reflux volcano

Reflux

In search of the Holy Grail of Antacids

I have not found a solution to reflux yet and trying has been a bit of a torturous journey. Heartburn was my presenting problem. I had never suffered before and thought my stomach was the least problematic part of my vintage 1960s anatomy. How wrong I was.

Omeprazole

Despite my hatred of medication, after diagnosis I relented and went on omeprazole, a proton pump inhibitor (PPI). This was 20mg once a day and it worked for a while but the heartburn returned during chemotherapy so I upped the dose to 20mg x two times a day and stayed on this dose all through surgery. I tolerated the drug pretty well except for the fact I still had occasional heartburn.

The vagus nerve is responsible for acid production and as this is cut during surgery, one would hope that acid reflux would be a thing of the past or in my case, the not too distant past. I continued on the omeprazole but was aware of a sensitivity in my oesophagus. In addition, I had the post-oesophagectomy cough which could get quite violent at times.

Lansoprazole

At around 3 months post-op, I mentioned the sensation to my GP who put me on lansoprazole, another PPI.  Again I tolerated the drug very well and the cough pretty much went away. However after about 2 months on lansoprazole, I developed colitis, which was consistent for 3 weeks. I took to the internet to find out the cause and from the medical literature, it was pretty clear that PPIs can induce something known as microscopic colitis in some patients – approx 15%. I needed to test whether it was the medication so it was with much trepidation that I decided to come off the lansoprazole cold turkey and see if it cleared up. It did. I braced myself for the acid rebound but it was not too bad and settled to a lower level within a couple of days. The cough came back a bit but not half as bad as in the post-op weeks.

Ranitidine

My GP then gave me ranitidine (zantac) assuring me that it shouldn’t cause problems. This is where I am up to today. Ranitidine gives me dullish headaches and makes me feel quite sleepy in the afternoon. It also makes me feel a little dizzy and a bit vague so my next change will be either back to omeprazole or esomprazole (Nexium). However there is no guarantee that either of these will induce colitis again.

What really helps reflux
At night

I am lucky in some respect as I do not have any problems at night and sleep relatively upright as I have described in the sleep post. Apart from sleeping upright two things help at night

(i) Gaviscon Advance: Gaviscon Advance LiquidA large slug of this white gelatinous gloop keeps the acid from creeping up during the night.  This comes in peppermint and aniseed flavours. Why oh why they have to flavour it at all is beyond me – I’d take it if it was flavourless and still worked. The secret to Gaviscon Advance is the whacking 1000mg dose of alginate which mixes with acid to form a raft over the stomach contents and protect the oesophagus from rising acid.

(ii) Food:  Yes you heard right – having something in my stomach seems to really help – not just at night but all through the day. Obviously the choice of food matters – so a vindaloo is not ideal – instead a small, lightish carby snack that is easy to digest should be fine.

During the day

As well as having food in the stomach, avoiding bending after eating is obviously a good way of preventing reflux. Sometimes it is necessary to pick something up off the floor, eg what if you dropped your keys. For scenarios such as this I got a helping hand and it is fantastic.  It picks up coins easily as there is a magnet at the end. Very good for picking up random clothing and loading in the washing machine. I can also recommend a long handled hoover like any of the Dyson cordless varieties as they are light and you can stand fairly upright whilst hoovering.

 

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