# PPI'S = reduced gastric acid.



## Mr 100 (Aug 1, 2011)

it's been theorised that probiotics are made less effective by gastric acid, preventing their survival intact to the small intestine and bowel.could it then be case that those taking PPI's [eg omeprazole] or H2-receptor antagonists [eg zantac] have an advantage in this area?


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## overitnow (Nov 25, 2001)

The supplements I take that need to dissolve in the small intestine are encapsulated to get through the stomach acid. I don't know if increased stomach acid would have affected them; but the capsules of grape seed blend, which brought an end to my GERD, were obviously effective even in that quantity/concentration. I think that is normally the case with probiotics, unless you are eating a food product with enhanced levels.Mark


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## Mr 100 (Aug 1, 2011)

hi mark, thanks for the reply.this thread was just a thought to put out there and see if anyone else had any ideas.yes i am aware of gastic acid [g acid] resistant capsules and coatings for tablets and supplements. i am wondering more about the effects that lower levels of g acid caused by taking ppi's, has on my ibs-d.the notes that come with ppi tablets warn of a greater risk of gastrointestinal infections.this is presumably because some bacteria could survive the lower concentration of g acid and passes into the more alkaline environment of the small intestine. my logic suggests that this could, perhaps, be used to positive advantage if one were trying to use foods to better deliver their probiotic content, intact, lower down the digestive tract.there are numerous foods and supplements that are thought to have their effect at least partially inactivated by stomach acidity, for example manuka honey, glucosamine, etc, that could perhaps become more effective for those taking ppi's.


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## Kathleen M. (Nov 16, 1999)

There can be a pretty large symptom bounceback coming off PPI's (Even if you didn't have heartburn before you start) so I don't know that I would use that solely to try to make a probiotic more effective.One other issue is that it isn't just the bacteria you want that may survive better, any of the usual reseeding you get may be just as likely to get through with other bacteria you may not be as interested in.


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## Mr 100 (Aug 1, 2011)

kathleen, thanks for the reply.yes i am aware of the potential for bounceback when reducing or stopping various medications and would never suggest that anyone think of taking ppi's just to deliver more probiotics to their gut. it's only because i am currently taking omeprazole that the idea came to me.i am just trying to shed a positive light on what for me has made a difficult situation [ibs-d with post movement mucus, leakage etc] even more unpredictable.


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## overitnow (Nov 25, 2001)

So "maybe?" what Kathleen warns about is why the PPIs can cause additional D, as the bad bacteria have an easier time of populating the small intestine?Mark


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## Mr 100 (Aug 1, 2011)

hi mark, yes, i think you are right. my limited time taking ppi's has caused additional D problems for me, although it's hard to be sure of the exact cause, given all the variables.kathleen, have you experienced bounceback after reducing ppi dosage? my GP advised me to cut down omeprazole from 2x20mg to 1x20mg daily, when i felt better, i have done this but seem to suffering from a sore throat now. it feels like i may be getting a cold, but i'm worried this is a result of the change of dosage. i'm seeing the GP on monday morning so may know more then. i will probably ask him to refer me for endoscopy or barium xray to see if i have hiatial hernia.


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## Kathleen M. (Nov 16, 1999)

I usually have to use other treatments to control the bounce back. Unfortunately right now things are bad enough even after the bounce back period is over that I'm back on the PPI's.I do find DGL (a form of licorice) does help a lot, but I get some voice trouble from the reflux even on that so like I said I'm back on the PPI's.


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## Mr 100 (Aug 1, 2011)

hi kathleen,following on from my last post, yes i was getting a cold, it wasn't acid bounceback, i am now again preparing to reduce the omeprazole from 40mg to 20mg. the GP didn't want to refer me for endoscopy at this time as i don't fit the 'NICE' guidelines [i'm not quite old enough!]. he also refused me a barium xray, on the basis that these are only allowed to be ordered by a consultant. so we are none the wiser as to the cause of my severe heartburn. i will look out the DGL.i have sourced an extra large pack of tums.and a large bottle of gaviscon advance.i plan to go down to 30mg [1.5x20mg tabs] for a few days then to 20mg thereafter. as a matter of interest, is it possible to reduce or come off ppi's with the use of histamine H2-receptor antagonists [eg zantac] to prevent bounceback? or do they have a similar drawbacks?i have enrolled on a tai chi course, as the movement involved gives the body a thorough but gentle workout that can help posture and digestion.i picked up an interesting article from the newsfeed on the current state of treatment options for medicinal and surgical approaches to the management of gerd. some of the newer endoscopic treatments currently in studies, look promising for the future. there is one new form of surgery being tested that has the big benefit of being reversible. here is a link,http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=756hi mark,i have been investigating quercetin, one of the ingredients of provex cv, and it looks very interesting. i am currently trying other supplements, but will add provex cv to my list of potential for the future.


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## Kathleen M. (Nov 16, 1999)

I haven't heard that the H2 have as much of a bounce-back issue, and they don't seem to be as bad about that for me. I often use Zantac when I come off a PPI.


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## Mr 100 (Aug 1, 2011)

so far so good. i've managed to bring my daily dosage down to 20 mg omeprazole. the gradual approach has worked very well. i have used gaviscon before bed and tums during the day at the first feeling of any heartburn.thanks for the posts kathleen


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## oelph (Sep 19, 2007)

I tried reducing my PPI usage (10mg rabeprazole once per day) back in May by going cold turkey and it didn't go so well. I've since been having chiropractic and I'm now 4 weeks since my last tablet. However what I do have (and had before stopping the tablets) is a dry, irritated throat - mostly at the top, back of mouth, and a sore tongue. I'm taking an h2 blocker occasionally as well as Gaviscon, but I've only ever felt the burn in my throat twice in those 4 weeks.I'm not sure if my throat soreness is down to reflux or something else.


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