FAQ

PPIs are an efficacious and safe drug class. They offer relief to patients in a patient-centered healthcare system. Unfortunately, these agents do potentially have some long-term consequences from continued use, including malabsorption issues and increased risk of infections. The pharmacist can be an advocate for the patient in the hospital system or in the community by understanding these risks and fostering patient-centered care by empowering a well-informed patient in healthcare decisions.

PPIs stop cells in the lining of the stomach producing too much acid. They are called 'proton pump inhibitors' because they work by blocking (inhibiting) a chemical system called the hydrogen-potassium adenosine triphosphatase enzyme system (otherwise known as the 'proton pump'). This chemical system is found in the cells in the stomach lining that make stomach acid. The proton pump is the terminal stage in gastric acid secretion, being directly responsible for secreting H+ ions into the gastric lumen, making it an ideal target for inhibiting acid secretion.

PPI	Full/standard dose	Low dose (on-demand dose)	Higher dose
Esomeprazole	20 mg once a day	Not available	40 mg once a day
Lansoprazole	30 mg once a day	15 mg once a day	30 mg twice a day
Omeprazole	20 mg once a day	10 mg once a day	40 mg once a day
Pantoprazole	40 mg once a day	20 mg once a day	40 mg twice a day
Rabeprazole	20 mg once a day	10 mg once a day	20 mg twice a day
Dexlansoprazole	30 mg once a day	15 mg once a day	30 mg twice a day

If one of your PPI does not work, you should try another PPI brand and so on until you find the “perfect” one. Also try H2 blockers. If you haven’t managed your diet then do so. Eliminate certain foods (lactose, gluten, carbs, fizzy drinks, junk food etc.) and see if that helps. If none of this helps then visit your MD. The last resort would be an esophageal surgery (Nissen fundoplication and other related procedures). Make sure you try everything else before surgery.

Proton pump inhibitors work best when they are taken 30 minutes before your first meal of the day (morning meal). If taking one pill before your first meal does not completely relieve your symptoms, talk to your doctor about taking another pill before your evening meal. If you are taking the evening pill, then you should take it 30 minutes before the evening meal.

There isn’t the best brand in terms of PPIs. All PPI brands work the same, by inhibiting the little pumps in our stomach and therefore allowing our stomach/esophagus to heal over time. Other types of PPIs have been compared to omeprazole (the first PPI type) and no one showed any significant difference in terms of being the best. The newer PPI (esomeprazole-nexium) also does not show any significant difference compared to omeprazole (prilosec). Dexlansoprazole which was approved by the FDA in 2009 (Kapidex, Dexilant). Showed a little advatanges when compared to esomeprazole but again, no significant difference.

The half-life of PPIs inhibition of gastric acid secretion lasts an estimated 24 hours. The half-life in the blood is 1-1.5 hours. The PPI should get out of your system in less than a week because it takes 4 half-life’s to eliminate the PPI from the body.

Half-life: action duration of a drug.

As often said, no drug is 100% safe. That doesn’t mean that you shouldn’t take one if you need it. But you should continually weigh the risks and benefits.
Many people take PPIs. People often take PPIs every day for years. This makes sense if you have a chronic problem with stomach acid, a severe case of Barrett’s esophagus, Zollinger-Ellison syndrome etc., but the occasional case of mild heartburn does not need to be treated with a PPI.

If you have a prescription for a PPI, you and your doctor should review the reasons for it periodically to make sure they’re still valid. If you do need that prescription and many people do it should be for the lowest effective dose.

There is no Addiction reported by people who take Omeprazole (PPI) yet. This review analyzes which people have Addiction with Omeprazole. It is created by eHealthMe based on reports from FDA, and is updated regularly.

Long-term studies have shown that PPIs are generally well tolerated and cause few adverse events. As a class, however, PPIs are associated with an increased risk of certain diseases.

Because PPIs give rise to profound and long-lasting elevation of intragastric pH, it is not surprising that they interfere with the absorption of concurrent medications. PPIs have been shown to reduce the bioavailability of many clinically relevant drugs (e.g. ketoconazole, atazanavir) by 50% or more compared with the control values. Omeprazole was associated with 30% and 10% reductions in systemic clearance of diazepam and phenytoin. Clinical trials have raised concerns about possible interactions between PPIs and clopidogrel. It has been suggested that therapy consisting of clopidogrel and aspirin may attenuate the anti-aggregation effects of those medications and augment the risk of cardiovascular ischemic events.

Initially absorbed in the small intestine and distributed to the gastric parietal cells, where they are activated in the acidic environment of their acidic vesicles and secretory canaliculi. (pH < 1) is reportedly necessary for the activation of PPIs, thus it has been believed that parietal cells are the only sites in the human body in which PPIs are activated. However, cells such as leukocytes and osteoclasts are also known to have acidic vesicles in their cytoplasm. If PPIs indeed exerted effects on the functions of these cells, additional interesting therapeutic possibilities may be revealed for PPIs. However, we would also need to pay attention to the adverse effects of long-term and high-dose PPI therapy.

vesicles: a small fluid-filled bladder, sac in the body.

canaliculi: microscopic canals/tubes

A proton pump is an integral membrane protein that is capable of moving protons across a biological membrane. In cell respiration. The proton pump uses energy to transport protons from the matrix of the mitochondrion to the inter-membrane space. The proton pump does not create energy, but forms a gradient that stores energy for later use. In addition to proton pumps in mitochondria, humans have a gastric hydrogen potassium ATPase or H+/K+ ATPase that functions as the proton pump of the stomach, primarily responsible for making the stomach acidic.

Mitochondrion: a powerhouse in a cell in which the biochemical processes of respiration and energy production occur.

The drugs don’t just turn off acid pumps in the stomach. Instead, the researchers say, PPIs also block the production of acid in every cell in our bodies, an effect that hampers the body’s ability to rid itself of damaged proteins -- the “garbage” that builds up as we age. “I think we now have a smoking gun,” says John Cooke, MD, PhD

Unfortunately, there can be a downside to such medication (NSAIDs): stomach upset and bleeding ulcers. The most popular generic NSAIDs include: naproxen, ibuprofen, aspirin etc. "If you're taking NSAIDs on a chronic basis, there's a very high percentage risk that you will develop significant symptoms," says Hoffman. Taking a second drug can reduce your risk of side effects related to traditional NSAIDs, says Hoffman. Among the options: an acid-blocking drug like PPI or a less potent drug like H2 blocker. Also you could try an ulcer protective drug: Cytotec.

Proton pump inhibitors act by irreversibly blocking the acid producing pumps in the stomach. Targeting the terminal step in acid production, as well as the irreversible nature of the inhibition, results in a class of drugs that are significantly more effective than H2 antagonists and reduce gastric acid secretion by up to 99%. Depends on the dosage.

Often referred as to “Big guns” the PPIs are currently the most effective drugs on the market. They are more effective than H2 blockers and allow the duodenum, stomach and esophagus lining to heal more quickly only by suppressing the stomach acid which is highly corrosive by its nature.

In conclusion, PPIs were superior to H2RAs in preventing LDA-associated GI ulcers/erosions and bleeding. Some of the RCTs included in our meta-analysis were poorly reported and of low quality, therefore, our meta-analysis should be interpreted with caution. More multicenter, high-quality RCTs are needed to compare two anti-secretory drugs for prevention of LDA-associated GI injuries.

