydochloric acid], also rennin, pepsin, mucin, potassium chloride and sodium chloride and water.

Thank you for your input.

 

 

[Sheryl]

10 hours ago, jamieoutlook said:

Okay, now i get it where we are differing as  it appears you have mistakenly thought that the secretion of gastric acid makes gastric fluid. This is incorrect.

The reason you are incorrect is because gastric acid is just another name for gastric fluid and also stomach acid; ie all three names are used by different people to describe the same thing.

 

So to reiterate,as i have said earlier that PPI's simply and only , reduce the amount of secretion [by volume from the gastric glands] of the gastric acid AKA gastric fluid AKA stomach acid so that there is less volume present, the mixture itself is not at all diluted or as you say, less acidic.

 

You are however  correct in your description of the basic make up of this liquid.

 HCI [hydochloric acid], also rennin, pepsin, mucin, potassium chloride and sodium chloride and water.

Thank you for your input.

 

 

Gastric acid and gastric fluid are not the same thing.

 

Gastric acid (HCL) is one of the constituents of gastric fluid, but the fluid itself is mostly water and also contains enzymes, electrolytes, and other substances, as well as remnants of any food and fluids taken recently.

 

Gastric acid is the component in gastric fluid that accounts for the fluid's acidity,This acidity can be reduced in several ways:

 

1 - Dilution with food or liquids i.e. eating or drinking something, this will always reduce acidity (by how much depending on the pH f what was ingested) but of course temporarily.

 

2 - Neutralization of the H+ ions (HCL releases H+ ions as do all acids) by ingestion of a medication that releases OH- ions, this is what antacids do and is the fastest means of reducing acidity but also a very temporary one.  (Some antacid preparations also contain a substance that helps coat the stomach lining to reduce irritation).

 

3 - Medications that reduce the amount of HCL secreted by cells lining the stomach (parietal cells). These in turn fall into 2 main categories: H2 blockers (cimetidine, ranitidine, famotidine etc) and PPIs.

[ClutchClark]

Highly informative posts above

12 hours ago, balo said:

I agree , but when the doctor diagnoses you with GERD it is too late for a diet change I think . At least that's what my brother told me , he tried some changes in the diet as well. 

 

  

I hear ya Balo.

I have no direct experience and the last few posts have been really informative.

 

I never thought I would be one of these people to promote health food fads or snake oil or go on about how this simple pill changed my life...but...I guess thats just what I have become when it comes to my experience with probiotics.

 

No...I am not a salesman and this is not an infomercial ;-)

 

But since Acid Reflux looks like it can be a chronic condition, you might want to take a gander at the topic of probiotics and not some industry website tooting its own horn but medical journals like this one:

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906699/

 

I am cringing at my post but drinking a kefir type yogurt daily shouldn’t do any harm and after a month or so might do a little good and lower the reliance on pharmaceuticals.

 

 

[xylophone]

18 hours ago, ClutchClark said:

Just curious but isn't anyone using probiotics for thiese types of health issues?  I keep hearing about treating the symptoms with medication but no responses that actually attack the issue itself. 

 

Modification of diet.

 

Just a glass of Kefir a day can make a real positive difference.

Yes I have tried probiotics and prebiotic's and just about every "biotic" one can find to help with GERD, but they have made no difference I'm afraid. Even ones with 25 and 50 billion colony-forming units as well as the fermented yoghurt drinks and so on.

 

You posted a link regarding probiotics, however that seemed to be mostly concerned with alleviating the symptoms of gastric ulcers and similar, but not with GERD.

 

As I said in an earlier post, there are many "theories" as to what causes this and it's probably a combination of a few I mentioned, and for my money probably the most likely of causes are stress (perhaps causing the stomach to produce more gastric acid)  and the fact that the oesophageal sphincter has a problem, either weakening over time and with wear and tear, or something regarding the mechanism which causes it not to open and close at the correct times.

 

For whatever reason, when people get this, certain foods trigger a reaction and as if to highlight this, at one time in my life I would love to eat raw onions with cheese. Unfortunately once GERD set in, I cannot touch an onion, although just a few in a stew or similar is passable. The same goes with red capsicums which at one time I loved, but they are absolutely a no no now.

