Reflux medication long term - how to find the root cause?

[Dryshampoofordays]

Hi all, looking for advice from anyone with knowledge of stomach issues/symptoms.

My DH is prescribed lansoprazole for a couple of years. His reflux/post nasal drip/irritating cough persists and is definitely worse when he tries to reduce his meds. He’s started with raised red skin on his face which is really bothering him, this can be a side effect of being on the medication a long time.

He is going to go back to the GP but he isn’t sure what he should be asking - basically is there a way to find out the root cause of his issues and cure them? Exclusion diet/lifestyle changes?

my DH thinks I’m UPF obsessed when I try suggest diet and lifestyle changes so looking for anyone with experience as struggling to find info online.

thanks!

What was his diagnosis? Or just treating symptoms with no diagnosis? My daughter has reflux symptoms and had a tonne of tests including checking stool samples (but he would need to come off the meds for 2 weeks for that I believe) a barium swallow and now awaiting an endoscopy.

Diet should be the first thing to change, potentially before medication unless severe.

Googling reflux diet will bring up a wealth of info.

The cause of reflux is nearly always a weak sphincter between the stomach and oesophagus so that acid ‘refluxes’ back up through it. Some people are just more prone to it. Losing weight would help by reducing pressure. Raising the head of the bed for some people and avoiding spicy food, coffee, fizzy drinks and alcohol.

For me (and maybe your DH) I’d rather just take the drug that very neatly solves my problem.

If it’s really really bad I believe you can get an op to repair the sphincter but there’s a risk of complications such as doing it too tight.

Thank you, I think the diagnosis is just reflux? He had the stool sample test to rule out a particular bacterial cause before he started medication, then was given a 30 day prescription to see if that helped the symptoms. He never actually had a follow up appointment but did call the surgery, a dr called back and said he would do a repeat prescription. That was a couple of years ago.

when I look at reflux diet it does say to avoid caffeine, spicy food etc but to me that is still just about managing symptoms. I get that he needs to avoid aggravating his gut but surely there must be a root cause of the inflammation for those foods to cause such a reaction?

Did your daughter have to ask for the barium swallow/endoscopy or was it arranged as part of her routine appointment?

He may have a hiatus hernia. They can do a very quick endoscopy to confirm.

I feel for him as I have a hiatus hernia, and it's very annoying! On omeprazole for life now!

Thanks, I still wonder why the sphincter needs repairing in the first place, surely there’s something going on to cause it? He is reluctant to even go to the gp I think he’d faint if he was offered an operation!

Thanks @LuckysDadsHat that’s helpful to know. I wondered what the endoscopy could be looking for!

This is considered alternative medicine but it’s been suggested that poor digestion means the stomach struggles, it’s starts to bloat and the acid is pushed up. To prevent this you can take digestive enzymes which help the stomach process the food better. Different types help with different foods. I haven’t been able to convince my husband to take it so unfortunately I can’t tell you if this approach helps or not

I understand the frustration with just treating reflux symptoms without finding a cause. My old GP wasn’t even that fussed about treating the symptoms so now after my new GP sent me for a gastroscopy to find out what’s going on I’ve been diagnosed with Barrett’s Oesophagus. I’ve been told this was caused by the reflux but still nobody has told me why I have the reflux in the first place!

@ThePure the medication was great initially but now that it’s causing the rash on his face he is really self conscious. He’s tried reducing how often he takes the medication by skipping a day to help his skin but the reflux and cough are back with a vengeance. I feel cruel saying this but the constant coughing and throat clearing is driving me insane!

They don't always offer a repair.
I had an endoscopy after years of reflux, I have a wide gastro-oesophageal junction with sliding hiatus hernia. All this has now caused me to have a barretts oesophagus. There is no specific reason I've ended up with a wide GOJ but my dad and my son have the same condition so they put it down to bad genetics. The surgeon who does my 3 yearly endoscopies thinks I need surgery. The surgeon that does the surgery said I'm not bad enough so I carry on with the medication. I've been on medication since 2007. I'm not overweight, my BMI is 21. I'm 40 years old.
My son has had the surgery because his reflux was severe, he had it done when he was 13.

My exh, son and nephew get bad reflux, no dx but likely hiatus hernia or similar as they’re really common.
the gastrointestinal consultant says ppi’s (omeprazole etc) are fine to stay on for long term

@BertSymptom That’s so frustrating! The dentist also asked if my DH had reflux as he could see signs of waring on his teeth. That’s what prompted him to go to GP years ago. You’d think there would be more effort to cure when it affects people’s health and quality of life in so many ways.

Without wanting to derail the thread, can you say what they’ve advised for you about the Barrett’s Oesophagus? I’m on low dose medication and haven’t really been told much other than “lifestyle changes” which weren’t hugely specific. I’m only in my thirties so in a bit of a panic!

The cause is mechanical incompetence of the sphincter. That’s the cause of all reflux. He already had H Pylori infection excluded. That’s really all there is for causes. A hiatus hernia is just a bad degree of sphincter incompetence that has gone as far as herniating. There is no mystery. I’m a Dr and I have reflux myself. What where you thinking would be the cause?

My dad has bad reflux too so I think mine is bad genetics

OP could you say what a 'root cause' would look like to you?

Reflux is very common, bad diet and being overweight don't help. Some people have weak sphincters or hiatus hernias but you seem to suggest you would then want to know the 'root cause' of those.

The human body isn't perfect, it only has to work well enough to keep us alive long enough to reproduce. Lots of bits go wrong all the time, it's just life.

I'm on pantoprazole and I have an endoscopy and biopsy every 3 years.
I was on omeprazole for years but it seemed to stop working for me last year so my GP switched me to pantoprazole.
I avoid any foods that give me noticeable acid. I don't drink or smoke anyway.

He’d probably be best off asking for a change of medication (there are non PPI ones) and maybe weight loss and dietary modifications if that’s relevant. I wouldn’t want an endoscopy myself unless absolutely necessary as they are quite unpleasant.

I've had awful reflux since my 20s, and it actually regurgitates up into my mouth at night. I've had it for 30 years, through being fat and thin. I don't drink or smoke.

Had my first endoscopy when I was 50, and the surgeon was expecting to see extensive damage in there - nope, everything normal. So I take care not to eat anything that triggers it, but regularly wake up with a start either swallowing vomit that has come up, or coughing it out of my windpipe. Sometimes it gets up in my nasal cavity. I have an endless itchy cough when I speak, and a sore and slightly enlarged uvula (presumably post-nasal drip?), I do a lot of throat clearing too.

But nothing can be done. I've taken 30mg lansoprazole for a good 10 years, and my GP has just halved it as I should be "weaning myself off them." I'll have to sleep sitting up, with my lower back and hips screaming, for the rest of my life!

I'd invest in one of those orthopaedic beds that you can adjust, but you have to have a memory foam mattress so it will fold and I loathe memory foam. First World problems!