# ppi's and ibs



## maitland

i started having acid reflux problems some time ago and after endless tests was finally prescibed nexium, which of course solves the problems but a few years later i developed ibs and had yet to consider any cause... at the time I assumed from a major trauma namely a death in the family, but after i had recovered from a lengthy period of grief....my stomach and intestinal problem continued and never went away.....i reasoned that having less stomach acid must have some serious side effects in the long run, and for me, it has been since 2003-2004..... anyway found out recently after many more tests that i have had a small uncomplicated hiatial hernia which of course is the source of my acid reflux and am now awaiting an appointment to talk to a surgeon, apparently a few sutures to reduce the hole in the diaphram and a patch to repair the hernia and i might be good to go....so now i plan to reduce the rabeprazole (much cheaper than nexium) i am presently taking from 20mg to 10mg and then to one 10mg every second day and so on but i hear there is a hyper-acidic backlash i am going to suffer, i am thinking at the same time my ibs may go away...am i kidding myself..... does anybody out there have any comments or thoughts, thanks


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## Mr 100

hi maitland, there is a gerd forum on the ibsgroup website that may contain some useful info.http://www.ibsgroup.org/forums/forum/25-gastroesophageal-reflux-disease-gerd/What type IBS are you? I have stopped taking a ppi some time ago, partly because it made my IBS more difficult to control. I have started using the calcium I take as part of my ibs-d control also as an anti-acid. Peak gastric acid occurs about 30-60 minutes after eating, and this is when I take half a 600mg calcium tab. Hopefully, by using this approach my digestive system will be working reasonably well.I am interested to hear that you may be able to fix your h. hernia with surgery. This is not a fundoplication then? I am interested because I think I may have a h. hernia too, and I can't understand why it is not possible to simply fix.It sounds like you are reducing ppi gradually which is the best way to reduce acid bounceback. Acid bback is not a problem for everyone, but the effect can go on for some time, up to 2 weeks, for others. Ranitidine and calcium can help those comming off ppi's. Lifestyle and dietry modifications also assist.Please ask any questions and let us know the result of your surgeon appointment.


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## Dr Peter Thatcher

MaitlandYou don't mention the type of IBS you have, but we know PPI's can cause diarrhoea in some sufferers. They can also cause a condition called microscopic colitis and this results in diarrhoea. As mentioned, you can use antacids as you reduce your PPI dose, but be warned, calcium based antacids can cause constipation and magnesium based antacids can cause diarrhoea. Good luck if you go through the surgery.Peter


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## maitland

Mr 100 said:


> hi maitland, there is a gerd forum on the ibsgroup website that may contain some useful info.http://www.ibsgroup.org/forums/forum/25-gastroesophageal-reflux-disease-gerd/What type IBS are you? I have stopped taking a ppi some time ago, partly because it made my IBS more difficult to control. I have started using the calcium I take as part of my ibs-d control also as an anti-acid. Peak gastric acid occurs about 30-60 minutes after eating, and this is when I take half a 600mg calcium tab. Hopefully, by using this approach my digestive system will be working reasonably well.I am interested to hear that you may be able to fix your h. hernia with surgery. This is not a fundoplication then? I am interested because I think I may have a h. hernia too, and I can't understand why it is not possible to simply fix.It sounds like you are reducing ppi gradually which is the best way to reduce acid bounceback. Acid bback is not a problem for everyone, but the effect can go on for some time, up to 2 weeks, for others. Ranitidine and calcium can help those comming off ppi's. Lifestyle and dietry modifications also assist.Please ask any questions and let us know the result of your surgeon appointment.


thanks for the reply mr 100....i have ibs-d....did your acid go crazy when you stopped the ppi routine...as for calcium, i thought extra calcium was filtered through the kidneys and continued use of extra calcium will cause kidney stones; when i asked about the surgery my doctor said she thinks i will have a very difficult time getting someone to do this type of procedure for a small uncomplicated hernia but when i pressed the issue because of ibs and the possible ill effects of the ppi's she went online and did some research and found that this procedure was available specifically..."surgeons and internists of mature experience know that uncomplicated hiatus hernia, with its usual peptic esophagitis, is cured, unequivocally, by adequate repair of the herniation. symptomatic relief is immediate. failure to cure signifies incomplete correction of the herniation. recurrent herniation is due to technical or tissue failure".so i am optimistic a surgeon may be willing to help me; many years ago i was a work-out overachiever and exercised 5-6 days a week meaning i did literally thousands of stomach crunches and leg lifts and machine exercises to strenghten the abdominals...and this was my first sign that i was getting acid reflux, which started to occur after every workout, i will mention i smoked and drank a fair amount during this period of time as well so i was aggrevating the situation but i had never even heard of acid reflux and problems of the lower esophagageal sphincter. i was never told about the hernia until recently but i think it was there all along, so now i am eating homemade soup, rice, fish, plain chicken, white bread not whole grain, little to no fat and little sugar, i have a problem with cookies and the like but i try my best and will see what happens...will keep you posted. maitland