PPIs may not be suitable for some people - for example, people with certain liver problems. Breast-feeding or pregnant mums should avoid them apart from omeprazole which is deemed to be safe. A full list of individuals who should not take a PPI is included with the information leaflet that comes in the medicine packet. If you are prescribed or buy a PPI, read this to be sure you are safe to take it. Also, patients who have occasional heartburn or stomach discomfort should not be on PPIs, they can manage their condition whith diet or a less potent drug.

The popular over-the-counter and prescription acid-blocking drugs proton-pump inhibitors (PPIs) do not appear to increase risk of birth defects when taken during the first trimester of pregnancy, a study shows.

In the study, 2.6% of more than 840,000 live births occurring in Denmark from January 1996 through September 2008 involved major birth defects. The study showed that 3.4% of 5,082 infants whose mothers took PPIs during the four weeks before conception through first trimester were diagnosed with a major birth defect. By contrast, 2.6% of 835,886 infants whose moms did not take these acid-reducing drugs during the same time period were diagnosed with a major birth defect.

The study is published in the New England Journal of Medicine. The researchers did an analysis of the study data on PPI use limited to the time period during the first trimester of pregnancy. Statistically speaking, there was no significant increased risk of birth defects seen among children of women who took PPIs -- including Aciphex, Nexium, Prevacid, Prilosec, and Protonix -- during their first trimester of pregnancy compared with women who did not take these drugs during the first trimester of pregnancy.

“We found no significant association between the use of PPIs during the first trimester of pregnancy and the risk of major birth defects,” conclude study researchers Björn Pasternak, MD, PhD and Anders Hviid of Statens Serum Institut in Copenhagen, Denmark.

Most of these medicines are prescription only. You can buy omeprazole and pantoprazole over-the-counter at pharmacies. However, if you need to use this medicine for more than 4 weeks you should consult your doctor. There is a ongoing debate from doctors that this medicine should not be OTC (over the counter), it should only be given by prescription.

In Croatia you can buy pantoprazole 20mg OTC, without prescription.

PPIs have remained the mainstay of treatment in GERD patients. Drug development in GERD has considerably slowed down as most PPIs became generic and were then available over the counter. However, there are still many areas of unmet need in GERDs, so new therapies are needed. Current compounds under development include improved PPIs (dexlansoprazole, tenatoprazole-clinical trial, ilaprazole-clinical trial), TLESR reducers, esophageal-specific pain modulators, and mucosal protectants.

I've read on forums that PPIs are not toxic but a doctor (David Jacobson) at Medscape said (year 2017) that they are probably more harmful then steroids (gaining quite a few up votes on his comment). Quote: “This class of medication is probably more dangerous than steroids, but most docs dispense it like Pez. Cellular modifying drugs should be used as a last resort”. Still, if they are FDA approved and used by millions of patients from all around the world, then PPI should be quite safe.

Put the tablet in 10 mL of water (two medicine spoons) – do not crush the tablets. (Tablets may be split in half if the dose is half of the full tablet.) Stir gently until a very cloudy mixture is created, this may take 5–10 minutes. You can add a small amount of fruit juice, apple sauce or yogurt to this mixture but do not use milk or fizzy water. Your child should eat/drink all the mixture straight away.

The advice regarding withholding proton pump inhibitors (such as omeprazole) for at least 2 weeks before endoscopy is common but you'll need to discuss with your GP about whether you can still take it before the procedure or any other antacid medication such as gaviscon. (hospital pharmacist)

These drugs are used in the treatment of many conditions, such as:

• Dyspepsia
• Peptic ulcer disease including after endoscopic treatment for bleeding
• As part of Helicobacter pylori eradication therapy
• Gastroesophageal reflux disease (GERD or GORD) including symptomatic endoscopy-negative reflux disease and associated laryngopharyngeal reflux causing laryngitis and chronic cough
• Barrett's esophagus
• Eosinophilic esophagitis
• Stress gastritis and ulcer prevention in critical care
• Gastrinomas and other conditions that cause hypersecretion of acid including Zollinger–Ellison syndrome (often 2–3x the regular dose is required)

Esophagitis is an inflammation of the lining of the esophagus. If left untreated, it can become very uncomfortable, causing problems with swallowing, ulcers and scarring of the esophagus. In some instances, a condition known as Barrett's esophagus may develop, which increases the risk for esophageal cancer.

The severity of reflux esophagitis is commonly classified into 4 grades according to the Los Angeles Classification

Inflammation within the duodenum or duodenitis is a common diagnosis, which is reducing with the use of drugs for symptoms of “indigestion” which drastically suppress stomach acid production.

It is caused by a bacterial infection or particular types of painkilling drugs has also changed the nature of the condition in the UK in the last twenty years.

A condition caused by chronic exposure to excess hydrochloric acid, which is characterised by inflammation, and most prominent in the duodenal bulb (D1), associated with Helicobacter pylori infection, chronic active gastritis and peptic ulcer disease. Peptic duodenitis is at the banal end of the spectrum of upper GI inflammation, at the other end of which is peptic ulcer disease.

A hiatal hernia occurs when the upper part of your stomach pushes up through your diaphragm into your chest region.

This condition mostly occurs in people who are over 50 years of age. It affects up to 60 percent of people by the time they reach 60, according to the Esophageal Cancer Awareness Association.

The exact cause of many hiatal hernias is unknown. In some people, injury or other damage may weaken muscle tissue. This makes it possible for your stomach to push through your diaphragm. Another cause is putting too much pressure (constantly) on the muscles around your stomach. This can happen when you:

• cough
• vomit
• strain during bowel movements
• lift heavy objects

Some people are also born with an abnormally large hiatus. This makes it easier for the stomach to move through it. Factors that can increase your likelihood of developing a hiatal hernia are:

• obesity
• aging
• smoking

Types of hiatal hernia: slided-common and fixed-uncommon.

In some cases, a paraesophageal hernia may slide into the chest and become trapped and unable to slide back into the abdomen. If this happens, there is a danger that the trapped hernia may die because its blood supply is cut off (strangulated). Symptoms of a strangulated hiatal hernia include sudden severe chest pain and difficulty swallowing. Such situation requires immediate medical treatment.

• Sharp or Severe pain
• Vomiting
• Blood in Excrement
• Constipation
• Malaise with or without a fever
• A burning or hot sensation around the hernia

I once came across a scientific paper (cannot find it anymore) which described an older woman in her seventies who came to the hospital because of chest pain. She had a strangulate hiatal hernia.

I could not find any forum neither a website or any other real-life source where someone mentions a strangulated hiatal hernia. Thereby, we can conclude that this condition happens rarely.

If you really had a strangulated hernia you would be in extreme pain and would have noticeable symptoms.

Achalasia is a rare disease of the muscle of the lower esophageal body and the lower esophageal sphincter that prevents relaxation of the sphincter and an absence of contractions, or peristalsis, of the esophagus.

The cause of achalasia is unknown. However, there is degeneration of the esophageal muscles and more importantly, the nerves that control the muscles.

Common symptoms of achalasia include: difficulty in swallowing (dysphagia), chest pain, and regurgitation of food and liquids.

