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I Have Been Taking 20 Mg Esomeprazole For 5 Years
Question: I have been taking 20 mg esomeprazole for 5 years and have been experiencing a persistent burning sensation over the past 4 days. The sensation is usually removed with Gavascon Advance but is unusually persistent as I seldom feel heartburn. I also have a history of occasional esophageal spasms in the back and retosternum. I had esophagitis before starting esomeprazole that resolved. My last egd(Feb 2018) showed irregular z line and my gi doc said I had ultra short segment BE and wants to follow up with egd @ 3 yrs. I’ m concerned about these new symptoms as being suggestive of malignancy. Or is it more suggestive of the progressive nature of gerd? Does this new onset of heartburn suggest malignancy? Also I am concerned about vivid if they do an egd. I’m a Caucasian 68 yr old male in otherwise good health.
Concern about covid(misspelled)
Thank you!
Thank you!
Brief Answer:
Kindly go through detailed answer.
Detailed Answer:
Hello and thank you for your query my dear patient,
Have gone through your query and I appreciate your details,
Firstly life time of Esomeprazole is 12 hours and is therefore always used in two times a day doses.
Secondly 20 mg a day is a pediatric dose(It's good that your symptoms responded to suboptimal doses). Minimal adult dose per day starts with 40 mg sir and ideal adult dose per day is 40mg twice daily.
GERD consists of two parts as the name suggests Gastro-esophageal refux disease.
So ideal treatment of GERD is-
1)Prevent excessive secretion of acid- Done by Proton pump inhibitors like Esomeprazole.
2)Prevent regurgitation of acid back into espophagus- Done by Prokinetic medicines like Domperidon.
Therefore ideal treatment as per books for a patient of GERD is a combination of both of them.
Yes Endoscopy should be done every five years but at present I would suggest you to avoid any hospital/Un necessary intervention.
Just increase the dose of Esomeprazole to 20 mg twice daily or 40 mg in morning and 20 mg in evening.
Take a cup of ice cold milk in morning and evening(Avoid it if you live at cold place).
Revert back how you feel after 3 days sir.
Cancer and all presents with severe symptoms and usually don't respond to medications easily.
Don't worry too much.
Just follow what I suggested.
Avoid any hospital visit or unnecessary tests.
Revert back after 3 days.
40 mg in morning(2 tablets) and 20 mg in evening.
Regards and feel free to follow up.
I am not suggesting you Domperidon as it's a prescription medicine.
Thank you!
Kindly go through detailed answer.
Detailed Answer:
Hello and thank you for your query my dear patient,
Have gone through your query and I appreciate your details,
Firstly life time of Esomeprazole is 12 hours and is therefore always used in two times a day doses.
Secondly 20 mg a day is a pediatric dose(It's good that your symptoms responded to suboptimal doses). Minimal adult dose per day starts with 40 mg sir and ideal adult dose per day is 40mg twice daily.
GERD consists of two parts as the name suggests Gastro-esophageal refux disease.
So ideal treatment of GERD is-
1)Prevent excessive secretion of acid- Done by Proton pump inhibitors like Esomeprazole.
2)Prevent regurgitation of acid back into espophagus- Done by Prokinetic medicines like Domperidon.
Therefore ideal treatment as per books for a patient of GERD is a combination of both of them.
Yes Endoscopy should be done every five years but at present I would suggest you to avoid any hospital/Un necessary intervention.
Just increase the dose of Esomeprazole to 20 mg twice daily or 40 mg in morning and 20 mg in evening.
Take a cup of ice cold milk in morning and evening(Avoid it if you live at cold place).
Revert back how you feel after 3 days sir.
Cancer and all presents with severe symptoms and usually don't respond to medications easily.
Don't worry too much.
Just follow what I suggested.
Avoid any hospital visit or unnecessary tests.
Revert back after 3 days.
40 mg in morning(2 tablets) and 20 mg in evening.
Regards and feel free to follow up.
I am not suggesting you Domperidon as it's a prescription medicine.
