PPI still working even though symptoms remain?

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melkon

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I've had constant chronic GERD for 12+ years. Was on Prilosec for 10 years and it worked great but earlier this year it stopped controlling symptoms. Since then have tried max doses of Protonix, Prevacid, and now Dexilant (used to be Kapidex). Heartburn symptoms (daily burning in chest/throat, chest/back pains) remain. Endoscopy from 6 mos. ago came up basically normal.

Two GI docs have maintained that the PPIs should still be working as they don't seem to show in studies that their effectiveness fades over time. Instead they propose that my symptoms may be due to a now hypersensitive esophagus, such that even a little bit of acid left over might be causing distress, but not likely to be causing much damage.

Still when I feel the burning on a daily basis now, I can't help but feel that my esophagus is getting beat up, and it worries me. Fears of complications that would make my already bad situation significantly worse has me rather nerve-wracked. Just wondering if anyone else is in a similar situation and what they think about it, i.e. if the PPIs are still protecting you even if they're not really controlling the symptoms very well. thanks.
 
In my opinion, yes they are still working. I had reflux that was under control with PPI's until 2008. During 2008, I spent perioRAB of time on all PPI's on the market. One gave me serious long-term side effects. I didn't really notice a lot of difference on the others. I'm currently on Dexilant. It or Prevacid Solutabs @ 80 mg. worked best for me.

I've had 3 endoscopies and pH tests over the last several years. Despite extremely severe readings on the pH testing, I have had normal endoscopies. I have acid up in my throat about 46% of the time even on PPI's and with lifestyle changes. My ENT, GI doc and PCP have said they haven't seen reflux as bad as I have. My GI doc said I appear to have a "cast iron" esophagus since he fully expected to see damage on the last EGD. I have to think the PPI's are providing some protection.

Now, if only we could find other solutions to help with the symptoms. There just isn't a cure for very weak esophageal sphincters.
 
Thanks MR for the reply (and the hug!). My endo's have shown little damage as well, and I'm not sure if that's because the PPI's are still working or if I have the lucky genetic trait of acid-resistant esophogeal lining, or maybe there just hasn't been enough time for much damage to occur.

One thing that annoys me is the second GI doc told me I should have gotten a Bravo test during my last endo. He said what I should have done was stay on the PPI's then do the Bravo test and see how much acid is still refluxing. That would indicate how much acid the PPI's are still blocking. This would have been very useful information to know. Now I just have to wait till the next one to try that I suppose. I'm getting rid of the first GI doc for that reason and a few others.

I'm still confused as to how I could have gotten such bad symptoms back if the acid is still being blocked, unless I really do have the hypersensitive nerves or whatever. I just want to go back to the way things were for so long on the Prilosec but I suppose this goes along with having long-term chronic illness. They tend to change over time so I think at this point I'm going to have to get used somehow to the "new normal". I'm sure given your situation you can unfortunately relate. Hope you're doing ok these days.
 
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