Laryngopharyngeal reflux (LPR), also extraesophageal reflux disease (EERD) refers to the flow of gastric contents to the upper aero-digestive tract, which causes a variety of symptoms, such as cough, hoarseness, and wheezing, among others. Although heartburn is a primary symptom among people with gastroesophageal reflux disease (GERD), heartburn is present in fewer than 50% of the patients with LPR. Other terms used to describe this condition include atypical reflux, silent reflux, and supra-esophageal reflux.

Bile reflux occurs when bile which is a digestive liquid produced in your liver backs up (refluxes) into your stomach and the tube that connects your mouth and stomach (esophagus). Bile reflux may come with acid reflux, but they are 2 separate conditions. Whether bile is important in reflux is controversial. Bile is often a suspected cause of reflux when people respond incompletely or not at all to acid supressing drugs.

Unlike acid reflux, bile reflux usually can't be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery.

Bile and acid reflux are both needed for formation of Barrett’s esophagus.

Zollinger-Ellison syndrome is a rare condition in which 1 or more tumors form in your pancreas or the upper part of your small intestine (duodenum). These tumors, called gastrinomas, secrete large amounts of the hormone gastrin, which causes your stomach to produce too much acid. The excess acid causes peptic ulcers, as well as diarrhea and other symptoms.

Zollinger-Ellison syndrome (ZES) is rare. The disease may occur at any time in life, but people are usually diagnosed between ages 20 and 50. Medications to reduce stomach acid (PPIs) and heal the ulcers is the standard treatment for this condition.

Acute gastritis is a sudden inflammation of the stomach lining often caused by: H. pylori, NSAID or corticosteroid usage, excessive alcohol consumption or other.

Chronic gastritis represents chronic/long lasting inflammation of the stomach lining caused by: longterm NSAID or corticosteroids usage, H. pylori infection, long lasting/chronic stress or other.

Atrophic gastritis is a chronic inflammation of the stomach mucosa, where gastric glandular cells get replaced by intestinal and fibrous tissues. It is caused by: long-term H. pylori infection or can appear as autoimmune disease.

Patients with atrophic gastritis have an increased risk for the development of gastric adenocarcinoma (cancer). The optimal endoscopic surveillance strategy is unknown but all nodules and polyps should be removed in these patients.

Erosive lining in general means that you have a small internal bleeding inside your esophagus/stomach. After the mucosa breaks, the stomach acid can easily digest your lining and therefore usually causes small amounts of blood visible on the lining. If left untreated, the erosive gastritis usually progresses to ulcers or even more bleeding which can be fatal.

For such condition, PPIs are prescribed for 4-8 weeks daily (dosage depends on the severity of the erosions). Althought this condition sounds scary, for most patients, medications allows the lining to heal in a short period of time.

Gastroparesis represents a condition where stomach emptying is delayed due to the vagus nerve damage. The never makes the stomach motility muscles malfunctioning therefore causing delayed stomach content emptying. Few people report having Gastroparesis due to PPIs and there isn’t a strong connection that PPIs could cause such condition. The medication often used for such condition is domperidone (generic) often sold by the brand motilium.

In the authors' previous study of gallbladder function before and after fundoplication, 58% of the patients demonstrated preoperative gallbladder motor dysfunction, and 86% of those retested after operation and cessation of proton pump inhibitors (PPIs) normalized. Short-term PPI therapy reduces gallbladder motility in healthy volunteers. Chronic PPI therapy may pose a risk for long-term gallbladder dysfunction and biliary complications.

After adjustment for other independent predictors of recurrence, patients with continuous PPI use remained at elevated risk of CDI recurrence. We suggest that the cessation of unnecessary PPI use should be considered at the time of CDI diagnosis.

In conclusion, our results suggest that PPI therapy is associated with an approximately 2 times increased risk of developing pneumonia possibly as a result of the endogenous oropharyngeal flora. In particular we found a significantly increased association between PPI use and S. pneumoniae pneumonia. It should be reminded that, in line with previous observational studies, the association between PPI use and adverse events may be due to confounding, with PPI use more of a marker for, than a cause of, higher rates of CAP due to S. pneumoniae. Therefore further studies are required to delineate the exact pathophysiologic mechanisms relating PPI usage to respiratory infection.

Let’s says something about absorption first.

Magnesium: typical magnesium absorption involves: 40% of magnesium intake absorbed in the small intestine 5% absorbed in the large intestine 55% leaving the body as waste

Calcium is absorbed in the mammalian small intestine by two general mechanisms: a transcellular active transport process, located largely in the duodenum and upper jejunum; and a paracellular, passive process that functions throughout the length of the intestine

Vitamin B12 is readily absorbed in the last part of the small intestine (ileum), which leads to the large intestine. However, to be absorbed, the vitamin must combine with intrinsic factor, a protein produced in the stomach.

Iron: the portion of the small intestine called the duodenum is the chief area where iron absorption takes place. There may be a second minor absorption site near the end of the small intestinal tract. Once iron is absorbed it is carried (transported) by a protein called transferrin.

All of the vitamin, minerals deficiencies (mentioned above) have been associated with the use of PPIs in some patients, especially patients who have been on higher PPI dosages for a prolonged period of time. Patient on a long-term PPI therapy should get their blood sample checked for Mg, Ca, B12, Fe and if they are low on any of this vitamin, minerals they should increase their intake and/or change the dosage, drug for some period of time but the first thing to do is to talk to your Doctor.

The use of PPIs is a risk factor for development of osteoporosis and osteoporotic fractures. However, as the direct pathogenesis remains unclear, specific points of intervention are lacking, other than being vigilant in regard to the indication for prescribing PPIs and to use the lowest effective dose where PPIs cannot be avoided.

People who use certain heartburn drugs for a long period of time may have a slightly heightened risk of suffering a heart attack, a new study suggests. Using medical records from nearly 300,000 U.S. adults with acid reflux disease (commonly called heartburn), researchers found that the risk of heart attack was slightly elevated among those using proton pump inhibitors.

Another class of heartburn drug -- so-called H2-blockers -- was not linked to any increase in heart attack risk, the study authors noted.

Researchers are not clear on how PPI use might raise dementia risk. Evidence suggests some PPIs may cross the blood–brain barrier and interact with brain enzymes and, in mice, may increase beta amyloid levels in the brain. Although the current study did not include vitamin B12 levels, other research has linked PPI use to vitamin B12 deficiency, which has been shown to be associated with cognitive decline, Dr Haenisch noted.

The recent study used data from a German health insurance provider of people aged 75 years or older to show that patients who had used PPIs were 44 percent more likely to develop dementia. The same group reported similar results in an earlier study on a different set of elderly Germans. This consistency is marred, however, by a third study from another group of German scientists reporting that the use of PPIs is associated with a 7 percent lower risk of dementia. All of these studies were observational, which makes it hard to draw conclusions. In the recent study, Germans who took PPIs were also more likely to have depression, cardiovascular disease, and polypharmacy (i.e., they were prescribed a lot of drugs). These conditions are all associated with a higher risk of dementia. While the scientists tried to control for these risks in their analysis, it is difficult to be sure that they succeeded without more studies to replicate their results and to look for extra clues in the data like a dose-response relationship, where higher doses of the drugs relate to a higher risk.

beta amyloid: amino acids which are involved in Alzheimer's disease.

PPIs are associated with increased risk for chronic kidney disease (CKD), according to two population-based analyses published online January 11 in JAMA Internal Medicine. The authors suggest the widely used drugs might be part of the reason CKD prevalence has risen faster than would be expected from the trends in known CKD risk factors, such as diabetes mellitus and hypertension.

