Esophageal eosophinilia and avoiding omeprazole bc of dementia risk?

[Anonymous]

PPIs coat the stomach. They are indeed good for acid prevention. I have serious acid reflux and use a daily dose of 20mg (the lowest possible) but I cannot get rid of that dose without misery and serious problems with the esophagus.

The coating can prevent mineral and vitamin absorption. I think long term that’s partially why there is a tie to dementia. So, I do daily vitamins.

I don’t drink, don’t eat dairy, don’t eat after 7 pm, use Gaviscon sparingly for symptom management.

I think if you watch your vitamin intake you can avoid some of the dementia risks.

[Anonymous]

I weaned off of PPIs after taking them for about 15 years and switched to prescription strength Zantac (before it was taken off market) and now Pepcid 40 mg twice a day. Protective effects controlling heartburn only lasts for 4-6 hours. PPIs contributed to my osteoporosis.

[Anonymous]

I use famotidine (Pepcid) 40 mg once a day. It works very well for me. Safe than a ppi.

[Anonymous]

Anonymous wrote:I use famotidine (Pepcid) 40 mg once a day. It works very well for me. Safe than a ppi.

Do you take it before dinner / in the evening? To protect while sleeping?

[Anonymous]

Anonymous wrote:There’s been a well documented uptick in dementia in recent years, and something must be causing it. It could be these meds plus all the people taking melatonin and other sleep aids which have also been linked to dementia.

Where did you hear this?

[Anonymous]

I’m the op (the posts weren’t from me btw).

I don’t drink. No pets.

And I don’t have any symptoms of acid reflux aside from whatever is going on with my esophagus.

I guess I’m wondering why they don’t start with allergy testing before prescribing omezaprole. Or food elimination.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I use famotidine (Pepcid) 40 mg once a day. It works very well for me. Safe than a ppi.

Do you take it before dinner / in the evening? To protect while sleeping?

NP. I take 40mg when I get up and 40 mg when I go to bed. If I can't avoid my triggers at dinner (red meat, tomato sauce) then I take my dose earlier in the day. When I got off of a PPI, it took about 2 weeks to start working.

[Anonymous]

The first-line treatment for eosinophilic esophagitis (EOE) is PPIs. If the eosinophils were only in the lower portion of your esophagus and near the gastroesophageal junction, the eosinophils might be related to acid exposure. If you had greater than 15 per high power field in mid or upper esophagus, it might not be from acid. PPIs are the first line treatment for EOE. For insurance, you usually need to fail a PPI before other medication can be covered. You can try food exclusions to treat. If it is EOE, you would need to exclude the cause forever. This is time consuming and procedure intensive because you need to keep having EGDs to see if the eosinophils are gone. Lactose is the most common cause. Hope that helps.

[Anonymous]

Anonymous wrote:The first-line treatment for eosinophilic esophagitis (EOE) is PPIs. If the eosinophils were only in the lower portion of your esophagus and near the gastroesophageal junction, the eosinophils might be related to acid exposure. If you had greater than 15 per high power field in mid or upper esophagus, it might not be from acid. PPIs are the first line treatment for EOE. For insurance, you usually need to fail a PPI before other medication can be covered. You can try food exclusions to treat. If it is EOE, you would need to exclude the cause forever. This is time consuming and procedure intensive because you need to keep having EGDs to see if the eosinophils are gone. Lactose is the most common cause. Hope that helps.

Then why not just do allergy testing first?

[Anonymous]

You can see an allergist in the mean time, but I don’t think allergy testing is usually conclusive, and people can have food get caught in their esophagus, which can be an emergency, so treatment should begin while thr other work-up is being done

[Anonymous]

I have a similar swallowing problem that got extremely bad a few years ago. I was diagnosed with silent reflux (like you, I had no serious reflux symptoms) and went on omeprazole for about 3 months while my esophagus healed and my swallowing improved. I also change my diet and used a natural acid blocker recommended by my ENT. (It’s called Reflux Gourmet and forms a barrier on top of the contents of your stomach to prevent acid from entering the esophagus.) I will occasionally go back on the medication for a short time if I feel my symptoms returning.

TLDR: you can use the medication to help alleviate your symptoms in the short term while making other long term changes.

[Anonymous]

Anonymous wrote:I have a similar swallowing problem that got extremely bad a few years ago. I was diagnosed with silent reflux (like you, I had no serious reflux symptoms) and went on omeprazole for about 3 months while my esophagus healed and my swallowing improved. I also change my diet and used a natural acid blocker recommended by my ENT. (It’s called Reflux Gourmet and forms a barrier on top of the contents of your stomach to prevent acid from entering the esophagus.) I will occasionally go back on the medication for a short time if I feel my symptoms returning.

TLDR: you can use the medication to help alleviate your symptoms in the short term while making other long term changes.

Thx.

I guess it’s just frustrating that my doctor didn’t suggest allergy testing.

Everything online says PPIs are the first line treatment in the US and Europe, but the PPIs don’t tend to work. Then they try food elimination. But how does elimination work when you aren’t symptomatic with reflux symptoms? My only symptom has been food getting stuck—which means I must already be pretty far down the line in terms of inflammation, etc.

[Anonymous]

Anonymous wrote:I’m the op (the posts weren’t from me btw).

I don’t drink. No pets.

And I don’t have any symptoms of acid reflux aside from whatever is going on with my esophagus.

I guess I’m wondering why they don’t start with allergy testing before prescribing omezaprole. Or food elimination.

My doctors did all that first. A gi does reflux. Allergist handles the allergies. You do both.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My gastroenterologist told me that the dementia risks are overstated.

Mine too. I’m not sure I believe her though. I’ve tried weaning myself off and I swear this drug is addictive. The rebound effects are terrible.

Gastroenterologists don't have much to offer for acid reflux treatment other than PPI's and Americans don't want to stop eating pizza and drinking wine.

I got Mom off of PPI's but it took simplifying her diet and a long slow 8 month taper to get her off of the PPI's.

I would able to switch to famotidine, but not at times of stress.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have a similar swallowing problem that got extremely bad a few years ago. I was diagnosed with silent reflux (like you, I had no serious reflux symptoms) and went on omeprazole for about 3 months while my esophagus healed and my swallowing improved. I also change my diet and used a natural acid blocker recommended by my ENT. (It’s called Reflux Gourmet and forms a barrier on top of the contents of your stomach to prevent acid from entering the esophagus.) I will occasionally go back on the medication for a short time if I feel my symptoms returning.

TLDR: you can use the medication to help alleviate your symptoms in the short term while making other long term changes.

Thx.

I guess it’s just frustrating that my doctor didn’t suggest allergy testing.

Everything online says PPIs are the first line treatment in the US and Europe, but the PPIs don’t tend to work. Then they try food elimination. But how does elimination work when you aren’t symptomatic with reflux symptoms? My only symptom has been food getting stuck—which means I must already be pretty far down the line in terms of inflammation, etc.

If this is EOE and not reflux, your only symptom might be food getting stuck. PPIs can work for EOE, but maybe not provide resolution. There is also swallowing inhaled steroids, or swallowed budesonide. There is also Dupixent. For most insurances, you need to fail PPIs for any of those.

Not all GIs will refer to allergy. Either go yourself or have your PCP refer.