When to take PPI

[Rachel357]

Hi, I am being prescribed Omeprazole for a possible ulcer and gastritis which I've had since last April after taking ibuprofen for a couple of days. So far I have been treating it with Biocare Slippery Elm Plus and homeopathic remedies, but it has recently got worse. My doctor has been unable to prescribe any H2 blockers, so I'm going to have to take Omeprazole which I'm very nervous about. I take Metavive first thing in the morning and at about 2pm. Please can anyone advise on the best time I should take the Omeprazole? Thank you.

[humanbean]

If you take Metavive for your thyroid I would suggest taking the Omeprazole 4 - 6 hours later.

I'm a bit dubious that taking ibuprofen for a couple of days could have caused ulcers and gastritis, there must have been something unhealthy going on in your gut before then and the ibuprofen made it worse. Yes, I would agree that taking NSAIDs like ibuprofen can cause gut damage but it would take longer than a couple of days.

Have you been tested for Helicobacter Pylori? If you haven't you should ask for a test.

en.wikipedia.org/wiki/Helic...

Has your doctor referred you for an endoscopy? It would be a good idea if he/she did so, so that you and the doctors know what is being treated with the PPIs, but in these penny-pinching days I wonder if the doctor would agree to it.

Bear in mind that a standard endoscopy via the mouth rarely looks beyond the duodenum.

One thing you could ask for that looks at a lot more is a capsule endoscopy.

en.wikipedia.org/wiki/Capsu...

I tried getting one, but not all hospitals offer them, and I couldn't afford to go private.

...

Try to avoid getting trapped on PPIs. They are hellish things to come off of. The body reacts to having no stomach acid by trying to create more... and more... and more... So people find their original symptoms are much, much worse when they stop the PPIs. When it comes time for you to come off them your Slippery Elm should help. Marshmallow Root is supposed to help too, although I've never tried that myself.

Do some research into "PPI withdrawal".

Unfortunately, for some people there is no choice but to take PPIs. But in doing so they reduce their absorption of nutrients. There are other serious side effects too :

en.wikipedia.org/wiki/Proto...

[Rachel357 in reply to humanbean]

Thank you for the information. I have had digestive issues for a few years before taking the ibuprofen. During the past year this had got worse, where it got to the point where I was becoming increasingly more sensitive to different food. I've never had a problem with digesting meat though, it was more plant based food, especially high fodmap foods.

The ulcer or damaged part of the lining is in my lower abdomen. My GP did recommend an endoscopy but the consultant in the hospital suggested an ultrasound instead due to the position of the pain. Nothing was found on the ultrasound, except for my stomach is a bit inflamed. I really don't want to have an endoscopy as I'm worried that it could cause more problems, but I will suggest the capsule endoscopy to my GP.

I have been tested for the H.Pylori bacteria and that came back clear.

I did want to try chinese medicine before trying conventional medicine, but the pain in my abdomen has got worse over the past week (due to moving house etc) so I'm worried about leaving it any longer in case it is an ulcer.

[humanbean in reply to Rachel357]

I've never had a problem with digesting meat though, it was more plant based food, especially high fodmap foods.

Unfortunately, taking PPIs may create problems you haven't had before. It might not develop obviously or quickly - but it is a fairly well-known side effect of PPIs.

What is so horrible and annoying about gastro-intestinal problems is that doctors jump to conclusions about them - and the patient - and act on them as if their guesses must be right. Getting the appropriate testing, rather than the most convenient and cheapest testing, can be very, very hard.

[Rachel357 in reply to humanbean]

Yes I've been worried that taking a PPI will cause more digestive issues and possibly a bacterial overgrowth. I really don't know what to do. If I do take the omeprazole, I don't plan on taking it for more than 2 months, then I will slowly wean myself off it. Do you know if H2 blockers also cause digestive issues to get worse?

[humanbean in reply to Rachel357]

H2 blockers reduce stomach acid just like PPIs do but the biological mechanism by which this reduction happens is different.