PPI treatment is known to increase the risk for acute interstitial nephritis (AIN) and CKD. However, whether PPI use is tied to a greater risk for chronic kidney damage in the absence of an earlier episode of acute kidney injury (AKI) has been unclear.

The possible mechanisms tying PPI use with chronic renal damage are also still unclear

Some patients do develop stomach ulcers as a side effect because of continuous PPI therapy. This ulcers are not harmful and endoscopy procedures can remove them.

Common symptoms include:

• Burning stomach pain
• Feeling of fullness, bloating or belching
• Fatty food intolerance
• Heartburn
• Nausea

Less often, ulcers may cause severe signs or symptoms (bleeding ulcer especially) such as:

• Vomiting or vomiting blood — which may appear red or black
• Dark blood in stools, or stools that are black or tarry
• Trouble breathing
• Feeling faint
• Nausea or vomiting
• Unexplained weight loss
• Appetite changes

When to see a doctor
See your doctor if you have the severe signs or symptoms listed above. Also see your doctor if over-the-counter antacids and acid blockers relieve your pain but the pain returns.

There is no evidence up to this date that PPIs could cause gastric cancer.

Currently, there are no medications to reverse Barrett’s esophagus. However, it appears that treating the underlying GERD may slow the progress of the disease and prevent complications such as esophagus cancer.

The junction of the squamous epithelium of the esophagus and the gastric columnar epithelium occurs at the junction of the esophagus and stomach where the lower esophageal sphincter is located. The common border (interface) of these two linings is often referred to as the Z line, because when examined during an endoscopy, it has a zig zag appearance.

The Z line is the area where Barrett’s cells are usually detected.

If biopsies are taken from patients with GERD who have a normal appearing Z line (no visible evidence of Barrett's esophagus), up to 30% will show the same intestinal type metaplasia as those that are seen in Barrett's esophagus. The presence of metaplasia on a routine biopsy of a normal appearing Z line in GERD should not lead to any change in management.

If biopsies are taken from patients with GERD who have a normal appearing Z line (no visible evidence of Barrett's esophagus), up to 30% will show the same intestinal type metaplasia as those that are seen in Barrett's esophagus. The presence of metaplasia on a routine biopsy of a normal appearing Z line in GERD should not lead to any change in management.

Patients with Barrett’s esophagus should be enrolled in a surveillance program to look for signs of abnormal tissue (dysplasia) or cancer. This is a very slow growing cancer and endoscopies are usually done every 3 years. Patients with esophagitis should have a repeat endoscopy to demonstrate healing. Occasionally, when the esophagitis is healed, one can see Barrett’s esophagus. It is extremely uncommon to develop Barrett’s esophagus and then develop esophageal cancer.

There is a 0.5-1% that Barrett’s will turn into cancer.

They protect it by drastically reducing stomach acid and creating an environment with very little stomach acid means that the stomach lining can heal over time because there isn’t a corrosive substance which damages it anymore (stomach acid).

The same goes for the esophagus lining. GERD may still be present but since the stomach acid has dropped in the stomach the reflux becomes less corrosive. Therefore the esophagus heals over time.

Most ulcers heal within 4 weeks, although some people may need up to 4 more weeks of treatment to complete healing. In rare cases, large ulcers need even longer treatment.

Gastritis means inflamed stomach lining. It usually occurs due to Helicobacter pylori or hypersecretion of gastic acid. It usually takes 4 weeks to heal. It also depends of what type of Gastritis you have. Acute, chronic, atrophic.

Metaplasia, dysplasia and neoplasia all represent the transformation of the stomach/esophagus lining (cells) which are not good. The normal stomach-esophagus lining is called the squamous epithelium.

Metaplasia: the exchange of normal epithelium (normal lining) for another type of epithelium. Metaplasia is reversible when the condition which caused it is healed or stopped.

Dysplasia: a disordered growth and maturation of an epithelium, which is still reversible (harder reversible than metaplasia) if the condition which caused it is healed or stopped.

Neoplasia: neoplasia of the stomach-esophagus lining means cancer and it is not reversible like metaplasia and dysplasia are. It represents an abnormal growth of cells. It can be benign and malignant.

Omeprazole (PPI) is completely metabolized by the cytochrome P450 (protein) system, mainly in the liver. Identified metabolites are the sulfone, the sulfide, and hydroxy-omeprazole, which exert no significant effect on acid secretion. About 80% of an orally given dose is excreted as metabolites in the urine, and the remainder is found in the feces, primarily originating from bile secretion

• Iron (absorption reduced)
• Calcium (There is no good evidence to establish that PPI use has a significant risk for bone density loss or osteoporotic-related fractures)
• Magnesium (rare)
• B12 deficiency (no studies have provided a longitudinal evaluation)
• Community acquired pneumonia (small risk)
• Clostridium Difficile infection (insufficient evidence to conclude that there is a definitive relationship)
• Small Intestinal Bacterial Overgrowth (no clear supporting data at present to suggest a positive relationship)
• Spontaneous Bacterial Peritonitis (no definitive evidence for conclusion)
• Interstitial Nephritis (rare)
• Dementia
• Heart attack (slightly elevated risk)
• CKD (increased risk for chronic renal damage)

In situations like this you should always talk to your specialist. Such questions are difficult to answer primarily because of your safety. However, if you really need the PPI and cannot substitute it with a less potent drug then you should stay on the lowest effective dose possible.

There isn’t a guide on what a patient should do in order to minimize the chances of getting a side effect from this drug. However there are general known principles:

• Work out
• Eat healthy
• Reduce your stress levels
• If you have an anxiety disorder then try to minimize it. It can be achieved with certain therapies
• Remove the trigger food from your diet
• Treat your disease with medication appropriately
• Don't use drugs on your own (OTC-over the counter) for more then 14 days

• Common
  • Headache
  • Nausea
  • Diarrhea
  • Abdominal pain
  • Fatigue
  • Dizzines
• Infrequent
  • Rash
  • Itch
  • Flatulence
  • Constipation
  • Anxiety
  • Depression

Based on studies, we can say that PPIs used long-term produce a change in the gastrin-parietal cell balance that results in a temporary rebound over-secretion of acid when PPIs are withdrawn suddenly.

Many factors can increase the likelihood of an adverse drug reaction. They include

• Simultaneous use of several drugs
• Very young or old age
• Pregnancy
• Breastfeeding

Hereditary factors make some people more susceptible to the toxic effects of certain drugs. Certain diseases can alter drug absorption, metabolism, and elimination and the body's response to drugs, increasing the risk of adverse drug reactions. How mind-body interactions, such as mental attitude, outlook, belief in self, and confidence in health care practitioners, influence adverse drug reactions remains largely unexplored.

Every drug has a side effect. There are common and rare side effects with any pharmacy drug. The majority of patients on PPIs react well on them and do not experience any severe side effects associated to the drug.

People often think that GERD = acid reflux = heartburn. In one way we can say that this is true. Heartburn is the key symptom here. GERD and acid reflux are here because of heartburn happening.

Acid reflux can be described as “occasional heartburn”. The main reason is overeating as well as bad diet and trigger foods, lifestyle often can fix acid reflux.

GERD on the other hand is a chronic condition where acid gets into your esophagus more often. Several times a week or daily.