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## maitland

Dr Peter Thatcher said:


> MaitlandYou don't mention the type of IBS you have, but we know PPI's can cause diarrhoea in some sufferers. They can also cause a condition called microscopic colitis and this results in diarrhoea. As mentioned, you can use antacids as you reduce your PPI dose, but be warned, calcium based antacids can cause constipation and magnesium based antacids can cause diarrhoea. Good luck if you go through the surgery.Peter


hi dpt, thanks for the reply.... i have ibs-d...would the micro colitis show up in a colonoscopy.... which i had last summer; in my case cacium based antacids and constipation sound good, but if i recall, when i took these antacids on a regular basis before ppi's, they would not last even an hour with me, will keep you updated on my story....maitland


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## Dr Peter Thatcher

maitland said:


> hi dpt, thanks for the reply.... i have ibs-d...would the micro colitis show up in a colonoscopy.... which i had last summer; in my case cacium based antacids and constipation sound good, but if i recall, when i took these antacids on a regular basis before ppi's, they would not last even an hour with me, will keep you updated on my story....maitland


Hi MaitlandMicroscopic colitis is only diagnosed if biopsies were taken during your colonoscopy. The colon looks normal to the colonoscopist usually. I routinely take biopsies when I perform colonoscopy, but I know its not necessarily universal. As far as your reflux is concerned, there are lots of other options to try for your indigestion symptoms, maybe step down to an H2 antagonist such as Ranitidine in conjunction with your antacids.Peter


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## Mr 100

Hi maitland, re kidney stones, I don't really know how much risk is increased by taking extra calcium. Are those that live in areas of hard tap water [high alkalinity] at greater risk? Or do inherited/genetic factors predispose one to greater risk? Perhaps Dr Peter Thatcher could comment? I like your quote about fixing the hernia. My rudimentary knowledge of anatomy suggests to me that nissen fundoplication is possibly unnecessary for most simple hiatus hernias, and that there is a lot of surgery and recovery time involved. I hope you find a suitable surgeon. Have you looked into the possibility of manipulation by a chiropractic? There is also the abdominal breathing technique that could possibly help. There are posts on the gerd forum about these ideas.I didn't have much bounceback when reducing my ppi. I did it very gradually over a week or so, even halfing some capsules. I took tums after meals and Gaviscon at bedtime. I have used ranitidine from time to time, I am not sure if this works for me.


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## Dr Peter Thatcher

Mr 100 said:


> Hi maitland, re kidney stones, I don't really know how much risk is increased by taking extra calcium. Are those that live in areas of hard tap water [high alkalinity] at greater risk? Or do inherited/genetic factors predispose one to greater risk? Perhaps Dr Peter Thatcher could comment? I like your quote about fixing the hernia. My rudimentary knowledge of anatomy suggests to me that nissen fundoplication is possibly unnecessary for most simple hiatus hernias, and that there is a lot of surgery and recovery time involved. I hope you find a suitable surgeon. Have you looked into the possibility of manipulation by a chiropractic? There is also the abdominal breathing technique that could possibly help. There are posts on the gerd forum about these ideas.I didn't have much bounceback when reducing my ppi. I did it very gradually over a week or so, even halfing some capsules. I took tums after meals and Gaviscon at bedtime. I have used ranitidine from time to time, I am not sure if this works for me.


Thanks Mr 100I'm not sure there is much evidence base for avoiding calcium in the diet in kidney stones. It is just logical to do so as the most common kidney stone is the calcium oxalate stone. Males, poor fluid intake, sometimes genetic tendancy, high oxalate in diet (spinach, chocholate, rhubarb), some drugs, hormone conditions such as primary hyperparathyroidism can all account for the stones. However, the most common reason is idiopathic i.e we just don't know!