 

So far, as has been posted, the proton pump inhibitors such as omeprazole seem to work the best for most people.

[ClutchClark]

4 minutes ago, xylophone said:

Yes I have tried probiotics and prebiotic's and just about every "biotic" one can find to help with GERD, but they have made no difference I'm afraid. Even ones with 25 and 50 billion colony-forming units as well as the fermented yoghurt drinks and so on.

 

You posted a link regarding probiotics, however that seemed to be mostly concerned with alleviating the symptoms of gastric ulcers and similar, but not with GERD.

 

As I said in an earlier post, there are many "theories" as to what causes this and it's probably a combination of a few I mentioned, and for my money probably the most likely of causes are stress (perhaps causing the stomach to produce more gastric acid)  and the fact that the oesophageal sphincter has a problem, either weakening over time and with wear and tear, or something regarding the mechanism which causes it not to open and close at the correct times.

 

For whatever reason, when people get this, certain foods trigger a reaction and as if to highlight this, at one time in my life I would love to eat raw onions with cheese. Unfortunately once GERD set in, I cannot touch an onion, although just a few in a stew or similar is passable. The same goes with red capsicums which at one time I loved, but they are absolutely a no no now.

 

So far, as has been posted, the proton pump inhibitors such as omeprazole seem to work the best for most people.

 

Very sorry to hear about your on-going condition.

 

Raw onions are a favorite of mine so that must be tough.

 

No doubt you would mitigate your stress level if you could.

 

Thanks for your response and best wishes.

 

 

[xylophone]

59 minutes ago, ClutchClark said:

 

Very sorry to hear about your on-going condition.

 

Raw onions are a favorite of mine so that must be tough.

 

No doubt you would mitigate your stress level if you could.

 

Thanks for your response and best wishes.

 

 

Thanks for your concern and best wishes CC, much appreciated.

 

Actually the condition is not so much ongoing these days as I did alleviate my stress problems by quitting the job I was in, which was a highly stressful one managing an investment advisory division with just under $2 billion worth of funds to take care of, not to mention thousands of clients and a few score staff.

 

I did mention in another post that I had managed to just about overcome it with omeprazole and some natural D-limonene capsules, and I rarely get a flareup these days, and if I do it's mostly caused by eating the wrong food or eating too late. My own bloody fault!

 

As others have said, living with GERD is a bit of a nightmare, however the meds and living in Thailand have helped me tremendously.

 

I wish you well.

[jamieoutlook]

6 hours ago, Sheryl said:

Gastric acid and gastric fluid are not the same thing.

 

Gastric acid (HCL) is one of the constituents of gastric fluid, but the fluid itself is mostly water and also contains enzymes, electrolytes, and other substances, as well as remnants of any food and fluids taken recently.

 

Gastric acid is the component in gastric fluid that accounts for the fluid's acidity,This acidity can be reduced in several ways:

 

1 - Dilution with food or liquids i.e. eating or drinking something, this will always reduce acidity (by how much depending on the pH f what was ingested) but of course temporarily.

 

2 - Neutralization of the H+ ions (HCL releases H+ ions as do all acids) by ingestion of a medication that releases OH- ions, this is what antacids do and is the fastest means of reducing acidity but also a very temporary one.  (Some antacid preparations also contain a substance that helps coat the stomach lining to reduce irritation).

 

3 - Medications that reduce the amount of HCL secreted by cells lining the stomach (parietal cells). These in turn fall into 2 main categories: H2 blockers (cimetidine, ranitidine, famotidine etc) and PPIs.

Jesus wept woman!

HCL is the symbol for Hydrochoric acid, not for Gastric Acid AKA Gastric Fluid.

Gastric acid

Gastric acid, gastric juice or stomach acid, is a digestive fluid formed in the stomach and is composed of hydrochloric acid, potassium chloride and sodium chloride

[Sheryl]

Wikepedia, which is where you took this from verbatim, is not the best source for detailed information on human physiology.

 

Gastric acid is HCL, at least in medical and scientific terms. Hydrochloric acid is the acid secreted by the parietal cells of the stomach.

 

 

 

 

 

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