GERD often needs chronic drugs treatment. If not treated things can get worse and although rare, cancer of the esophagus can form which such condition.

Remember: GERD> acid reflux > heartburn

As with everything else, if you have occasional stomach pain (let’s say once or twice month), if you get stomach pain from overeating or binge drinking then you hardly need to visit your doctor. However if you have a persistent stomach pain and other symptoms accompanying the pain for longer than 1 week or if this is repeating itself every month or so, then you should definitely visit a doctor.

You can always try to manage your condition with diet or eliminating certain foods when having often stomach pain/discomfort. If that doesn’t help then you know that something else is going on which doesn’t mean that it’s something serious but needs medical evaluation.

Of course, if you have unbearable stomach pain followed by other symptoms, then you should visit the emergency room.

Definition in the literature for "long-term" is lacking; neither the AGA guidelines nor the ACG guidelines define what is considered long-term. For the rest of this article, the authors use long-term to designate therapy greater than 14 days. Basically, if you continue PPI therapy for longer than 14 days every year you can they say that you've been longterm on them.

Yes PPIs are one of the most prescribed and bought over the counter drugs in the world. They are just behind pain, cholesterol and blood pressure medication in terms of usage.

Mucous-producing cells at the neck of the gastric pits create a layer of protective mucous covering the stomach lining. This mucous layer includes bicarbonate ions which act as a chemical barrier against the protons in gastric juice.

Gastrin is a hormone the stomach produces which then stimulates the release of gastric acid when you eat. It breaks down protein in the food and kills bacteria which is in the food. In this way the gut is being protected from infection.

High levels of gastrin cells and circulating gastrin hormone can also occur if the pH of the stomach is too high (the stomach is low in acid).

Low gastrin levels are rare. When low levels do occur, the condition can increase the risk of infection in the digestive system, and also limits the stomach's ability to absorb nutrients.

Peristalsis is a series of wave-like muscle contractions that moves food to different processing stations in the digestive tract. The process of peristalsis begins in the esophagus when a bolus of food is swallowed. The strong wave-like motions of the smooth muscle in the esophagus carry the food to the stomach, where it is churned into a liquid mixture called chyme.

GERD can affect the sinuses. This is a matter of increasing interest to researchers.A number of studies make a very plausible connection between GERD and chronic sinusitis.

Although the connection between acid reflux and CRS (chronic rhino sinusitis) isn’t well understood, there are several possible reasons for the increased risk of CRS in acid reflux patients. One is that exposure to acid gastric fluids could injure the lining of the nasal cavities, provoking a series of immune responses such as inflammation and allowing infection. They could also irritate sympathetic nerves in the respiratory system, causing nasal congestion, excessive nasal secretions and continuous post nasal drainage. LRS may also contribute to infection of the upper airways by bacteria from the intestinal tract.

The proton pump inhibitor esomeprazole (Nexium, AstraZeneca), at $4.7 billion is the top 10 drugs sold in the US reaching number 8 on the list.

GERD affects between 18% and 28% of the adult U.S. population (children, teenagers not included). That means between 42 million and 64 million adults in the U.S. suffer from GERD.

Europeans, Middle Easterners and South Americans also have high rates: in Europe, between 9% and 26% of the adult population meets the criteria to be diagnosed with GERD, as do up to 33% of adults in the Middle East and 23% of adults living in South America. Meanwhile, the rate of GERD in East Asian adults is only around 2% to 8%, and in Australian adults it's 12%.

Some people with LPR do have heartburn. Some people with LPR don't have heartburn very often, but actually about half the people who have LPR never have any heartburn at all. This is because the material that refluxes does not stay in the esophagus for very long. In other words, the acid does not have enough time to irritate the esophagus and cause heartburn.

PPIs were developed in the late 80’s. With omeprazole being the first PPI to be launched on the market in 1988. After that came Lansoprazole being launched in Europe in 1991 and the US in 1995. Pantoprazole was the third PPI and was introduced to the German market in 1994 after 7 years of clinical trials. Then came Rabeprazole which is a novel benzimidazole compound on market, since 1999 in USA. It is similar to lansoprazole. After that came esomeprazole in 2001 which was launched in USA. Dexlansoprazole was launched as a follow up of lansoprazole in 2009. with its popular dual release technology.

Doctors still do not recommend taking blood test to check for some mineral, vitamin deficiencies if you are on a long-term drug therapy. However if you do get side effects or are on a continuous PPI therapy for years, it would be wise to check your blood for any mineral, vitamin deficiencies as well as your overall blood picture. Remember to discuss your actions with your doctor.

Bleeding in the upper digestive tract including the esophagus, stomach and upper portion of the small intestine is the most worrisome cause of black stools. The blood causes the stool to turn black as it works its way from the upper to the lower intestine before being passed during a bowel movement. Bleeding in the lower digestive track usually causes red or maroon stools, or bloody streaks or clots in the fecal matter rather than black stool. It takes a significant amount of bleeding -- usually at least 100 milliliters or 0.4 cups -- from the upper digestive tract to cause black stools. Some of the possible causes of this type of upper digestive tract bleeding include:

So, black stools could indicate upper GI bleeding, whereas bright red stool indicates lower GI bleeding.

Before the discovery of H. Pylori. Doctors thought that stress was the cause of ulcers. After the discovery of the bacteria, things have changed. The today thought is that stress can only make ulcers worse but does not cause them.

„Stress, especially prolonged stress, can have an effect on stomach acid production. While this alone can cause ulcers in some cases, most of the time the bacterial infection or use of anti-inflammatory drugs in the stomach is required. “

“Stress won't cause stomach ulcers, but it can make them worse,” says Dr. David Graham, professor of medicine and molecular virology and microbiology at Baylor College of Medicine. “Stress causes the body to produce higher amounts of acid, which can irritate preexisting ulcers.”

Prilosec (generic-omeprazole) and Protonix (generic-pantoprazole) are the least expensive PPIs.

Dexlansoprazole (Dexilant) and Omeprazole/sodium bicarbonate (Zegerid) are the most expensive PPI drugs on the market.

the minimum amount of gastric acid produced by an individual in a given time period. Normal adult volume is 2 to 5 mEq/hr. It is used infrequently in the diagnosis of various diseases of the stomach and intestines, such as gastric ulcers and Zollinger-Ellison syndrome.

The pancreas (organ) produces large amounts of bicarbonate and secretes bicarbonate through the pancreatic duct to the duodenum to completely neutralize any gastric acid that passes further down into the digestive tract. Thereby, you don't have stomach acid which could harm your small intestine<

'It's true that a body under stress may produce acid, but not enough to create or aggravate an ulcer,' said Dr. Seymour Sabesin. Dr. Jerome Rotter, of the UCLA Medical Center, said heredity, not stress, is the likely cause of 80 percent of the duodenal ulcers that afflict 500,000 Americans. The genes your parents pass down to you will most likely determine your susceptibility, he said.

The article also said ulcer sufferers may not have to follow a bland diet.

Sufferers 'should avoid any food that causes irritation and should use alcohol and caffeine in moderation,' the article said. 'But a bland diet just doesn't make a difference.'

A drug interaction is a reaction between two (or more) drugs or between a drug and a food or beverage. Taking a drug while having certain medical conditions can also cause a drug interaction. For example, taking a nasal decongestant if you have high blood pressure may cause an unwanted reaction. A drug interaction can decrease or increase the action of a drug or cause unwanted side effects.

