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[juniper85]

Hi everyone, I have been on HRT (Evorel patches 50) and mirena coil from progesterone for about 3 years. One of the symptoms I had before starting HRT was acid reflux (as well as other peri menopause symptoms like hot flashes etc). Initially the HRT helped the acid reflux. But now it comes back a lot. I take omeprazole or esmoprazole on and off, sometimes for as long as a couple of months. I have had an endoscopy and no major issues but they said that the lower esophagus sphincter (muscle) was a bit loose. Recently after trying esmoprazole for around a month, when I came off it, I had really bad (possibly rebound) acid reflux, mainly heartburn. I know you shouldn't be on omeprazole/esmoprazole for a long time, so I am trying to wean myself off, however, how do I manage the rebound symptoms without going back on? Gaviscon Advance doesn't stop the heartburn. I have tried cutting foods, caffeine etc but it doesn't seem to make a huge difference. I'm unsure what to do now. If the acid reflex is due to hormonal imbalance, do I look to change my HRT? I am not sure I can come off completely as I am only 45, and also it was a symptom before I went on HRT too, so I may still have it. Grateful for any advice.

[CLKD]

HI - welcome.

I've been swallowing omeprazolol for several years, I am aware that Dr James on the Telegraph seems to believe that it can do more harm than good.  However it's about Quality of Life.  I have a capsule with breakfast to line the gut for the day. 

Milk of Magnesia as a top up when necessary - bounce back is awful!

I'm not on HRT other than for vaginal atrophy - do read the threads about that 1, 4warned is 4armed 

Gaviscon   

Browse round, make notes ask away.

[bombsh3ll]

 The questions to ask are what do you think is likely to happen if you take the PPI long term?

How likely do you think this outcome is ie how many tens of thousands of people have to take it for one to be harmed?

Does this concern warrant the impact on your quality of life, and potential health risks of untreated acid reflux (including ulcers and increased risk of oesophageal cancer)?

I have been on omeprazole since my twenties, including throughout two pregnancies, and if I'd known about it sooner it would be longer than that.

I personally will be on it for the rest of my life.

It is one of the medications with the best benefit vs harm ratios that I can think of. It does far more people more good overall and negligible harm compared to something like paracetamol that people pop without thinking, for minimal clinical benefits and high harms at a population level.

[Pippa52]

Raising the head of your bed 7 - 8 inches can help at night.  Small meals more often rather than 3 main ones and not eating near bedtime.  I have had reflux for years and find doing these few things does help.  Hope so much your reflux settles down for you x

[Shorty Pants]

Long term PPI usage has been shown to result in certain vitamin deficiencies, particularly B12. There's lots of info on this on a Health Unlocked Forum for the PAS. This can have serious consequences - I know first hand.

I feel your pain (literally), having been a lifelong heartburn sufferer. GPs seem oblivious that long-term PPI use is counter-indicated.

@Juniper85 it sounds like we have a similar condition. I haven't had a diagnosis but essentially it's like a mild hiatus hernia, where the valve doesn't close off to your stomach properly. this lets the contents of your stomach leak upwards, or even let the top of your stomach itself into the oesophogus.

I manage ok with just the odd gaviscon tablet nowadays after adjusting my diet to improve gut health. Basically I copied and adapted what Tim Spector at Zoe was doing without paying the extortionate fees!

I had some 'trigger' foods, which would set me off, which I now avoid or have in moderation. These aren't always the usual suspects though, as white flour, bread, pastries, particularly with sugar can be one of mine.

I massively increased my 5 a day to at least 15 and introduced pre biotics such as live yogurt and saurkraut to my diet.

The difference in weeks was amazing.  Bloating gone and reflux massively reduced.

I know everything ends up, for good or bad, being attributed to menopause nowadays, but I did once say to my GP, 'What if there's more than one thing going on?'  Mindblowing eh?!  Chances are if you had this pre menopause, it's a separate issue.

Couple of other things that help me for sleep are to either sleep on my left - the side my stomach lives on 😄 - or my back, with decent pillow support to keep your head elevated.
Hope that helps - it's a horrible condition. 

[bombsh3ll]

Whilst there will always be someone in the daily mail or internet forums extolling the dangers of a particular medication, this is invariably either a gross exaggeration or distortion of scientific data.

If the "risks" of long term PPI use outweighed the benefits, doctors would not prescribe them long term. It would contravene the Hippocratic oath.

Yet billions of people worldwide including myself take them long term with zero problems.

Vitamin deficiencies if you are concerned can be avoided by a healthy diet and/or supplementation.

What is never mentioned is the risks and suffering caused by NOT treating the condition for which the vilified medication is prescribed.

The same happened around HRT, the statistically marginal increase in breast cancer was shouted about, but the epidemic of osteoporosis, premature CVD and women's suffering without treatment didn't even get a whisper.

Severe untreated acid reflux over the long term, as well as making you miserable, can lead to oesophageal ulceration, with mediastinitis if it erodes all the way through, and also to Barrett's oesophagus and cancer.

This is not to say that everyone who goes untreated will get these, but it is always worth being in a position to make an informed choice, which includes awareness of the risks of non-treatment.

[Shorty Pants]

@bombsh3ll Please don't misunderstand me.  I fully understand the implications of long-term untreated reflux - as a sufferer, an ex nurse and also having known people who have died from oesophageal cancer.

Unfortunately, there are still some GP's out there who will dish out prescriptions and whilst there might be a need for long-term use on balance if no other solutions can be found, there should be ongoing follow ups and monitoring.

Also unfortunately, like some other drugs this can be a bit of a quick fix to get the patient out of the door when there might be more effective long-term remedies, or at least improvements to be made, such as in my case with diet regulation.

There is a lot of info out there about long-term use, although this does appear to only be something that has become more prevalent in recent years. Here's just one link from the NHS website:
https://www.nhs.uk/medicines/omeprazole/side-effects-of-omeprazole/

As you say - on balance, like most treatments, it's a matter of informed choice, which is why people need the right information.

[Ayesha]

I’ve been on Omeprazole for a few years, I tried to reduce my dose but after three months the reflux returned, I immediately asked to go back on the dose I was previously on.
I have not had any issues with it, I can now eat some of the food that I had to give up, walking round the supermarket seeing the foods I could no longer buy was to me heartbreaking, another nail in the coffin of an ageing body, so depressing.
I am very happy that I have a quality of life back and not the odd one out with the strange eating habits when out to dinner, these tablets have given me this freedom and I won’t be giving them up, no matter what the supposed side effects are, the possible consequences of not taking them can be much worse.
Again its another condition that can affect us differently, you can say what you do and eat but it will have no bearing on the next person, we have to find our own way of dealing with it and that can take a long time.

My advice has always been to take supplements when on PPI’s, I think they are important when taking this med, I take Zinc, VitD and a probiotic.

[dangermouse]

Not sure if this helps but high oestrogen can cause acid reflux. I had it in early peri very badly which I had oestrogen surges. I was put on very high dose PPIs for months as they assumed I had an ulcer. I couldn’t tolerate PPIs as the lack of acid  stopped my food from digesting and that caused gastritis from all the food stuck in my stomach regurgitating.

Any time since that I have tried oestrogen HRT, the reflux is crazy, almost making me vomit as it surges upwards and it’s as if the valve that normally keeps it down is wide open.

Even the vaginal oestrogen gave me a weird dry mouth at night and then I worked out it was the acid coming up.