Dexilant

[Tam2628]

I was just reading about PPI's and chronic D. My doctor switched me from Protonix to Dexilant about 5 months ago. My D started about 7 weeks ago now (with NO relief yet, even with Entocort) has anybody else had this start because of Dexilant?

[Eric]

How long were you on the Protonix? Some may chime in with specific experience regarding dexilant, but you are correct in connecting PPIs to chronic D. PPIs have specifically been implicated in the onset of MC and past use is commonly reported by those on this forum. Some find that they do require PPIs or other means to reduce stomach acid but it seems that in many cases it was low levels of stomach acid (or some other issue) that were actually causing the symptoms in the first place and PPIs or other stomach acid reduction methods just make the problems worse. Unfortunately, inadequate and excess levels of stomach acid can have similar symptoms.

Many others here are much more knowledgeable about this issue and may be able to help you figure out if you really need the PPI or if you might be able to safely discontinue it under the supervision of your doctor.

How long have you been on the Entocort? It doesn't work for everyone but it can take time to see results.

http://www.ncbi.nlm.nih.gov/pubmed/21039674

[christinakay]

Tam

I was switched from Nexium to Dexilant in September of last year. My Chronic D started in October and in December I was diagnosed with CC.

Christina

[tex]

Hi Tam,

Diarrhea is the most common side effect of Dexilant. If you want to get your life back you will need to stop taking PPIs. In the long run, PPIs will cause other types of damage to your health.

IMO, they should be illegal to prescribe unless the patient clearly understands the risks involved, and signs a waiver accepting full responsibility for any adverse events that may result from taking the drug. That would force doctors to fully disclose the risks involved with taking a PPI.

Tex

[Tam2628]

Thanks Tex. Could that have caused my MC?

[Jazi]

Tex, what if you have GERD and it was prescribed? I was diagnosed with Gastroesophageal reflux disease with my endoscopy and was put on Prilosec as well. I only take it every other day because of what I read on here. I'm asymptomatic but thought that if GERD wasn't treated it can turn to esophageal cancer

[tex]

Thanks Tex. Could that have caused my MC?

Yes, PPIs have been known to be a common cause of MC since soon after they became available, but most doctors seem to be oblivious of that risk.

Tex

[tex]

Joanne,

This topic comes up regularly, because GERD is commonly associated with MC. We have learned that there are much safer ways to control GERD, using natural methods. PPIs have far too many adverse health consequences to be using then to treat GERD. The biggest problem is that they actually cause reflux (by weakening the lower esophageal sphincter), but the patient is unaware of the problem, because PPIs neutralize the stomach acid so that patients don't feel the burn when the reflux occurs.

For my views on the best ways to treat GERD, please read my first post in the thread at this link:

http://www.perskyfarms.com/phpBB2/viewtopic.php?t=17376

Also, research shows that GERD is associated with inadequate vitamin D levels. Several members who had severe GERD problems have found that in addition to doing the things mentioned in that post, taking a substantial vitamin D supplement (5,000–10,000 IU daily) definitely reduces their GERD issues.

PPIs cause a rebound effect when they are discontinued, which can cause symptoms to be worse than they were before the drug was used. That means that PPIs must be weaned very slowly in order to discontinue them without suffering major problems. Many people find that taking an H2 blocker while they are weaning off a PPI is a big help for preventing symptom rebound.

The FDA approved label on PPIs states that they should not be used for more than 2 weeks, but doctors seem to love them, and far too many of them prescribe PPIs indiscriminately, and for long-term use (which results in long-term damage to the parietal cells of the stomach, some of which can turn out to be permanent damage in some cases).

Tex

[Jazi]

Wow Tex, that is very interesting. I work for a physician and he is always prescribing PPI's

How do you know all this??

[JFR]

I used to have severe heartburn and took Nexium daily. When I switched to a mostly paleo low carb diet the heartburn went away never to return again. That was about a decade ago. It's been that many years since I have taken Nexium.

Jean

[Tam2628]

I have been on one form or another of PPI's for 9-10'years. I hate to think what this has done to my system...I am so confused. Do I quit taking them right away? Do I wean off by using the Protonix and gradually lowering my dose? Do I talk to my doctor? Help Tex!! What is an H2 blocker. In your opinion, will it heal my MC if I quit taking them?

[tex]

How do you know all this??

By reading medical research articles that are available on the internet. This problem is so common that I started writing a book about this topic a while back, but the board has become so busy in recent months, and I've had to spend time on other projects also, so the book has been side-tracked for a while.