Drug interactions occur when one drug alters the pharmacological effect of another drug. The pharmacological effect of one or both drugs may be increased or decreased, or a new and unanticipated adverse effect may be produced. Drug interactions may result from pharmacokinetic interactions (absorption, distribution, metabolism, and excretion) or from interactions at drug receptors.

The 5-year survival rate for people with esophageal cancer is 18%.

However, survival rates depend on several factors, including the stage of the cancer when it is first diagnosed.

• The 5-year survival rate of people with cancer located only in the esophagus is 41%
• The 5-year survival rate for those with disease that has spread to surrounding tissues or organs and/or the regional lymph nodes is 23%
• If esophagus cancer has spread to distant parts of the body, the survival rate is 5%.

• Early detection is the key to surviving stomach cancer.
• Lifestyle changes, such as smoking cessation and eating a diet rich in fruits and vegetables, can potentially reduce the risk of stomach cancer.
• Treatment of H. pylori infection (a common bacterial infection of the stomach) can decrease the risk of stomach cancer development.
• Knowing your family history and discussing it with your healthcare provider can help determine if you are at risk for inherited cancer syndromes.

• If healthcare providers find the stomach cancer in early stages when the cancer is still only in the stomach, the 5 year survival rate is about 65%.
• If they find the stomach cancer when it has spread to areas near your stomach , the 5 year survival rate is about 30%.
• If they find the stomach cancer when it has spread far away from your stomach, the 5 year survival rate is about 5%.
• For all stages of stomach cancer combined, the five-year survival rate is about 29%.

Alcohol can irritate the lining of the stomach and cause excess production of acid. This may lead to ulcers and gastritis, and it can also aggravate GERD. In addition, alcohol can cause clumping of red blood cells, which may clog blood vessels, leading to bleeding, hemorrhaging and possibly to death.

Although drinking alcohol is not contraindicated when using lansoprazole (PPI), caution is advised. Side effects from taking lansoprazole include drowsiness and dizziness, which may be aggravated by NSAIDs. These medications may cause stomach ulcers and bleeding, which might be exacerbated by the consumption of alcohol. Certain medical conditions may be made worse if you drink alcohol while taking lansoprazole. If you have an alcohol problem, are suffering from dehydration, or have low blood sodium levels, your doctor may advise you to avoid drinking alcohol while taking this medication.

If you are taking a PPI then you should definitely find a way how to reduce your smoking passion. Smoking not only increases stomach acid but also relaxes the valve (sphincter) because of the nicotine substance which closes after the food enters your stomach and therefore prevents reflux. The opening/closing sphincter is actually the main culprit for GERD. If it is really hard for you to stop smoking then at least stop smoking during the ongoing PPI therapy usually 4-8 weeks. Smoking will definitely extend the healing of your stomach/esophagus lining.

Heartburn foods to avoid:

• Foods that are fried, sautéed, or prepared in butter or oil
• High-fat side dishes such as onion rings or French fries
• High-fat sauces, gravies, and salad dressings
• Tomato-based foods and juices
• Caffeinated beverages such as cola and iced tea
• Citrus drinks such as lemonade or orange juice
• Alcoholic beverages
• Chocolate
• After-dinner mints (peppermint can exacerbate heartburn)

Heartburn foods to look for:

• White meat, which is lower in fat than dark meat
• Leaner cuts of red meat
• Smaller portion sizes
• White wine instead of red
• Lighter desserts, such as angel food cake

A study tested a LCHF (low carbs high fiber) diet on a few people with this problem, and they got significantly better. Even the pH in their esophagus improved.

Another slightly larger, study has tested this idea again. Not only does it find that carbohydrates, sugar and the glycemic load of the diet was associated with reflux disease. They also test what happens when the participants goes on a lower carb diet. The result indicates that all women in the study were able to get off their reflux (GERD) medications.

The results from researchers at the University of North Carolina, Chapel Hill, published in the August 2006 issue of "Digestive Diseases and Sciences," which showed that a carb-restricted diet helped reduce the amount of time acid was present in the esophagus of the participants in addition to improving most of the pain and other symptoms related to their acid reflux. The diet used in this study was not completely carb-free because it included 20 grams of carbs from nonstarchy vegetables daily, but eliminated grains, starchy vegetables, fruits and sugar.

The exact mechanism for the effectiveness of low-carb or carb-free diets in the management of acid reflux has yet to be determined. if you are overweight or obese, a low-carb diet can help you lose weight, which can reduce the pressure on your stomach and prevent acid reflux from occurring. However, the positive results found in the UNC study with a very low-carb diet appeared within less than a week, indicates that a carbohydrate-restricted diet may alleviate acid reflux in more than one way.

An article published in September 2011 issue of Diseases of Esophagus noted how a number of published studies have shown that gluten-free diet can efficiently control esophageal symptoms and help prevent recurrence. In one study from 2009, Italian researchers found that gluten-intolerant people on a gluten-free diet responded more favorably to GERD treatment with medication. They also found that fewer gluten-free dieters experienced a recurrence of their GERD symptoms, compared with the control group. The researchers concluded that a gluten-free diet could help reduce GERD symptoms and prevent damaging acid reflux in those with celiac disease.

Most experts don’t believe that gluten intolerance leads to GERD, or has any connection to GERD. "Eliminating gluten for reflux doesn't make sense because there's no association for reflux," says Michael Vaezi, MD, PhD, clinical director of the division of gastroenterology and hepatology and director of the Center for Esophageal Motility Disorders at Vanderbilt University in Nashville, Tenn.

A study published in Gut and Liver assessed the relationship between cow’s milk and acid reflux. When exposed to milk, 72 of out the 81 participants had digestive problems such as acid reflux.

These participants were then given medication called omeprazole to reduce stomach acid. Even with the medication, 27 of these participants still experienced symptoms.

Researchers then eliminated dairy from their diets. The result? The researchers concluded that milk allergy GERD are linked. All participants showed significant improvement in their symptoms after eliminating milk from their diets.

Probiotics, apple cide vinegar, dgl liquorice, chamomile tea, slippery elm, digestive enzymes, aloe vera, cabbage juice, persimmon tea, papaya

Of course you should. If you have such a condition where you have been told to stay on PPIs for life no matter what your specialist says try to dig for a solution which could at least reduce your drug dosage. Today with the help of the Internet everyone can “engineer” their life’s better than ever before. If you decide to go off that medication keep in mind that you should get off the medication slowly (not overnight).

For most patients PPIs will help heal their condition no matter what. If you smoke, drink, eat unhealthy PPIs will improve your condition despite your bad habits. The problem is that once your tapper off the medication, there is a big chance that your condition will return. The best thing to do is to go on a diet to get the maximum effective and rapid healing process. The key is to find the trigger foods. You will find these by eating and seeing what food, drink doesn’t go well on your stomach, oesophagus. If you have a chronic condition it would be wise to stay on a lifetime diet, avoiding smoking and heavy alcohol use. This doesn’t mean that you can‘t eat unhealthy food once in a while. It means that you should be aware of you chronic condition and treat it with caution.

