Additional Problems Attributed To PPI Use

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tex
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Additional Problems Attributed To PPI Use

Post by tex »

Hi All,

New research shows that not only do PPIs not reduce the risk of bleeding from the use of NSAIDs, (something that they have been specifically prescribed to do), but they make it worse, and distort the gut bacteria profile, to boot. :shock:
RESULTS: Both PPIs significantly exacerbated naproxen- and celecoxib-induced intestinal ulceration and bleeding in the rat. Omeprazole treatment did not result in mucosal injury or inflammation; however, there were marked shifts in numbers and types of enteric bacteria, including a significant reduction (∼80%) of jejunal Actinobacteria and Bifidobacteria spp. Restoration of small intestinal Actinobacteria numbers through administration of selected (Bifidobacteria enriched) commensal bacteria during treatment with omeprazole and naproxen prevented intestinal ulceration/bleeding.
The moral of the story appears to be, if we feel obligated to take a PPI, we'd better take a good probiotic, along with it, if we want to prevent the development of additional problems.

http://www.ncbi.nlm.nih.gov/pubmed/21745447

Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by Gabes-Apg »

Tex
thanks for the reminder of why i chose not to take the PPI's - and i will be printing that article for my GI appointment in October.

the potassium powder and calcium carbonate are working marvellously (and they are cheaper!)
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Post by Beth »

Oh, I'm curious to know what you take the potassium and calcium carbonate for, Gabes. To help with bloating? Or something else?
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Post by motsy »

I work with the elderly and there is an association with ppis and hip fractures, which are one of the more common elder problems. I have suspicions that ppis prevent mineral absorption (calcium) and there have also been concerns with lower stomach acid making one more susceptible to foodborne pathogens. There is not much proven yet, but associations are there.
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Post by Gabes-Apg »

Beth
I take the potassium powder and calcium carbonate is for acid reflux.
i dont get the pain of heartburn so much, acid regurgitation has been the main issue.

the potassium powder is called 'gastric buffer', sports people also use it when they are doing events like triathelons/extended distance cycling etc

a recent scope by a GI confirmed that i have hiatius hernia and the acid is causing some damage. the GI prescribed a PPI but i have chosen to stick with the supplement approach that have minimal side effects compared to the ppi meds.
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Post by tex »

Motsy,

Thanks for mentioning that. We discussed that association a couple of years ago, I believe, but I had forgotten about it. PPIs have so many serious problems that it's not easy to keep track of them all, and yet doctors continue to prescribe them as if they're risk-free. :roll:

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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by tex »

Gabes,

It's good to hear that it's working. :thumbsup:

Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by motsy »

Part of my job is reviewing the medications of nursing home residents. Typically, I believe 80 + percent are on ppis-once they are prescribed, they aren't often stopped. I think that is true of lots of medications, so that by the time we are elderly we are on so many drugs that they are counteracting each other and causing side effects that are treated with even another drug- hmmm.. wonder if we could reduce our medical costs and increase our quality of life by really evaluating our prescriptions- sorry- one of my soapboxes...
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Post by tex »

Motsy wrote:Typically, I believe 80 + percent are on ppis-once they are prescribed, they aren't often stopped.
I can believe that, because research shows that the body becomes dependent on them after only a couple of weeks. :roll:

You're right - it's a real racket, and the sad part is that it's not only legal, but virtually mandatory. A couple of days after my last surgery, I choked on some food, and blew out the respirator tube. They insisted on replacing it again, unless I agreed to take a PPI, (so that I wouldn't choke on any reflux). I took the damn PPI, (for several days, before they discharged me), because respirators are not much fun. After I got home, for the first time in my life, I had problems with acid reflux. That certainly wasn't just a coincidence, IMO. Fortunately, I figured out how to make some changes that resolved the problem, until my lower esophageal sphincter could regain it's muscle tone, and I haven't had any more reflux problems, since.

Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by Polly »

Tex,

Great find! And another example of something messing with the gut bacteria. I didn't realize PPIs did that. Between PPIs and antibiotics it's a wonder anyone has any gut bacteria left. And now I wonder if NSAIDs and hormones also screw up the gut bacteria?

