Why am I getting heartburn on top of ibs?

[JulieB5200]

Hi everyone,so I have lived with ibs constipation for years .About 18 months ago I started having a different pain under my left ribs.The doctor suspected it was a stomach issue and in February this year I had an endoscopy which surprisingly came back normal.The consultant said he thought the pain was ibs related which I find odd considering it’s a new pain!Anyway I decided to stop omeprazole seing as I appeared not to have a stomach problem.Plus I think this medication makes my constipation worse. I haven’t noticed any big change since stopping it (apart from 3 weeks of a very acidic stomach which apparently is normal.)However this past week I am having recurring heartburn virtually after every meal. I have suffered a great deal of pain over the years but never heartburn!So now I totally baffled as to why this is happening 🤔.Does anyone else suffer with heartburn on top of their ibs and if so what do you take for it?

[Maureen1958]

Hi, after many years of IBS, when I spent most of my time in the toilet, I have come to the conclusion that if you have IBS (D), all the pain is usually below the waist. But if you start to get constipation, which is quite common as you get older, then you start to have indigestion problems up the top as well. This is what I have experienced anyway. As you have always had constipation, perhaps your constipation has got worse and this is what's causing your problems up the top end?!

[JulieB5200 in reply to Maureen1958]

This makes sense Maureen,thank you so much xx

[Hidden]

Hi there omeprazole does cause constipation , if your blocked one end it causes problems higher up , I get pain under left rib prob trapped wind x

[Fencinggirl]

Hi Julie, yes I suffer from IBS C and I also have upper gut issues. Like you, it began with pain under my left ribs. I don't exactly have heartburn though, these days my pain is often in the space between my bellybutton and my ribs. I think in my case it is non-ulcer dyspepsia (also called functional dyspepsia) This is apparently quite common in IBS sufferers.

On the heartburn side, if you can't take PPI's you could try something like silocolgel, which has helped me in the past when I have had heartburn. Other people have tried things like liquorish, slippery elm and Aloe Vera gel with some success (although with the latter you have to make sure it is the type that is fit for human consumption). Kefir also seemed to help my mum when she suffered from HB, so that is an option.

If the above doesn't work, or you don't fancy trying those options, you could also go back to your doctor and ask for an alternative to the PPI you were on. Omeprazole is the most common PPI, but a lot of people can't get on with it, so going with another brand might work for you. You can also ask about H2 blockers which also lowers your stomach acid, but works in a different way to PPIs. I'm not sure how easy it is to get a prescription for these as they don't tend to be discussed very often, but they are mentioned on the NHS website.

Good luck!

[JulieB5200 in reply to Fencinggirl]

Thank you so much for your wise advice xx

[xjrs]

I agree with Maureen1958 . The more constipated I am, the more likely I am going to get acid reflux. Since treating constipation and getting things moving, the reflux tends to improve. If you are highly constipated having food sitting around in your system longer for bacteria to feed off of them is likely to produce more gases which puts pressure in your system weaking the valve that sits between your stomach & throat allowing acids to flow back. Plus if food is a bit backed up, your stomach may take longer to empty increasing the chance of reflux.

In addition to trying to improve your IBS-C if this is a problem, you could try DGL licorice (not straight licorice since this increases blood pressure), suck 1 tablet 20 mins before meals and at bed time. This can take months to start to work, but the idea is that it coats your throat making it more tolerant to acids. Also you could raise the head of your bed by 20 cm using plastic bed risers found on the internet helping to keep contents there.

Having acid reflux long term can cause complications, so if it continues to persist you'll need your doctor to help you bring it under control. I used to take Nexium (esomeprazole) when I had a permanent sore chest from reflux to help heal it - it was the one that gave me least side effects, though I did get a rash from it after 6 months so I had to come off of it.

In the mean time, it can be best to try other measures so you don't need PPIs such as a high fibre FODMAP elimination & reintroduction diet via a GP referral to a dietitian to see if there are specific foods that make your reflux worse. Although not related to FODMAPs, chocolate, mint, high fat foods, coffee, citrus fruits, tomatoes and carbonated beverages can make reflux worse. I even go as far as using a fennel instead of mint based toothpaste, since sometimes even the aroma of mint can weaken the valve between the stomach and throat. Some people with hiatal hernia get reflux and may need to be on PPIs long term for it, but the fact you've had an endoscopy and they didn't mention it means that this may not be true in your case.