Tam,

Yes, you will need to wean off slowly, and it won't be easy to do, after using them for so long. The reason why I mentioned an H2 blocker, is because they serve almost the same purpose as PPIs, to lower the acidity of the stomach contents. But unlike PPIs, they don't alter the functioning of the parietal cells in the stomach (the parietal cells produce stomach acid, when they are stimulated by histamine).

H2 blockers (they block histamine) are also known as H2 receptor antagonists. Think of them as antihistamines for H2 type receptors (which are found in the stomach). By contrast, most of the common antihistamines that most people are familiar with are designed to target H1 histamine receptors, which are found in the nasal passages, mouth and throat, skin, and other locations. IOW, H1 type antihistamines block histamine from binding to type H1 histamine rectptors in the nasal passages, mouth, throat, skin, etc., (in order to prevent allergic reactions there), and H2 type antihistamines block histamine from binding to type H2 histamine receptors in the stomach (to prevent the production of stomach acid).

When the receptors are blocked by an antihistamine, then they cannot be activated by histamine that's in circulation in the blood, or available in adjacent tissues. Consequently, the parietal cells cannot produce acid, because they are prevented from being stimulated to do so. PPIs became popular and caused H2 blockers to fall out of favor, because PPIs take control of parietal cell functioning for about 3 days, whereas H2 blockers are effective for only a few hours. Therefore H2 blockers have to be taken before each meal, rather than just once each day, (as in the case of PPIs).

This means that when you are trying to wean off the treatment, it should be much easier to wean off an H2 blocker than a PPI, because of the shorter half-life of H2 antagonists, compared with PPIs. It will take a long time for the parietal cells in you stomach to return to normal, because with long-term use, PPIs physically change the shape and function of the parietal cells. In fact after using them for that long, you will probably have some degree of permanent residual damage, but normally, enough of the cells will return to normal functionality to allow your stomach to function normally, after some healing time.

But preventing GERD and reaching the point where your lower esophageal sphincter (LES) will once again function normally is a separate issue. The problem is that the clamping strength of the LES is determined by the acidity of the stomach contents on the backside. If the pH is very low (very acidic), then the clamping strength is high. But if the pH is relatively high (only weakly acidic), then the clamping strength of the LES is low, and the chances of reflux occurring are much higher.

Normally, stomach pH is only weakly acidic when the stomach is empty, but when food arrives, the pH decreases drastically (becomes very acidic), in order to facilitate the digestion of the food. This causes the LES to clamp tightly shut. Because PPIs prevent the stomach acidity from increasing significantly, the LES muscles become steadily weaker over time (without exercise, all muscles become weaker). It will take quite a few months for the LES to regain it's strength, after both PPIs and H2 blockers are discontinued. But by tapering the dose of an H2 blocker, so that the stomach acidity is allowed to slowly increase in small steps, over time, it should slowly strengthen.

In the U. S., all four FDA-approved types of H2 receptor antagonists (cimetidine, ranitidine, famotidine, and nizatidine), are available over the counter (in relatively low doses). You may need to discuss what you want to do with your doctor, and ask for a prescription form of one of these, because the prescription versions are much more potent. Early on, the OTC versions may not not be adequate, but as your LES regains it's strength, you should be able to wean down to an OTC version, and eventually wean off that, as well. Your PCP should be able to help you with this.

So the direct damage done by PPIs is in the form of physically altering the histology of the parietal cells in the stomach, and weakening the lower esophageal sphincter. The indirect damage done by PPIs includes increasing fracture risk, increasing the chances of a bacterial infection, poor digestion, etc., and significantly increasing the risk of developing MC.

For some people, just discontinuing the drug that caused their MC and avoiding it forever, is enough to bring lasting remission. But for others, especially if they have been reacting for years, they usually eventually develop food sensitivities that must also be avoided.

You may be interested in this article.

Tips for weaning your patients off PPIs

Tex

[Jazi]

How do you know all this??

By reading medical research articles that are available on the internet. This problem is so common that I started writing a book about this topic a while back, but the board has become so busy in recent months, and I've had to spend time on other projects also, so the book has been side-tracked for a while.
Tex

You're a very thoughtful person... thank you.

[Leah]

That was a great explanation Tex. I always love the fact that I continue to learn so much here and then i am able to actually explain these things to my clients ( and friends and family).

leah

[tex]

Thanks Leah,

I appreciate the kind words. IMO, the more mystery we can remove from the field of medicine and health issues, the fewer medical and health issues we are likely to have. Kudos to you for explaining the details to your clients and others.

Tex