Lansoprazole issue?: Alan is now 2... - Oesophageal & Gas...

Oesophageal & Gastric Cancer

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Lansoprazole issue?

AlisonStobart profile image
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Alan is now 20 months Post Ivor Lewis (for oesophageal cancer) and appears to be ‘doing well’ (my natural pessimism leads me to believe I will jinx things if I’m too positive!). This is despite also suffering from shingles that started in December! His recovery has been very similar to lots of people who have gone through this procedure: tiredness, pain, reflux etc. One thing that causes us both concern is the regular bouts of diahorrea. We read that this is common too so that helps us to relax again rather than think it’s a more ominous sign. However, he’s just told me that he hasnt taken Lansoprazole for 3 days and hasn’t had diahorrea in that time, rather than daily or every other day. Obviously I’m delighted he hasn’t had diahorrea but alarm bells ring as I clearly remember the ward sister and dietician saying that it was vitally important that he took Lansoprazole every day for the rest of his life. Alan hasn’t recently complained of having reflux but I had read that one can have reflux (and the damage it causes) without being aware of it. Do you think taking Lansoprazole is very important? If it is then are there alternatives for keeping possibly unnoticed reflux in check? Maybe it’s not the Lansoprazole that’s been causing the diahorrea. Maybe the diahorrea stopping is just coincidence?

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AlisonStobart
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Have a look at the leaflet that comes with Lansoprazole and see whether diarrhoea is one of the side effects. These things can be very individual and it might be causing the problem.

Most often, though, diarrhoea can be the associated with the absence of some of the stomach acid related defences to bacteria in the gut that might cause the diarrhoea, just the thing that PPI medication like Lansoprazole is linked with because by definition they reduce stomach acid. But the effect does seem very quick for this to be the case. And stopping any PPI can often cause a 'bounce' effect of extra reflux for a couple of weeks because the chemical balance changes. For some people, perhaps 10-20%, PPI medication does not seem to work at all, or at least does not make any impact on their problems.

Silent reflux is sometimes associated with reflux affected the larynx, and it is true that not all people feel reflux has heartburn. For people with an oesophagus, this might sometimes be because, over the years, the cells have changed to protect against the pain of heartburn.

There are some people who go give up PPI medication after an oesophagectomy without any apparent ill effects.

My inclination would be, now that your husband has stopped for a few days, to wait for a couple of weeks and see whether the reflux, or the feeling of reflux, returns. If it returns, take Gaviscon Advance and see your doctor about whether an alternative PPI would make a difference. If the reflux does not return, think about checks to test how acidic the saliva is (there are chemical strips that can test for this that you can buy from a pharmacist, or from Amazon) and it may be possible to have a hydrogen breath test and/or pH acid test from the hospital to see how much acid is being refluxed.

If he has really bad, persistent diarrhoea, it might be small intestine bacterial overgrowth which might need a substantial period of special antibiotics, possibly from a gastroenterologist.

I agree that diarrhoea after this operation is much more likely to be the result of the surgery on the digestive system rather than anything more sinister.

But do take all this with a pinch of salt, because it is medically unqualified speculation!

in reply to

And perhaps I should have said that there may be specific technical reasons for your husband to continue with a PPI. There are sometimes worries that if a patient has had Barrett's oesophagus, and these lesions are still apparent in the stump of the oesophagus left behind at the surgery, there needs to be some preventive medication to stop any further problems, but this situation is very unlikely, and in any event it would be a small risk that most surgeons would discount, I think.

So it is something non-urgent to check at the next follow-up appointment.

And apologies for a couple of typos in the post above!

Npride profile image
Npride

Hi Alison, this would really be a doctor question, just ask the GP for advice. My husband could not go 1 day post surgery without Lansoprozole, in fact he frequently was prescribed 2. When taking the horse pill sized capsule was too tricky he moved onto orodispersable. But certainly for him, if he didn't take it he would be in agony all day with indigestion and the likes of that.

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