After discovering some moderate damage to the lower esophagus, the
surgeon recommended Protonix. At first he asked about the Prilosec I
was taking (1 tablet a day, 10 mg) and if it was working. It generally
did work (on a few occasions I still had problems). I've been using
Prilosec for about two years now. So, before he recommended the
Protonix, he asked about Prilosec and then said, "I'd like to you take
two Prilosec every day." Then for some reason he changed his mind and I
was given a prescription for Protonix. Now.. I've not had any side
effects with Prilosec (although the dosage is quite low). And there is
no way to determine if the "damage" to the esophagus was created before
or after my starting it.

Anyway, I've been on Protonix for a week now: headaches, chest pains,
aching in the backs of the legs just started.. increased burping (and
occasionally it "almost" seems as though they are acid burps but that
could be my imagination). Unfortunately he is away for another week. I
called the hospital pharmacy and they suggested cutting them in half.
My own physician told me to just revert to the Prilosec.

Question: Is there something healing in Protonix that is not present in
Prilosec and would help me to heal better if I "toughed it out"? If
not... then wouldn't it be better to go back to Prilosec and just use
two if the need arose?

I would really appreciate some input here. Thanks so much.

mary

I'm interested, too, in hearing from others about this. It does seem as
if Protonix gave me indigestion, which I was never concious of before,
despite the evidence of Barrett's Esophagus.

leushino

Hi, Mary

I've only been on Protonix for a week (and I'm about to abandon it with
my primary physician's permission). I can say, however, that the burping
increased dramatically (as did the flatulence. It "seemed" to me that
some of the burping was actually a bit acidic, but that might have been
my imagination. I never experienced any of these sort of
"indigestion-like" symptoms with Prilosec although I must add that the
dosage was considerably less. I'm not sure this is what you are
describing. Is it?

mary

Yes, that's what I'm talking about. You are much more careful than I
am, though. I just quit taking the Protonix, when to Prilosec and later
(2 months) got a prescription for Nexium, which seems to work. I don't
have severe symptoms, just a stomach ache, which has gone from a 3
(pre-meds) to a 1 (post-meds). and this Barrett's, which is damage, I
suppose, to the esophagus and raises a cancer red flag. This is why I
am paying attention, I guess. I'm in the middle of the process of
quitting chocolate, caffine, alcohol, ice-cream, etc. Some of this is
more difficult than others. Behavioral changes are so much more
difficult than taking a pill, aren't they?

howard mccollister

Note that PPI's can stop acid reflux, but do nothing for non-acid reflux.
Non-acid/alkaline reflux accounts for as much as 40% of the refluxing
population, and appears to be every bit as much a contributer to the
progression of Barrett's esophagus (and therefore esophageal cancer) as acid
reflux. PPI's can decrease some or all of the pain, which is more often due
to acid, but don't necessarily decrease the risk of esophageal cancer.

HMc

leushino

That's not very encouraging. So, if we follow the dietary rules and try
not to stress about daily events AND take a PPI, do we have a good
chance of preventing this progression?

howard mccollister

No. But you'd have some chance of controlling the symptoms

PPI's likely do nothing to stop the progression of metaplastic change in the
lower esophagus (Barrett's), and in fact there is some rather compelling
evidence that suggests that PPI's *increase* that risk. Lack of acid in the
stomach allows precipitation of bile salts, which are highly damaging to the
squamous lining of the lower esophagus, more damaging than acid. But, the
symptoms of heartburn are gone.

GERD is a disease caused by malfunction of the lower esophageal sphincter.
There is no medical way to address that. We can *ameliorate* it by lifestyle
changes eg... stopping the things that contribute to reflux, such as
achieving and maintaining normal weight, eating small meals, no caffiene, no
alcohol, no nicotine, no tomato spices. The disease persists, however. Just
the symptoms are managed. Sort of like taking aspirin for a brain tumor - it
helps the headaches.

Stress has little or nothing to do with reflux.

HMc

leushino

I do NOT believe this. In fact, I'm copying this out and showing it to
my surgeon at my next appointment. In my office alone, nearly half have
acid reflux and some have been diagnosed with GERD. If this unstoppable
progression were inevitable as you claim, we would hear of tens of
thousands of people dying of cancer but that is not the case. You've
given some helpful information in the past, but this sort of posting is
just beyond the pale. I'm leaving this forum since it is not very
encouraging and in fact has deeply upset me. Good-bye.

howard mccollister

It's always wise to be skeptical of medical advice one reads on the
internet, and leushino should most definitely discuss his rather pronounced
fears with his doctor.

What he is assuming, I now see belatedly, is that everyone with acid reflux
will develop Barrett's esophagus, and that everyone with Barrett's will
progress to cancer. That's not the case. Only about 10% of GERD patients
develop Barrett's, and only about 10% of those will develop dysplasia and
progress to cancer.

Even so, leushino should indeed be concerned - the incidence of esophageal
cancer makes it only the 5th most common cancer, behind breast, lung,
prostate, colon, but it's incidence is increasing at a rate faster than any
other cancer. In fact there *are* about 20,000 new cases of esophageal
cancer diagnosed every year.

Dr. Tom DeMeester has a slide in one of his talks that graphs the incidence
of esophageal cancer year-by-year since about the mid-60's. On that slide,
he has superimposed sales of anti-secretory medication (H2 blockers, then
PPIs) over the same time frame. The graphs are identical. Now, that does not
establish cause and effect, although our fledgling understanding of non-acid
reflux is shedding a lot of light in that regard, but it's worth noting that
a very similar graph of lung cancer incidence compared to smoking incidence
was what led researchers to suspect the link between smoking and lung cancer
back in the 50's.

HMc

mary

I appreciate your posts, which are always thoughtful - and thought
provoking.