Thank you!
Above answer was peer-reviewed by :
Dr. Prasad
Thank you! So recent increase in heartburn is not worrisome and risk of cancer is low this long(2.3 yrs) after egd?
Brief Answer:
Esophageal cancer is a rare thing dear. Try meds for 3 days.
Detailed Answer:
Hello again my dear,
The first clinical catch of any cancer is that it does not respond well to medications.
Now days we have modern machines but in 70's and 80's Endoscopy was not done for every thing so clinical presentation as well as response of patient to medicines was also a criteria at that time(Young doctor don't pay much heed to these).
As per the experience of this old man I know that it's not cancer.
Symptoms of carcinoma don't respond to conservative treatment usually.
Therefore as covid crisis is going on I would like to keep you away from hospital.
Just take the doses suggested above if things keep on worsening go for endoscopy to rule out cancer however if you respond to increase in doses forget it you don't have cancer.
Even 40 mg in morning and 20 in evening is not optimal dose.
Minimum ideal dose in patient of GERD has to be 40-40mg and could be raised to 80-80 mg.
Esophageal cancers are rare and generally symptoms like dysphagia,Chocking,Feeling of food in esophagus etc are presenting symptoms.
Chronic uncontrolled GERD for many years may cause Achalasia cardiac a condition in which type of cell changes in esophagus which may cause cancer(Adenocarcinoma in 10% patients ) but as said earlier just increase in heartburn etc at pediatric doses of Esomeprazole is not an indication of Endoscopy.
First increase the dose and follow up after 3-5 days my dear.
Hope I was easy to understand.
Follow ups are welcome.
Thank you!
Esophageal cancer is a rare thing dear. Try meds for 3 days.
Detailed Answer:
Hello again my dear,
The first clinical catch of any cancer is that it does not respond well to medications.
Now days we have modern machines but in 70's and 80's Endoscopy was not done for every thing so clinical presentation as well as response of patient to medicines was also a criteria at that time(Young doctor don't pay much heed to these).
As per the experience of this old man I know that it's not cancer.
Symptoms of carcinoma don't respond to conservative treatment usually.
Therefore as covid crisis is going on I would like to keep you away from hospital.
Just take the doses suggested above if things keep on worsening go for endoscopy to rule out cancer however if you respond to increase in doses forget it you don't have cancer.
Even 40 mg in morning and 20 in evening is not optimal dose.
Minimum ideal dose in patient of GERD has to be 40-40mg and could be raised to 80-80 mg.
Esophageal cancers are rare and generally symptoms like dysphagia,Chocking,Feeling of food in esophagus etc are presenting symptoms.
Chronic uncontrolled GERD for many years may cause Achalasia cardiac a condition in which type of cell changes in esophagus which may cause cancer(Adenocarcinoma in 10% patients ) but as said earlier just increase in heartburn etc at pediatric doses of Esomeprazole is not an indication of Endoscopy.
First increase the dose and follow up after 3-5 days my dear.
Hope I was easy to understand.
Follow ups are welcome.
Thank you!
Above answer was peer-reviewed by :
Dr. Prasad
Brief Answer:
Follow up.
Detailed Answer:
Hi again,
Yes they do flare up...However it's usually related more to sudden food change(Diet change) or Medicine tolerance then age.
Age may be a factor but not a major one.
Thanks.
Follow up.
Detailed Answer:
Hi again,
Yes they do flare up...However it's usually related more to sudden food change(Diet change) or Medicine tolerance then age.
Age may be a factor but not a major one.
Thanks.
Above answer was peer-reviewed by :
Dr. Raju A.T
Does gerd sometimes flare-up and does it often get worse as we age?
Brief Answer:
Thanks.
Detailed Answer:
Your welcome,
Hope u get well soon,
Do rate the answer.
Thank you!
Thanks.
Detailed Answer:
Your welcome,
Hope u get well soon,
Do rate the answer.
Thank you!
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you again for your detailed and timely answer.I wish you the best!
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