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Dr. Andrew Rynne

Family Physician

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Suggest medication for gastric problems

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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 2853 Questions

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Posted on Wed, 15 Mar 2017 in Medicines and Side Effects
Question: I have read that PPI's are not the best way forward to treat gastric problems. Would you recomend i take probiotics instead and perhaps l-glutamine powder?

You advided me to take ppi's but ive read up a lot of literature that says ppi's only do more damage than good in the long term. Ive been advised by a nutritionalist to try probiotic capsules and l-glutamine in my case. What are your views on these recomendations?
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 52 minutes later
Brief Answer:
Information

Detailed Answer:
Hello,

I agree that PPIs should not be used as freely as they are commonly prescribed these days. They do have risks (including cardiac risks for some people), and they are known to cause rebound hyperacidity when discontinued. So people end up somewhat hooked on them sometimes due to that rebound hyperacidity effect.

However, prescription strength PPIs used for a given duration can be the best treatment for peptic ulcers and severe gastritis and esophagitis.

Depending on what symptoms you are having, you may benefit from a probiotic, particularly if you are having lower gastrointestinal symptoms (cramping, loose stools, constipation,gas,etc). Sometimes probiotics can help upper digestive symptoms too. I don't think a probiotic would hurt.

Regarding L-glutamine, there isn't much research to support it's use here.

If you are having continued sore stomach symptoms, rather than a PPI, I recommend an H2 blocker such as ranitidine (Zantac). These are much safer than PPIs, and don't have the rebound effect. Zantac can cut down on stomach acid production by 70% which helps the stomach, duodenal, and esophageal linings to heal while still allowing enough acid for digestion. Usual dose is 150 mg twice a day. As your symptoms have been going on for a month, you may need to use it for several weeks. But you will know within a few days that it is working for you.

If the ranitidine does not do enough, then it is time to see your doctor. Also, if you have black tarry stools, bloody stools, or coffee ground appearing vomiting.

Do not use NSAIDs (ibuprofen, naproxen, aspirin) as these can compound the situation. Also avoid caffeine, but caffeine is not as big of an issue as NSAIDs are.

I hope this information helps. Please let me know if I can provide further information.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Bonnie Berger-Durnbaugh 12 hours later
Than you so much Dr. Your answer sounds very very helpful. So i wont take the l glutamine for now. Will continue on the pro biotics capsules and will try rantidine for a while and see if it works for me. I was trying Rennie but it seemed to make the pain in my upper stomach (like the liver area) more severe so i stopped taking them. Thats when i read up on PPi's. (I do have a cardiac disease, mitral valve disease hence my fears to take these)

I greatly appreciate your advice
Thank you
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 12 hours later
Brief Answer:
Information (and good luck to you!)

Detailed Answer:
Hi - Sorry to get back to you so late.

I looked up Rennie (was not familiar with it - I don't think it is sold under this name in the US) and it is calcium carbonate which is an acid neutralizer. This is ok for mild acid upset, but not too helpful for ongoing problems that require healing. They don't decrease acid production, just neutralize some of it. And for some people calcium can be a bit irritating.

About the L-glutamine: as I mentioned there isn't research to say that physicians should advise taking it for gastritis/duodenitis problems. However, there are some early studies suggesting it may help in cases where there is gastric ulcer caused by helicobacter pylori. Again, though, I wouldn't know how much of it you would take. So if the other suggestions aren't helping, try a low dose supplement. But it is probably best to try one thing (addition of ranitidine) at a time so that you can see how things work for you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 33 hours later
Thank you.
Please can you advise me how often i should take the ranitidine? Because i believe that it can take upto a month (as i my case since i have had this problem for a few weeks alrady) does it mean i shoukd take it after meals regardless if the pain is there or not? Or should i take it at the onset of the start of the pains. The pains seem to be (over the last three days) a daily event especially at night time. But on all three occasions they occired after a light supper (7:30 pm) having eaten my dinner already at about 4:30/5:00pm. Maybe i should exclude eating a supper altogether, would you advice?
Regards
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 39 minutes later
Brief Answer:
Information

Detailed Answer:
Hi -

It's not uncommon when people have gastritis or duodenitis for there to be more pain in the evening, after eating.

As your pain has been going on for around a month, with daily pain for a few days now, I recommend you take the ranitidine on a scheduled basis, every day. This will allow the lining to heal. If you don't notice some benefit after several days of this, then the problem may be something else, but it sounds, from your symptoms, like some degree of gastric, esophageal, or duodenal irritation. It's recommended to take the ranitidine for 4-6 weeks. You may be better before that though.

You can take the medicine at any time of day. Some people take both doses at bedtime. I think it may be better for you to take one of the two daily doses around 30 - 60 minutes before eating dinner. Then you will be in better shape for your supper and the aftermath of that.

I am wondering if the evening irritation after supper is from your stomach being irritated with having more food in it (since you ate dinner and then supper). I don't know how big your dinner is; in the US that is typically the largest meal. I am not saying that you are eating too much. Rather I am thinking it just might be setting off irritation that has been building up all day.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 4 hours later
Thank you Dr. I shall continue now to take the ranitidine twice daily. With regards to the dinner and supper. Because of the nature of my problem i eat a small ceareal bowl of pasta for dinner (it seems to be the only food that my stomavh can tolerate at the moment) and then abpt two hours or so later i have a tiny bowl of alpen (museli) for supper. This is just so that i can take my probiotic capsule which must be taken with food. I take one capsule after brakfast and one after supper to help with my bed time. However it seems like either the extra meal or the extra probiotic which may be causing the night time discomfort. I have now stopped all other things even probiotics and will only take the zantac and see what happen. Thank you for your advice
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 10 hours later
Brief Answer:
Good plan.

Detailed Answer:
This sounds like a good plan.

Let me know how it goes, please.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 11 hours later
Hello again dr., i had another very bad night even with zantac alone. I do know that i must give it time to work but i cannot endue the pain even to allow time to do its work. So ive switched to omeprazole 20mg this morning first thing and shall see. So far breakfast is sitting well with me after the PPI intake this morning.

But just one more word of advice please. If during the day after luch perhaps should the pain come on again is it safe or wise to take some gaviscone advance whilst taking the ppi also? I believe its not a good idea to do so but your advice would be greatly appreciated. Thanking you again
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 3 hours later
Brief Answer:
Antacid and PPI are compatible.

Detailed Answer:
Hello,

I am sorry your pain was so bad. Yes, you can take both omeprazole and an antacid (Gaviscon). They are compatible.

But I am concerned about the intensity of your pain. If the pain is getting worse, and the omeprazole is not helping enough, it is time to go in to be seen. You may need an upper endoscopy to see what is going on. At minimum, you should be seen so the doctor can do a physical exam and see where the pain is located for sure too.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 52 minutes later
Thank you dr.
Yes i did get an apointment on friday at my GP and she did examine me and seems to think its reflux for sure. I asked for an endoscopy but she did not think to arrange one for me. She also advided me to take omeprazole but i decined due to having read up on the literature as said earlier. However im begining to feel that i should have listened and taken her advise on friday then maybe i would not be in so much pain. But having said that, the pain is much more bearable now and is very slight discomfort rather than pain even with the ppi's taken this morning. So ill wait and see how it goes in a couple of days. Will take gaviscone advance in between meals and at bed time if necessary.
Thanking you again.
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 4 hours later
Brief Answer:
Best wishes to you!

Detailed Answer:
I'm glad you went in. And glad the pain is better!

Best regards,
Bonnie Berger-Durnbaugh, MD
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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