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## maitland

Dr Peter Thatcher said:


> Thanks Mr 100I'm not sure there is much evidence base for avoiding calcium in the diet in kidney stones. It is just logical to do so as the most common kidney stone is the calcium oxalate stone. Males, poor fluid intake, sometimes genetic tendancy, high oxalate in diet (spinach, chocholate, rhubarb), some drugs, hormone conditions such as primary hyperparathyroidism can all account for the stones. However, the most common reason is idiopathic i.e we just don't know!


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## maitland

well that's good enough for me...i am on my way to the pharmacy for some calcium thanks for the info. maitland


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## maitland

Mr 100 said:


> Hi maitland, re kidney stones, I don't really know how much risk is increased by taking extra calcium. Are those that live in areas of hard tap water [high alkalinity] at greater risk? Or do inherited/genetic factors predispose one to greater risk? Perhaps Dr Peter Thatcher could comment? I like your quote about fixing the hernia. My rudimentary knowledge of anatomy suggests to me that nissen fundoplication is possibly unnecessary for most simple hiatus hernias, and that there is a lot of surgery and recovery time involved. I hope you find a suitable surgeon. Have you looked into the possibility of manipulation by a chiropractic? There is also the abdominal breathing technique that could possibly help. There are posts on the gerd forum about these ideas.I didn't have much bounceback when reducing my ppi. I did it very gradually over a week or so, even halfing some capsules. I took tums after meals and Gaviscon at bedtime. I have used ranitidine from time to time, I am not sure if this works for me.


hi mr100 and dr peter....i went to a chiro for many years for my spine but i think this problem ..... the diaphram esophageal opening has enlarged and needs stiches and the hernia needs to be corrected surgically.....in all probability, is beyond the skill sets of a chiro, but thanks for the idea....yes.... i am not crazy about the fundo wrap part of the procedure and would probably not have the surgery if the surgeon insisted on doing the wrap despite my reservations.... i now have a prescription for ranitidine 300mg so i hope dr peter will tell me that diarrhea is not a side effect with this class of drug..... the idea that i have had this major problem for about 8 years and it is the result of no one telling me about a surgical solution or that this all might be the side effect of nexium not ibs leaves me numb.... maitland


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## maitland

Mr 100 said:


> Hi maitland, re kidney stones, I don't really know how much risk is increased by taking extra calcium. Are those that live in areas of hard tap water [high alkalinity] at greater risk? Or do inherited/genetic factors predispose one to greater risk? Perhaps Dr Peter Thatcher could comment? I like your quote about fixing the hernia. My rudimentary knowledge of anatomy suggests to me that nissen fundoplication is possibly unnecessary for most simple hiatus hernias, and that there is a lot of surgery and recovery time involved. I hope you find a suitable surgeon. Have you looked into the possibility of manipulation by a chiropractic? There is also the abdominal breathing technique that could possibly help. There are posts on the gerd forum about these ideas.I didn't have much bounceback when reducing my ppi. I did it very gradually over a week or so, even halfing some capsules. I took tums after meals and Gaviscon at bedtime. I have used ranitidine from time to time, I am not sure if this works for me.


mr 100....you did not mention for how long you took these ppi's and if the ibs-d subsided when you went off the medication, i am hoping the acid reflux will get worse (and eventually be helped with surgery) and that the ibs cramps and gas and d will get better....maitland


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## pillpopper50

Mr 100 said:


> hi maitland, there is a gerd forum on the ibsgroup website that may contain some useful info.http://www.ibsgroup.org/forums/forum/25-gastroesophageal-reflux-disease-gerd/What type IBS are you? I have stopped taking a ppi some time ago, partly because it made my IBS more difficult to control. I have started using the calcium I take as part of my ibs-d control also as an anti-acid. Peak gastric acid occurs about 30-60 minutes after eating, and this is when I take half a 600mg calcium tab. Hopefully, by using this approach my digestive system will be working reasonably well.I am interested to hear that you may be able to fix your h. hernia with surgery. This is not a fundoplication then? I am interested because I think I may have a h. hernia too, and I can't understand why it is not possible to simply fix.It sounds like you are reducing ppi gradually which is the best way to reduce acid bounceback. Acid bback is not a problem for everyone, but the effect can go on for some time, up to 2 weeks, for others. Ranitidine and calcium can help those comming off ppi's. Lifestyle and dietry modifications also assist.Please ask any questions and let us know the result of your surgeon appointment.


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## pillpopper50

Unfortunately, calcium supplements are now being linked to plaque formation that may lead to heart attack; see http://www.cbsnews.com/8301-204_162-57440558/study-links-calcium-pills-to-heart-attacks/Conversely, calcium obtained through diet, especially dairy, is being linked to lower heart-attack risk.


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