[JulieB5200 in reply to xjrs]

Thank you for your advice,what you say makes a lot of sense 👍. I think it maybe evening primrose oil that’s caused my heartburn.I have only been taking it around a week n it’s since then the heartburn has occurred.So today I haven’t taken it and so far so good.Hoping it was just that as I have enough issues without another pain to deal with!😊

[xjrs in reply to JulieB5200]

When symptoms change it's always a good idea to look at what about your diet, supplements or lifestyle have changed to coincide with the change in symptoms. Well done for spotting that!

[3443Ness]

Hi I have IBS D and also suffer with acid reflux and heartburn I was prescribed Lansoprazole and I also take Rennie's when needed it's not pleasant having heartburn or acid reflux on top of IBS it's a living nightmare. Hope yours settles soon

[JulieB5200 in reply to 3443Ness]

Thank you Ness, I know I thought oh no not more pain issues!! I have a feeling taking evening primrose oil could have caused it so today I’ve stopped taking it.Hopefully it’ll go away now. I live on rennies though!x

[3443Ness in reply to JulieB5200]

Hope it settles down soon x

[Luisa22]

I have a theory based on my own experiences, but just look at it as "my theory" and don't take it as gospel. I didn't run anything past my doctor.

I'll just say what happened to me.

I have mainly IBS-D. But I suspect it might be IBS alternating to some extent, though predominantly D. It started about 2018 then died down, seemed to disappear, but came back 3 years ago and apart from some remission times, hasn't gone away since.

I'd never had heartburn/GERD/acid reflux ever in my life. In December 2020 I suddenly got acid reflux. I noticed at the same time my loose stools improved! I was having normal bms, and occasional mild constipation.

At times the acid reflux was bad, the lower gut behaved perfectly. At times the acid reflux was a little bit easier, the gut was looser, and vice versa.

When the acid reflux suddenly disappeared (April 2021), the loose guts came back.

So what I think was happening was a motility problem. Things were speeding up and slowing down in my GI system.

This makes sense as all the stool tests I've had show no inflammation, infection etc.

When things slowed down I got heartburn. I think that was caused by slower gastric emptying. But at the same time food went through intestines and colon slower too, and absorbed more water (thus normal bms).

When things speeded up, stomach was fine again but food went through me too fast to absorb enough water (loose bms).

I haven't so far been able to fix this random speeding up and slowing down thing, but it hasn't slowed down enough since last year to start the upper stomach problem off again (yet)

[JulieB5200 in reply to Luisa22]

This is very interesting to read because the past few years I have started having a lot of stomach pain.It definitely goes hand in hand with my constipation. I get a burning pain in my stomach which sometimes radiates up my chest into my throat and neck,Strangely my endoscopy showed up no stomach problems.The consultant put all the pain down to constipation and ibs. I really would like to understand what’s taking place in my gut but no one seems to be able to explain it.My gp has just prescribed esomeprazope to reduce stomach acid yet the hospital say I don’t need it 🤪

[Luisa22]

I shouldn't really say things like this because I am not a doctor. But I feel those PPIs are given out like sweets and many times a problem isn't too much stomach acid at all, but a motility problem connected to ibs. And sometimes indigestion-like sensations can be caused by too LOW stomach acid. Not enough acid to digest properly. H Pylori is a risk from lowering stomach acid too much, so is sibo. And other gut infections.

I was a bit shocked to hear that my Aunt's doctor put her on PPIs. I asked if she had heartburn or reflux for him to do that, and she said no, that she'd never had stomach problems of any kind! He told her it was "just to prevent her getting indigestion". That makes no sense to me.

[JulieB5200 in reply to Luisa22]

Yes they do seem to be dished out like sweets which isn’t good at all.My dad has them for hiatus hernia but my mum was on them before she died for indigestion.My endoscopy showed up fundal polyps which apparently aren’t a cause for concern.However I googled and they can be caused by having ppi’s for long periods of time. I am currently weaning myself off them as I feel it’s wise but if you go cold turkey you can experience acid overflow. I guess your gut gets used to them and doesn’t know how to act without them!