Now I am confused about probiotics. I thought that one would have to take them forever to repopulate gut bacteria - that once you stopped them, the
the bacteria went back to pre-probiotic numbers. Sooooo, why do we recommend taking them in situations like when we take antibiotics or PPIs? Is it because they provide an excess amount of bacteria to be wiped out and therefore more of the resident gut bacteria might be preserved? I know I sound like I am talking nonsense here, but honestly, some of our most basic beliefs really confuse me. :roll:

Motsy, I couldn't agree with you more about the elderly and drugs, and I am so happy to know that people like you are doing surveillance. My mom was in longterm care for the last 10 years of her life. Fortunately, the only med she needed was thyroid hormone, but they were always trying to add something else - PPI, meds for depression, etc. And yet they did not routinely give therapeutic levels of vitamin D to the residents - only what was in a multi-vitamin. I finally got it upped to 2000 IU/day but it was a battle (for a while I had to take a vitamin D supplement to her when I visitied). Once on that level, she had far fewer illnesses.

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Polly
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Post by tex »

Polly wrote:Sooooo, why do we recommend taking them in situations like when we take antibiotics or PPIs? Is it because they provide an excess amount of bacteria to be wiped out and therefore more of the resident gut bacteria might be preserved?
That's a good question, and I've wondered the same thing. I believe that your suggested reason is probably correct. By flooding the gut with benign bacteria, this probably distracts and confuses pathogenic bacteria into believing that there must not be many potential attachment sites available, since so many "free" bacteria are in circulation, (IOW, it appears that the "free" bacteria were unable to locate attachment sites). Unless they can find an attachment site, pathogenic bacteria usually aren't much of a threat.

In the meantime, this may give surviving beneficial bacteria some sort of competitive edge, (I have no idea why, but it appears that they are somehow able to propagate viable colonies, and thereby out-compete the pathogenic strains). I can see how this could work when there are surviving beneficial bacteria. I'm not even sure that any antibiotic is capable of killing every last bacterium, but if one is, then I don't understand how recolonization could take place, either, (without a transplant from an appropriate donor).

Love,
Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by sarkin »

I have been wondering about the role of biofilms recently, since I read this link Zizzle posted in the last couple of weeks: http://www.endfatigue.com/health_articl ... litis.html

What caught my eye was this throwaway sentence at the end:
That Pepto Bismol works (helped in 100% of the cases with none of the placebo group benefitting) raises the question of the role of Biofilm infections, in collagenous colitis. Biofilm infections respond poorly to antibiotics but are very sensitive to the Bismuth found in Pepto Bismol.
Maybe that's why Pepto works for those who can tolerate it - and why it stops working, if no further action is taken to protect good flora, or re-establish them, or kill the baddies that are disrupted from biofilm?... and maybe a non-salicylate bismuth formulation would benefit those who can't tolerate Pepto? Like this one, which isn't available in the U.S.: http://www.medsafe.govt.nz/consumers/cmi/d/de-nol.htm (I found two other bismuth subcitrate medications - one contains metronidazole and tetracycline, and the other ranitidine - admittedly I don't know much about looking up meds, there may be others.)

I was curious about medication, because it seems as though it might be a way to achieve some of the Pepto benefits, without the salicylate problems. I'm not suggesting that bismuth is safe over a long period of time - I think it's still a short-course round of treatment.

And then, of course, once the pathogenic organisms that have been living in biofilms are detached from their polymerized hold on the gut (and/or other tissues), and on the loose, what would be my plan for killing, eliminating, or replacing them? The complex and inter-dependent list of variables about what conditions favor which bacterial populations seems unaskable, much less answerable. I am pretty confused, as you can tell.

I can say that my mother's recurrent C. difficile infections were stopped when I added probiotics to her regimen, and that at least one type of probiotic was useless. Whether the probiotics disrupted the spore-producing C. diff bugs from succeeding in their reproductive cycle, and eventually eliminated the "spore bank" - or whether they outcompeted for living space in her body? - or some third thing? No idea.

I would love an expanded understanding of this - are there biofilms that are beneficial, and would bismuth disrupt those to the detriment of the human host???

I know this biofilms thing is just a footnote on the larger discussion - but there they are, hiding out, an inaccessible to testing or treatment.

Love,
Sara
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Post by tex »

Sara,

Sure there are useful biofilms - they're probably ubiquitous. If you're interested in biofilms, you might be interested in the comments about them in the article at this link, (which I posted in a thread in the Discussions on MRT Testing forum:

http://www.miller-mccune.com/science/ba ... -us-23628/

It's a long article, ( but an excellent one) - the biofilm info is almost halfway down in the article, near the photo of a part of the Titanic, which is covered with bacteria colonies.

Love,
Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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