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Have barretts syndrome, hiatal hernia. Taking PPI. Can gastro reflux take place?

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Gastroenterologist, Surgical
Practicing since : 1984
Answered : 913 Questions
i have metaplasia (barretts syndrome)---also a hiatal hernia---on a ppi called zegerid---- the ppi robs body of magnesium--can you get the magnesium in the body without being robbed by the ppi---also read that grapefruit. lemons , limes are alkalined---so can they creep up as acid into the esophagus- ?turn alkaline---will gaviscon be a better substitute than a ppi??---need answer from a gastrointestinal expert--not a general dr
Posted Tue, 17 Jul 2012 in GERD
Answered by Dr. Ajit Naniksingh Kukreja 2 hours later

Thanks for posting your query

I appreciate your level of awareness

Yes PPi are known to cause reduced serum magnesium levels in some cases as early as three months of continuous use, but rest after a years use

Contradictory to this FDA warning we have seen patients going safe with use of PPi for around a decade, but that does not prove it to be safe

Grapefruit. lemons , limes - all citrous fruits because of their inherent behaviour do cause increased acid production - atleast in cases with hyperacidity

Gaviscon works good for symptomatic relief and has its own limitations in hiatus hernia

Here are few tips if you can follow :

1] Avoid spicy, fermented meals
2] Do not have heavy meals
3] Avoid smoking and alcohol
4] Wear loose clothes
5] Do not stoop
6] Do not lift heavy weights
7] Raise the head end of your bed
8] If Obese lose weight
9] If under stress - Manage stress levels by meditation and exercise

Hope I have been able to clarify your doubts
Am available for followup queries
Get Well Soon

Above answer was peer-reviewed by
Follow-up: Have barretts syndrome, hiatal hernia. Taking PPI. Can gastro reflux take place? 1 hour later
i appreciate your prompt reply but again to straighten out the grapefruit-lemon-lime issue---all health people i work with say: lemons, limes, grapefruits turn immediately to alkaline and thus not acidic--(all alkaline info indicate this ) are you saying that they are really acidic and are harming my esophagus ) if so my juicing these fruits for over 3 years may have worsened my increased metaplasia--- therefore is the statement that "as soon as they hit the stomach they turn alkaline" a falsehood (i then thinking i was helping the problem - i was really creating the problem) -if so what fruits are not acidic???-------you didnt answer if i stay on the ppi how i can get magnesium into my system as supplements wont work ( would liquid supps get there sooner) and lastly will gaviscon do the same as ppis so i dont have to inherit the ppi side effects---bottom line i want to get off the ppi but want to manage or eliminate the metaplasia----thanks again
Answered by Dr. Ajit Naniksingh Kukreja 29 minutes later

Thanks for your followup

Considering what is acidic and what is alkaline - Grapefruit is acidic and Fresh Lemon and Limes are alkaline, The best alkaline fruits will be Banana, Fresh coconut, Figs[Raw & Dried], Watermelon etc

No it is not always harmful it is subjective because of the citrus nature these fruits give a feeling of increased acidity but hopefully they do not worsen metaplasia

Magnesium supplement does not help in atleast 25% patient with depletion because of PPi , so if your serum levels show a fall it is better to stop PPi

I have mentioned earlier Gaviscon can not replace the effect PPi have on increased production on acid, Gaviscon will neutralize the existing acid only

To manage metaplasia or eliminate it needs surgical intervention

Barret's Oesophagus with or without dysplasia is being managed by ablation

But to prevent reocurrance antireflux surgery is needed

Also do not abruptly stop PPi, taper it gradually as it will lead to rebound hypersecretion

Best is follow the tips I have mentioned earlier

Hope this helps
Am available for followup queries
Wishing you healthy life ahead
Above answer was peer-reviewed by
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