I can only comment from my own experience (having taken both) that with H2 blockers the reduction in stomach acid is not so great as it is with PPIs.

Sticking with the PPIs for a maximum of 8 weeks to give the problem in your gut time to heal is a good idea. But (my personal opinion) if for any reason you need to stay on something long term I would suggest you consider trying H2 blockers if you can. I admit it is a really poor solution to your problems - but desperate times may require desperate measures.

A series of six articles you may find helpful... They are quite long but they do explain how some of the most common causes of gut problems arise (I don't think they mention the thyroid though) and how they leave us suffering, often for many years, and possibly for life.

chriskresser.com/what-every...

chriskresser.com/the-hidden...

chriskresser.com/more-evide...

chriskresser.com/how-your-a...

chriskresser.com/how-your-a...

chriskresser.com/get-rid-of...

[humanbean]

I can no longer find ranitidine in the shops. Can you tell me where you've seen it available? I was prescribed it until about 3 months ago and it is no longer available for prescription because of the FDA warning that it contains a carcinogenic impurity.

I think there is an intention to bring it back... But goodness knows when that will be. It could take months or years before the FDA approves it again, and no doubt the UK will follow what the FDA does.

[Rachel357 in reply to humanbean]

When I went to pick up my prescription for the Omeprazole at a Boots pharmacy, I asked if they had any H2 blockers and they had Ranitidine 150mg! But it was prescription only. I'm going to try and get my GP to prescribe it for me and take that instead.

[Alanna012 in reply to Rachel357]

Ranitidine is available over the counter still, but not as Zantac which is the main product name, a bit like how Neurofen is the main branded product for ibuprofen. Zantac is recalled (although some pharmacists are still selling their old stock which they shouldn't.)

I brought own branded ranitidine with no issues from Lloyds pharmacy about a month ago.

Another H" blocker alternative I've heard is good is Nexium. Some people prefer this to anything else. Nexium is still available.

I agree that a H2 blocker paired with something like Rennie occasionally is a slightly better bet for longer term use. You don't have to take everyday either once symptoms are under control. It works by reducing a certain type of histamine.

But in the short term if you have damage to your oesophagus then you need to take the PPI. It's important to prevent Barratts oseophagus.

[humanbean in reply to Rachel357]

I think you should try the PPIs for 4 - 8 weeks. Having zero stomach acid can be helpful in healing an ulcer or gastritis in the short term.

It is long term use of PPIs that causes problems. If your ulcer and/or gastritis hasn't healed after 8 weeks then I'm not sure what your best options are at that stage.

When you come off the PPIs be prepared with your Slippery Elm Plus supplement to help with the rebound acid secretion.

[Rachel357 in reply to humanbean]

Thanks. I will try the PPI first and will only get the ranitidine if the PPI doesn't work well for me.

[humanbean in reply to Rachel357]

You might find this protocol for coming off PPIs helpful if you have problems :

howtotreatheartburn.com/how...

[Rachel357 in reply to humanbean]

Hi, I have been taking Ranitidine for the past two weeks and it seems to be affecting my thyroid. The same thing happened with the PPI which I was taking prior to this. I'm taking the Ranitidine four hours after the Metavive in the morning and I'm taking it again in the evening (about six hours after my afternoon Metavive dose). Is this normal for this to happen? I have increased my Metavive dose and it looks like I will have to increase it again soon. I still find I get a pain in my abdomen when I'm hungry so I'm not sure if it's really working for me. It was worse when I was taking the PPI though.

[humanbean in reply to Rachel357]

The ranitidine could be reducing your absorption of your thyroid meds or reducing your absorption of your food and nutrients or both.

It must be very frustrating for you because as far as I can tell from your posts in this thread the prescription of these drugs (the PPI and ranitidine) has all been based on guesswork about what is actually being treated. I am really not impressed that you were given an ultrasound instead of something that could actually find the area of damage directly and see what the problem actually is.