You may lift weights and not realize you have a hiatal hernia if you don't develop the main symptom of acid reflux. Upon discovery of a hernia, your doctor may restrict your weightlifting activities if he thinks the sport is interfering with your health. Because excess pressure in the abdominal region can cause a hernia to worsen, you may need to work with lighter weights, or switch to hand weights until you've had your hernia repaired.

There are quite a few persons who have been on PPIs for 25+ years (stories are on the Internet, forum posts). You can find these forum posts on my web page, click here. In the link above you can find Cindy story who was on PPIs for almost 30 years.

Antacids

They work immediately on excess acid. They do not prevent excess acid occurring. These are drugs that neutralise the acid. Most commonly they are made of chalk, calcium carbonate. Examples are Tums or Rennie.

Alignates

Gaviscon is the brand name of the white milky liquid that floats on the stomach contents as oil floats on water to reduce the possibility of reflux whilst also providing a temporary protective film to the lower oesophagus and neutralising the acid with an antacid component. (Some generic versions are now available.)

H2 blockers

Histamine H2 Receptor Antagonists work to block the (histamine H2) signals that tell the stomach to produce acid. (N.B. This is not the same as an antihistamine which blocks histamine H1). The most common is Ranitidine, brand name Zantac but others are available as shown below. These work proactively to reduce the amount of acid rather than being an instant antacid. Often prescribed to be taken in the evening to reduce nighttime reflux of acid.

A lot of data has been collected from patients in the hospital who are on PPIs. PPIs have been associated with disease such as: ckd, nephritis, osteoporosis, certain infections, dementia, heart problems etc. Up to this date no study can confirm if PPIs really causes any of the condition above but correlation has proven positive. Remember correlation does not equal causation.

In the last 2 years a lot has been written about PPIs and their negative impact on kidneys. Every once in a while a new study comes which heavily correlates PPIs with nephritis and CKD at the end. No one knows for certain what could be the mechanism of PPIs which would cause an impact on kidneys or whether PPIs really do some damage on them.

Nevertheless, PPIs are one of the drugs which are being heavily discussed in the media because of 2 things. They are used by millions throughout the globe and there is a negative trend in terms of developing GERD and stomach problems which shows that there will be more and more people who will develop gastroesophageal diseases in the upcoming future not to mention that the media anxiously waits for “bad news” to write sensation articles.

This question is too serious and very complicated to be given an answer from myself.

PPIs do not directly affect the immune system but by decreasing the stomach acid you might become vulnerable to certain bacteria’s which the immune system has to eliminate then. You can think of the stomach acid as the first line of defence against bacteria’s. Our stomach acid is so powerful that it destroys the bacteria which enters your digestive system. Lack of stomach acid allows the bacteria to move further and then the immune system has to get rid of it. This is why doctors say to remain on the lowest effective dose.

Patients often get scared about this, especially when they have been on this drug for years. The reason why this is written is because you should talk to your doctor after you are using the drug more than 14 days and review your condition with him. OTC drugs should not be taken longterm, they are here to give you temporary relief. If the problems is still present after 14 days then visit your doctor.

The answer is quite extensive so please click on the link above

Historically, heart burn symptoms were rarely seen in the developing world. For example, in a review of 36 published studies, the risk of having acid reflux symptoms in China was less than 5% in any given week. The risk of acid reflux is also extremely low in Africa.

The fact that acid reflux is rarely seen in the developing world is reason for hope. It suggests that there is something about the American lifestyle which contributes to this condition. Based on these studies, if we can change our lifestyles then most people can avoid acid reflux.

Anxiety is not your fault.

Psychological research is beginning to understand what causes anxiety (if we understand the cause, we can treat anxiety by getting to the root of the problem) however, thus far researchers haven’t been able to definitively pinpoint exact causes. That said, we do know some things:

1. Genetic Disposition for Anxiety
2. Someone’s environment stress level, lifestyle, etc. can contribute to anxiety.
3. Neurology, things happening in the brain, play a role.
4. Learned behaviors can make someone anxious (For example, if a parent responds to the world in an anxious fashion, a child can learn anxious patterns. This does not mean, though, that parents cause anxiety in their kids. Modeling a behavior might be a contributing factor in anxiety’s development, but it’s not a single-handed cause.)
5. Psychological factors can increase anxiety, particularly unhealthy thought patterns

Anxiety and stress are not the same. Anxiety is much more than stress. Even if you experience stress on a daily basis (we all do today) this doesn't mean you are suffering from anxiety.

Helicobacter pylori (H. pylori) is a type of bacteria which causes infection in the stomach. It is found in about 2/3 of the world's population. It may be spread by unclean food and water, but researchers aren't sure.

The mode of transmission of helicobacter is unknown but studies show that people with helicobacter infections may have it also in their saliva. So, in this study, 75% had helicobacter identified by molecular Probes. This has lead to some people saying that transmission by saliva is common.

The price varies. You can buy an endoscopy machine from 10 000$ up to 40 000$, at least based on the given URL.

It doesn't hurt but it is uncomfortable. Some patients find it tough and some have no problems with it. In general, it is not a pleasant procedure but as long as you keep calm and breathe it will be ok.

The endoscopy procedure lasts 5-15 minutes in general (based on my experience). Keep in mind that 5 minutes is more than enough for a skilled specialist to examine your oesophagus, stomach and duodenum.

If you go on for an endoscopy procedure several times you get used to it and in general it becomes a normal procedure.

An endoscopy is a very safe procedure. Rare complications are the following:

Bleeding which may occur if a stomach polyp is removed or a biopsy is taken.
Infections: most endoscopies consist of an examination and biopsy, and risk of infection is low. The risk of infection increases when additional procedures are performed as part of your endoscopy.
Tearing of the gastrointestinal tract occurs in an estimated 1 of every 2,500 to 11,000 diagnostic upper endoscopies. The risk increases if additional procedures, such as dilation to widen your esophagus, are performed.

Risk can be reduced further by following exactly the commands from the doctor during the procedure (without anaesthesia) and before the procedure.

There are other procedures (alternatives) such as barium swallow and capsule endoscopy but keep in mind that the standard endoscopy procedure is the golden standard and the best way to clearly examine the situation inside your esophagus-stomach-duodenum and even further inside your small intestine (example: biopsy for celiac disease). With this instrument the specialist can have a thorough look inside all parts of your upper digestive tract.

If you take an alternative procedure into consideration then keep in mind that there is a high possibility for you to undergo the standard endoscopy procedure to further examine your condition (if something shows up previously or if you still experience some gastro symptoms)

Your doctor will give you specific instructions to prepare for your endoscopy. In some cases your doctor may ask that you:

Fast before the endoscopy. You will need to stop drinking and eating 4 to 8 hours before your endoscopy to ensure your stomach is empty for the procedure. It needs to be empty in order to NOT throw up stomach content when you will burp after the specialist puts the tube inside your and
Stop taking certain medications. You will need to stop taking certain blood-thinning medications in the days before your endoscopy. Blood thinners may increase your risk of bleeding if certain procedures are performed during the endoscopy. If you have chronic conditions, such as diabetes, heart disease or high blood pressure, your doctor will give you specific instructions regarding your medications.

Tell your doctor about all the medications and supplements you're taking before your endoscopy.

It really depends. If you really think that you cannot endure 5-10 minutes with the endoscope inside your stomach then go for it. Remember, an endoscopy is a safe procedure and the risks are minimal.

This happens rarely.

