Weaning off Omeprazole

[sportsman]

This is a regular topic but I am interested to hear from anyone who has succeeded/reduced. Now nearly 11 years post op I continue to take 20mg at night and 10mg each morning and a couple of good spoonsful of Gaviscon at night and I seem to cope pretty well at that level, just the very occasional problem at night. In the earlier days I took 40mg each day. My thinking is to start by reducing the morning intake, perhaps every other day, and extending the interval until I eliminate it completely (I hope!). Twice I have dabbled with this for a short time but have had some reaction. I have read from some of you about "reflux bounce". Any advice will be greatly valued.

[phil]

I am 10 years post ops and stopped taking PPIs for a couple of years . But it effected my quality of life. Being active ,bending down etc in the day caused reflux and at night I had to take gavascon 2 or 3 times.

I only take 20 mg of esomemprozole a day. And that suits me.I also think that a PPI has a protective effect on what's left of our oesophagus. Also my consultant advised me to stay on this low dose. There is nothing worse than a reflux in the middle of the night that goes into your lungs.

All the best

Phil

[HONORIUS]

Hi Sportsman,

I had an I.L. in June 2015. Having read a good deal concerning the adverse effects of long-term use of PPIs, I was anxious to reduce my dependence on them (40mg in the morning, daily). By the same token, I also wanted something that could better alleviate the nightly ravages of vomiting thick, oily, orange, burning bile and the concomitant wheezing chest and racking cough, which in its turn precipitated more vomiting. The lack of sleep resulting from this vicious circle was seriously standing in the way of recuperation. Regular visitors to this site will know that this is the point where I advocate acupuncture. I went for a treatment in March of this year and had a 'top-up' in May. I've been reflux-free since March. With my consultant's approval (the brilliant Simon Dwerryhouse at Gloucester Royal) I reduced my dose of Omeprazole to 15mg taken in the morning every other day. Given that we're all pretty much without a cardiac sphincter since our procedure, this has to be a physiologic result: I can't accept that I'm living life bile-free psychosomatically. But if (however implausible) this is the case, who cares? I don't need to be able to build a car to drive one. It works. I applaud it.

[werfvan5 in reply to HONORIUS]

Hiya, hoping you can help me, ive been banging on to my GP for ages , i convinced 15mg of Omeprezole would work for me.....can i ask where you get yours from....cheers

[HONORIUS in reply to werfvan5]

Hi Werfvan5, sorry, only just picked up your question while doing some housekeeping. I was splitting a 30mg tab (Lansoprazole, not Omeprazole) but my GP pointed out that this is not entirely reliable in ensuring a consistent dose; so she altered my prescription. I now receive Laaoprazole tabs in 15mg form. The pharmaceutical company is Mylan, they come in boxes of 28... Hope this helps

[AoifeMcC]

I had a total oesopghagectomy in 2007 and I have been off PPI since 2009 as I was trying for children and did not want to take anything when I was pregnant - I did it under medical advice. I have been off them since though do occasionally use gavascon. I am also a type 1 diabetic, have kidney disease due to acute kidney failure post surgery, sarcoidosis, pernicious anemia, regular anemia, graves disease...but am also mother to a 5 and 6 year old that I love to bits.

[Hidden]

It is a tricky issue, and is complicated by the fact that everybody has variable factors like how much of their stomach they retain, how much of the reflux is acid and how much bile, a history of Barrett's Oesophagus, how they react to medication as individuals, tendency to bacterial problems in the intestines, dosage, timing of when you take them, and so on.

I suspect that there are some long term effects of any medication that build up over time, for good or ill. PPIs reducing the absorption of calcium is one of them, but that can be dealt with by supplements.

Most of the advice about PPIs is not specific to patients who have had an oesophagectomy. There are articles where you can pick out some relevant advice. It does give a sensible warning about consulting your doctor through all of this: howtotreatheartburn.com/how...

It may be possible to gain relief from other types of anti-reflux medication. There has been quite a lot of publicity about PPIs recently, but that has to be taken against a background of enormous numbers being prescribed them on a long term basis when that may not be the best thing. (Some PPIs are also available over-the-counter which is a complication). They have not suddenly turned from a safe medication to a problem overnight and it is important not to over-react.

The other factor to bear in mind is that prolonged exposure to reflux is not a good thing; it may have been a factor contributing to the need for an oesophagectomy in the first place, so having had that surgery puts you into a special position compared to the general population with reflux problems. There is a theoretical risk that having developed adenocarcinoma from Barrett's Oesophagus, any remainder of the oesophagus might be vulnerable to developing dysplasia again into the long term future; that is a tiny theoretical risk, but I have no idea how that risk compares with other potential problems supposedly presented by PPIs (or the extent to which PPIs may help against that risk).

Prescribing medication is often a balance of lots of different factors, benefits and risks. Reviews every so often are valuable, and in one sense, that is why we have doctors to consult about these issues.

[Brinal7]

You said you are Post-op

What surgery did you have? Was it the Nissan fundoplication surgery?

I've had the Nissan fundoplication surgery, 9 months ago. But have not been able to reduce or stop the PPI's.

Most people who've had fundo op. Do not have to go back on the PPI's, mine is a rare case, I need to go back and have a scope to see what's going on.

[ccfc]

I agree with Alan. I am over 3 and a half years post op and was on a PPI (lansoprazole) for years before that due to Barretts oesophagus. I have seen these reports of so called problems with long term use of PPI's. I wish I had gone on them earlier and prevented Barretts developing in the first place, so I would rather take the 'risk' and keep taking them than risk the Barretts returning and all that entails. The way I look at it, i got away with it once and I was lucky. Best Wishes, James.

[sportsman]

Thank you all for your helpful comments. I'm reflecting on them but, just at this moment, I'm feeling maybe I should leave well alone.

[sportsman]

I meant to add what a boon it is to have this facility to consult and obtain real practical experience.