Most people think of acid reflux disease as an “old person’s” disease since it is more common in older adults. However, young and middle aged adults struggle with this disease, too. When GERD strikes early, it presents serious challenges over time due to the progressive nature of the disease. If you have had acid reflux symptoms for more than 10 years, please read this response to our member’s question.
Do you have a question? We’d love to answer it! Just submit your question using the form at the bottom of this page.
I am 36 and have been on PPIs for 14 years, but had the diagnosis 20 years ago. I had my first endoscopy 5 years ago, and the most recent test was done one year ago. At that time, I was on 20mg of omeprazole and all of a sudden it just stopped working. My GI doctor had my gallbladder removed, and since then I have been on every PPI out there. I ended up staying on Protonix, 80mg daily, until I developed heart palpations. Once I developed them, I quit taking it and now I am on Nexium 40mg daily. I do okay as long as I eat very, very bland food. But if I have 1 cookie, I pay! They are recommending fundoplication surgery, which I am not on board with yet. I am desperate for anything other then that surgery. I also forgot to mention that every test so far has been negative including the manometry. I have yet to do the PH test, which I guess is next. Any suggestions?
Thank you for your question, and I am sorry for your 20 years of struggles to manage this disease. You are not unique, but you are considered outside of the norm for individuals with GERD. According to research performed by Healthline in their article, Acid Reflux Statistics and Facts, over 50% of those diagnosed with GERD are between the ages of 45 and 64 and a significant majority are over the age of 40. With a GERD diagnosis at 16, you are certainly in the minority. You appear to have non-erosive reflux disease, or NERD, since your test results have all been negative. The standard treatment option for those with NERD are continued daily PPI medication.
You have noticed some of the side effects of these medications. Unfortunately, it is the side effects of PPIs that you don’t recognize that can be dangerous. We have mentioned these downsides often, but it is always good to summarize them again. Dr. Tom DeMeester discussed several of these in his Huffington Post article, Acid Reflux Treatment Problem: The Warning on the Pills Label Says Use for 14 Days: “The FDA warns that the long-term use of PPIs is associated with decreased calcium absorption, leading to bone fractures, decreased absorption of magnesium leading to hypomagnesaemia and heart arrhythmias, increased incidence of pneumonia, and increased incidence of Clostridium difficile infections.” In addition to the risks mentioned by Dr. DeMeester, medical research has found several additional significant side effects associated with daily long-term use of PPIs:
- A team of researchers at Houston Methodist determined that daily users of PPIs were 16% to 21% more likely to suffer a heart attack compared to others with GERD who did not use PPIs like Nexium and Prilosec.
- Research performed by the VA followed 173,321 daily PPI users and 20,270 H2 blocker users over five years. They found that those taking PPIs had a 96% higher risk of kidney failure and a 28% higher risk of developing chronic kidney disease.
- A German study with medical data on 73,679 men and women using PPIs daily found an increased risk of dementia of 53% for men and 42% for women.
Clearly, PPIs have many risks to consider, and unless they are absolutely necessary, they should only be used for a short term or intermittently.
What can be done to combat your symptoms of acid reflux?
First, if you decide to stop using PPIs on a daily basis, be sure to discuss your decision with your doctor and include your specialist as you design a step down program. Second, you should consider a more comprehensive approach to symptom management including:
- Maintain a healthy BMI. The number one recommendation for most overweight or obese adults with GERD is to reduce their BMI to 24 or less. For anyone who is excessively overweight or obese, it is doubtful that any of the following recommendations will provide adequate relief. We recommend a GERD-friendly weight loss program, and we hope you will consider Scale Down for Relief.
- Adopt a GERD-friendly diet. There are many elements to a daily meal plan and GERD-friendly diet program like those contained in Recipe for Relief. Diet changes are typically at the top of all GERD experts’ recommendations, and they have been very effective for many suffering from acid reflux.
- Make the necessary lifestyle changes. There are many lifestyle choices that can have a positive impact on your acid reflux symptoms. These ranging from when you eat, how often you eat, how much you eat, raising the headboard of your bed, drinking alkaline water, trying several home remedies, eliminating alcohol, and smoking cessation to name a few.
- Utilize less powerful antireflux medications. Research has not found any issues with long-term daily use of H2 blockers and antacids. We recommend using the least powerful antireflux medications as infrequently as necessary to manage your symptoms to your satisfaction.
Antireflux surgery is certainly a big decision, and we understand your hesitancy to take that step. However, GERD and LPR are a result of one primary problem: a weak or damaged lower esophageal sphincter (LES). This is a physical and structural problem that can only be fixed with surgery. The most recent advancement in antireflux surgery, the LINX procedure, is reporting very good results, and it is reversible. All the other treatment recommendations, including daily PPI medication, only mask the symptoms of GERD, but they do not stop the reflux. Although it appears that you have non-erosive GERD, continued bathing of the esophagus with the contents of stomach acid (which may include bile and pepsin) can result in disease progression over time.
We hope that you will design and adopt a comprehensive plan to find relief and good health. If you follow the process noted above, your symptoms may subside or even disappear. However, if these steps do not resolve your symptoms, you should consider surgical alternatives. If you do, we would be happy to assist you to find a GERD expert that is experienced in antireflux surgery. Get started today – you can do this!