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Hello ! My name is Thiago and I started a

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Posted on Wed, 6 Feb 2019
Question: Hello !
My name is Thiago and I started a psychiatrist program with my doctor taking Frontal (Alprazolam) , SSRI serotonin reuptake , Patz Sl (Zolpidem) , since 2013.
4 years ago my stomach started burn and my psychiatrist prescrived ppi (Pantoprazole) 40 mg a day.
And after she changed to Nexium 40 mg.
1 year and a half ago my pains started to get worst.
I went to a gastroenterologist , made 2 endoscopy. And the result in all was the same : Gastritis - H. pylori-negative.
I made a lot of blood exams and was all normal.
I switched to Dexilant 60 mg during the last 1 and a half year.
But appears the medication stop working.
I still have a lot of pain ,every day.
Because I am taking Dexilant 60 in the morning. And during the day 1 or 2 gaviscon to make the pain get better.

Nowadays I am using every day.
1 pill Dexilant 60 mg /
1 pill Luvox (Fluvoxamine) 100 mg /
1 pill Frontal (Alprazolam) 1.00 mg /
1 pill Patz SL (Zolpidem) 5 mg /
My questions are :
My psychiatrist says that my stomach problems are not related with my prescribed drugs from her.
But my Gastroenterologist sayd the opposite ,these drugs can cause gastritis and heartburn.
I already read those medications can cause , gastritis,heartburn, reflux.
I have a healthy feeding.
I don’t drink alcoholic drinks.
I don’t smoke.
So ,what can I do to overcame my gastritis ?
I really appreciate an attention in my case.
Thank you !

I found these articles about the drugs that I am taking :
Selective serotonin reuptake inhibitors, or SSRIs, have also been associated with an increased risk of stomach ulcers.
Researchers believe SSRIs may increase the risk of ulcers because they deplete serotonin from platelets in the blood, in turn lowering the blood’s ability to clot.
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The benzodiazepine is usually never considered as the cause by the prescriber or by any other specialist they see. Some patients consult numerous specialists in this time, chasing their tails in search of answers to their mysterious ills, and still do not receive a proper diagnosis. After numerous tests and sometimes the passing of many years, a few lucky patients discover, usually on their own, that the long-term benzodiazepine prescription was responsible for their problems all along.
Gastrointestinal: Acid Reflux, Gastritis, Irritable Bowel Syndrome
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The widely prescribed sleep-inducing hypnotic zolpidem (Ambien®) suppressed nocturnal arousals and awakenings in response to acid reflux events and increased the duration of each esophageal acid reflux event in healthy individuals and patients with GERD.






doctor
Answered by Dr. Ashok Kumar (8 hours later)
Brief Answer:
Consultation

Detailed Answer:
Dear Thiago,
Thanks for using Healthcaremagic.

I read your query and understand your concerns about puzzling answers from different specialists.

First of all I like to inform you that both of your specialists are partially right in saying about the gastritis in your case.

Because all of the prescribed medications can cause gastritis (as mentioned even by you) which proves comment of your gastroenterologist. The other factor which proves this comment, gastritis started after starting medications which establishes temporal association.

Your psychiatrist is also correct as severe gastritis is very rare side effect in practical life. In my 15 years of practice with psychiatric medications I have seen only two patients with severe gastritis after use of SSRI and benzodiazepines (one for each).

Since it is very clear after the two endoscopy and multiple blood tests that gastritis is cause for severe heartburn following can be done.

1. Addiction of bismuth subsalicylate. This covers the gastric muclosa and protects it from harmful effect of number of medications. This can be added to give extra relief from heartburn (my first choice).

OR

2. Doubling the dose of dexilant. This is off label indication and can be tried in case there are reasons for not adding bismuth to your prescription.

OR

3. Change of current medications. This can be tried provided other two options are not feasible and there are alternative options available to treat your OCD.

I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar (18 hours later)

Thank you !
Yes , I am trying hear different oppinions.
Because my two doctors in Brazil , my
Gastroenterologist and Psychiatric are having different oppinions about this subject.
I have a few more questions :
After a take Dexilant (60 mg) 8:00 am my stomach start burning around 10:00 am / 10:30 am, before of my lunch time.
I usually eat ,get a little better but I still need to take Gaviscon.
Why I have pain after take Dexilant in so short time ?

I tryed switch Dexilant 60 %3E Nexium 40. But I returned with Dexilant because Nexium was bad too.

I am having problems to stop these medications :
Which one is worst for my stomach ?
Because I would like to stop one per time to see how my anxiety react.
Between
SSRI , Benzodiazepines , Zolpidem.
Actually I am trying to reduce/stop alprazolam.
I will talk with my doctor about your suggestion Bismuth subsalicylate.
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Follow up: Dr. Ashok Kumar (14 minutes later)
Continuing the previous question ...

Which one is worst for my stomach ?
Because I would like to stop one per time to see how my anxiety react.
Between
SSRI , Benzodiazepines , Zolpidem.
Actually I am trying to reduce/stop alprazolam.
I will talk with my doctor about your suggestions Bismuth subsalicylate
doctor
Answered by Dr. Ashok Kumar (14 hours later)
Brief Answer:
Follow up

Detailed Answer:
Dear Thiago,
Thanks for follow up.

Although it is not possible to know which is the most significant cause for the stomach burn as all three in different forms cause gastric irritation and stomach burn, but we can identify it by trying different medications in different combinations.

Since Zolpidem and SSRI cause mild to moderate irritation to gastric mucosa we need to start with alprazolam to either decrease the dose or stop it alltogether. It is also recommended that after few weeks of alprazolam prescription the dose should be reduced as soon as possible. Considering these two facts alprazolam should be tapered down under the guidance of your doctor. I must acknowledge that after six years of use it will definitely cause withdrawal symptoms and slow or very slow tapering is the only option to deal with it.

Regarding your experience of heartburn after few hours of Dexilant intake I must inform you that it indicates that there is something else other than gastritis. It is old teaching that if your PPI does not help you in two weeks look for other causes for heart burn. In addition I must share with you that PPI is not something which helps immediately. It is indicated for long term relief.

I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ashok Kumar

Psychiatrist

Practicing since :2000

Answered : 3160 Questions

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Hello ! My name is Thiago and I started a

Brief Answer: Consultation Detailed Answer: Dear Thiago, Thanks for using Healthcaremagic. I read your query and understand your concerns about puzzling answers from different specialists. First of all I like to inform you that both of your specialists are partially right in saying about the gastritis in your case. Because all of the prescribed medications can cause gastritis (as mentioned even by you) which proves comment of your gastroenterologist. The other factor which proves this comment, gastritis started after starting medications which establishes temporal association. Your psychiatrist is also correct as severe gastritis is very rare side effect in practical life. In my 15 years of practice with psychiatric medications I have seen only two patients with severe gastritis after use of SSRI and benzodiazepines (one for each). Since it is very clear after the two endoscopy and multiple blood tests that gastritis is cause for severe heartburn following can be done. 1. Addiction of bismuth subsalicylate. This covers the gastric muclosa and protects it from harmful effect of number of medications. This can be added to give extra relief from heartburn (my first choice). OR 2. Doubling the dose of dexilant. This is off label indication and can be tried in case there are reasons for not adding bismuth to your prescription. OR 3. Change of current medications. This can be tried provided other two options are not feasible and there are alternative options available to treat your OCD. I hope this helps you. Feel free to write back to me if you have more questions. Thanks and regards.