Do you have a history of abdominal surgery for any reason? If you have then you might be suffering from adhesions that are tugging on structures within the abdomen - muscles, nerves, blood vessels, the intestines, bowel, uterus, ovaries etc. Unfortunately, most doctors in my experience don't "believe in" adhesions and dismiss them as not a problem.

I took ranitidine for several years until recently when I had to switch to lansoprazole, and although I wasn't happy about taking them I did okay on them with the addition of a very occasional antacid. (I take an NSAID for chronic pain and the drug can cause damage to the stomach lining.) I have started to get more indigestion and gut pain too, and I also feel much more exhausted than I used to despite nothing else in my life changing either in terms of diet or supplements or other meds.

Did you ever read that list of six links from Chris Kresser that I posted earlier in this thread? I found it helpful because it helped me to understand the biology behind what goes wrong with low stomach acid and how the solutions people use are not good for the gut.

Sorry, I'm waffling. I'm afraid I can't think of anything more that you can do unless you actually find out what your problem actually is and what you are trying to treat. And if the problem is in your intestines or somewhere that can't be reached with a standard endoscopy then I don't know how the medical profession will deal with the issue. You could push for a capsule endoscopy - but first you'd need to find hospitals in your area which actually offered them. I know my local hospital doesn't, and I was shocked to find out that my GP had never even heard of them even though they aren't particularly new technology.

Has anyone suggested diverticulitis or diverticulosis as a possible diagnosis? I have never been diagnosed with this myself, so I don't know anything about the standard treatment for it or whether that standard treatment actually cures anything or, like a lot of medical treatment nowadays, is just a sticking plaster over a problem that never fixes anything.

[Rachel357 in reply to humanbean]

Thank you for your reply. No I've not had any abdominal surgery before. Yes it's very frustrating with not knowing whether it's an ulcer or gastritis. If it was gastritis I would try diluted ACV in water, but I can't try that in case it's an ulcer. The day after I first got the pain I did try ACV in water after breakfast and the pain went away but I'm not sure if that was related to having eaten something or the camomile tea which I also had. I should have tried it again but I felt too worried to. It has got a lot worse since then and as it's a localised pain and it hurts when I press on that area, especially lying on the side where it is, makes me think it might be an ulcer. The pain is mostly on the right of my belly button and I get a pain there when I'm hungry and also if I eat something acidic or high in fat or salt. I had an ultrasound in case it was my ovaries or gallbladder but these were ok. I've also had a blood test and there was nothing abnormal there.

I have read the Chris Kresser articles you posted thank you. Yes I found it interesting too. I wish I could try some of the things he recommends. I'm going to enquire about a capsule endoscopy when I next speak to my GP, but I don't think they do them at my local hospital (Exeter).

[humanbean]

Do a search for "ranitidine recall" to find out more info on the subject.

[humanbean]

I think it is. But I've never taken that myself.

[Rachel357]

Thanks. I think I will ask about H2 blockers at the chemist when I pick up my prescription.

[salmanc1]

Hi Rachel

I don’t have a thyroid and found acid and gastritis issues flaring up regularly.

What helped me was :

Eating no later than 7pm everyday

On empty stomach slightly warmer water not cold

Having Mastica Gum before bed

Eating a good mixed plate of fresh salad at least every other day with meals (prebiotic)

No milk

No bread

Eat smaller meals

When hungry get healthy snacks - almonds nuts banana

Very rarely omeperazole

Have one big spoon of biopot yoghurt - probiotic

Reduce stress in your life - gastritis runs on stress aswell - morning yoga YouTube video helps

Deep breathing excercises such as Wim Hof method

Don’t sleep really late - get your sleep hygiene correct

MAKE SURE WATER intake is correct aswell with all this

Get your thyroid a little more balanced as per the advice on this forum from many others - blood tests etc

I did this for around 6 months and my symptoms reduced by around 70% making it manageable.

Needs a bit of discipline but now I can have milk sometimes and other foods with no issue - gut has repaired mostly.

[Rachel357 in reply to salmanc1]

Thank you