PROTON PUMP INHIBITORS

. Posted in GERD AND LPRD

PPIs are the newest and most effective medications used to treat GERD/LPRD. This class of medicines works by completely blocking the production of stomach acid. They do this by shutting down a system in the stomach known as the “proton pump.” They work best when taken 30 - 60 minutes before eating a meal that contains protein, such as meat, cheese, or fish. If you take the medicine once a day, it is important to take it 30-60 minutes before you eat your largest meal, usually dinner. If you take the medicine twice a day, take one dose 60 minutes before breakfast and one dose 60 minutes before dinner. If you do not eat dinner, take the medicine 60 minutes before lunch.

Proton pump inhibitors generally don’t cause many side effects. The most common side effects are diarrhea, a feeling of being sick, constipation, abdominal pain, and headaches. They can also cause allergic reactions, itching, dizziness, swollen ankles, muscle and joint pain, blurred vision, depression, and a dry mouth - although these reactions are rare. These medications come in OTC and prescription formulas. Some common proton pump inhibitors are rabeprazole sodium (AcipHex), esomeprazole magnesium (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), and pantoprazole sodium (Protonix).

If you are diagnosed with LPRD, the principal therapy will include a PPL Within 2-3 months of treatment, most people will report a reduction in their symptoms. After 3 months, PPI therapy can be weaned off. However, if symptoms return once off of medication, therapy can be continued indefinitely.

Robert was a 38-year-old man who came to the office complaining of waking up at night and feeling as if he were suffocating. This experience had been going on for 3 months. He had a history of some minor allergies and had sinus problems for years. Robert complained that
when his sinuses acted up, he suffered from bad sinus headaches. His wife, Constance, reported that Robert also snored and often woke up with a stiff neck. He had nasal congestion with recurrent infections and yellowish mucus, which passed back into his throat. As a result, he had a chronic cough and frequently found himself clearing his throat to get rid of the mucus. With these coughing fits, his reflux would act up. Constance told me that she could tell when Robert was getting a sinus infection because his breath smelled moldy, like a humid locker room. Furthermore, Constance could also tell when Robert’s reflux acted up because his breath got sour. In fact, she was so astute, that she was able to discern which sign was the initial trigger: She could always smell the sinus infection first, and the smell itself became sour as his reflux symptoms become worse and Robert’s voice turned hoarse.

A surgeon had told Robert that he needed sinus surgery. I decided to treat Robert with antibiotics and nasal steroid sprays first to clear up his sinus infection. I requested that he follow my GE Reflux Recommendations, and started him with a PPI.

After 3 months, Robert came back to my office. He had lost some weight and reported a considerable improvement. He noted that with the new GERD medication, he felt like a new person. His reflux rarely acted up; and when it did, it was usually when he forgot to take his medicines. Now his sinus infections are very infrequent and remarkably less severe; and when they do occur, a quick course of antibiotics usually clears them up. He likes his nasal spray and is quite compliant with his saline irrigation. Best of all, Robert was able to forego surgery by following the CAID medication regimen and GE Reflux Recommendations.

Sinus Tips:
I frequently find that my patients with GERD/LPRD often feel relief from their symptoms after sinus surgery. However, if your reflux problem is severe, or the excess acid cannot be
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