Perforation would cause sudden unbearable pain, and you'd collapse in shock (nurse report).

Perforation symptoms can include:

• Fever
• Severe chest pain
• Shortness of breath
• Bloody, black or very dark colored stool
• Difficulty swallowing
• Severe or persistent abdominal pain
• Vomiting, especially if your vomit is bloody or looks like coffee grounds

Call your doctor or go to an emergency room if you experience any of these signs or symptoms.

It is safe to eat after the procedure. However, go with something light for the beginning. I went for an endoscopy and after an hour/hour and half I started with some liquid then a bit later proceeded with some food. Do not overeat!

The next day, you can eat normally.

Your doctor may recommend esophageal manometry if you experience symptoms that could be related to an esophageal disorder. Esophageal manometry provides information about the movement (motility) of food through the esophagus and into the stomach. The test measures how well the circular bands of muscle (sphincters) at the top and bottom of your esophagus open and close, as well as the pressure, strength and pattern of the wave of esophageal muscle contractions that moves food along.

A barium swallow is a radiographic (X-ray) examination of the upper gastrointestinal (GI) tract, specifically the pharynx (back of mouth and throat) and the esophagus (a hollow tube of muscle extending from below the tongue to the stomach). The pharynx and esophagus are made visible on X-ray film by a liquid suspension called barium sulfate (barium). Barium highlights certain areas in the body to create a clearer picture.

A barium swallow may be performed to diagnose structural or functional abnormalities of the digestive tract such as: cancers, tumors, hiatal hernia, structural problems, muscle disorders, achalasia, GERD and ulcers

Vagotomy is a surgical procedure for peptic ulcer diseases which involves removing parts of the vagus nerve. The vagus nerve is used to regulate the heartbeat and the muscle movement necessary to keep you breathing. This nerve also regulates the chemical levels in the digestive system so that the intestines can process food and keep track of what types of nutrients are being gained from the food that is taken in. Vagotomy was once commonly performed to treat and prevent ulcer diseases. However, with the availability of excellent acid secretion control with H2 receptor antagonists, such as cimetidine, ranitidine, and famotidine, and proton pump inhibitors (PPIs), such as pantoprazole, rabeprazole, omeprazole, and lansoprazole, dexlansoprazole etc. the need for surgical management of peptic ulcer disease has greatly decreased.

During fundoplication surgery, the upper curve of the stomach (the fundus) is wrapped around the esophagus camera.gif and sewn into place so that the lower portion of the esophagus passes through a small tunnel of stomach muscle. This surgery strengthens the valve between the esophagus and stomach (lower esophageal sphincter), which stops acid from backing up into the esophagus as easily. This allows the esophagus to heal.

If open surgery (which requires a large incision) is done, you will most likely spend several days in the hospital. A general anesthetic is used, which means you sleep through the operation. After open surgery, you may need 4 to 6 weeks to get back to work or your normal routine. If the laparoscopic method is used, you will most likely be in the hospital for only 2 to 3 days. A general anesthetic is used. You will have less pain after surgery, because there is no large incision to heal. After laparoscopic surgery, most people can go back to work or their normal routine in about 2 to 3 weeks, depending on their work. After either surgery, you may need to change the way you eat. You may need to eat only soft foods until the surgery heals. And you should chew food thoroughly and eat more slowly to give the food time to go down the esophagus.

Stretta is a minimally invasive endoscopic procedure for the treatment of gastroesophageal reflux disease (GERD) that delivers radiofrequency energy in the form of electromagnetic waves through electrodes at the end of a catheter to the lower esophageal sphincter (LES) and the gastric cardia - the region of the stomach just below the LES. The energy heats the tissue, ultimately causing it to swell and stiffen; the way this works was not understood as of 2015, but it was thought that perhaps the heat causes local inflammation, collagen deposition and muscular thickening of the LES and that it may disrupt the nerves there. Its relative safety and efficacy are controversial, with the American College of Gastroenterology recommending against its use in 2013, and in the same year the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) giving it a strong recommendation for people who refuse laparascopic Nissen fundoplication,

It’s a simple device with life-changing potential. LINX is intended for patients diagnosed with Gastroesophageal Reflux Disease (GERD) as defined by abnormal pH testing, and who are seeking an alternative to continuous acid suppression therapy.

Ablative therapies for Barrett's esophagus offer the promise of correction of the histological lesion without the attendant risk of surgery. There has recently been renewed interest in this approach with the development of novel modalities for ablative therapy. Data demonstrate that complete reversion to neosquamous epithelium is achievable in most patients undergoing ablative therapy. However, data demonstrating a decrease in cancer risk following therapy are scarce because most studies do not have the statistical power or comparator groups available to assess cancer risk.

TIF procedure:

• No scars, due to incisionless approach
• Faster recovery, since there is no internal cutting of the natural anatomy
• Fewer adverse events and complications than conventional surgery
• Can be revised if required

The TIF procedure is performed through the mouth without incisions. A surgeon utilizes the EsophyX device to reconstruct the valve between the esophagus and the stomach and restore the body’s natural protection against reflux.

TIF is an acronym:

• Transoral – The procedure is performed from within the GI tract, through the patient’s mouth
• Incisionless – There are no incisions, resulting in reduced risk and discomfort, faster recovery, and no scars
• Fundoplication – The antireflux valve is reconstructed by wrapping the upper portion of the stomach (fundus) around the esophagus

The relative risk (RR) of a bad outcome in a group given intervention is a proportional measure estimating the size of the effect of a treatment compared with other interventions or no treatment at all. It is the proportion of bad outcomes in the intervention group divided by the proportion of bad outcomes in the control group.

Absolute risk of a disease is your risk of developing the disease over a time period. We all have absolute risks of developing various diseases such as heart disease, cancer, stroke, etc. The same absolute risk can be expressed in different ways. For example, say you have a 1 in 10 risk of developing a certain disease in your life. This can also be said to be a 10% risk, or a 0.1 risk - depending on whether you use percentages or decimals.

Prevalence in medical parlance refers to the number of cases of a disease in a population during a specific period of time. It is used in reference to how widespread a disease has become and the ratio between those who are already infected and those who are at risk. It is used to determine the total number of cases of a disease in a given population and the impact that it has on society. It includes the length of time that the disease has been encountered and takes into consideration old and new cases.

Incidence, on the other hand, refers to the rate of the manifestation of a certain disease. It is used to measure the rate of occurrence of a disease at a given period usually dealing with the number of new cases that are diagnosed within a population during a specific period.

The hazard ratio is a comparison between the probability of events in a treatment group, compared to the probability of events in a control group. It’s used to see if patients receiving a treatment progress faster (or slower) than those not receiving treatment.

A Cohort study, used in the medical fields and social sciences, is an observational study used to estimate how often disease or life events happen in a certain population. “Life events” might include: incidence rate, relative risk or absolute risk.

In the social sciences and life sciences, a case study is a research method involving an up-close, in-depth, and detailed examination of a subject of study (the case), as well as its related contextual conditions.

In statistics, a confounder (also confounding variable or confounding factor) is a variable that influences both the dependent variable and independent variable causing a false association.

A confounding variable is an “extra” variable that you didn’t account for. They can ruin an experiment and give you useless results. They can suggest there is correlation when in fact there isn’t. They can even introduce bias. That’s why it’s important to know what one is, and how to avoid getting them into your experiment in the first place.