Dr. Kurt Barrett's GERD Blog - Patient Outcomes

What about P.P.I. Side Effects?

nospam@example.com (Kurt Barrett, D.O.) — Thu, 13 May 2010 16:43:08 -0700

A "new" study was recently released and made the CBS NEWS and others. What I've seen so far is not new information. Some is actually "junk science"...i.e., clostridium difficle is an acid resistant spore and hence the pH of the gut should NOT BE RELEVANT since it is not altered by the presence or absence of acid. We can talk about the bias in the retrospective studies because it seems that some of these findings result from the disease state (GERD) not the from the treatment. The only people that take these drugs in these cases are PEOPLE WITH GERD. We have no information on what results would be if non-GERD patients took the same treatment.
That said, ALL meds have some risk. We need to do every thing we can to minimize that risk. The benefit /risk determination needs to be ascertained on a case by case basis. Concern for children should be acknowledged but given the lack of adverse results in the short run (months up to 5 years) I believe the risk (small) is clearly justified given the benefit. Similarily, I would not withhold penicillin in the child with fever and sore throat based on the possibility that anaphylactic reaction could result. The small risk seems acceptable since benefit in both cases is substantial.
I might add that I have treated hundreds of patients with P.P.I.s (Proton Pump Inhihitors) for over 25 years and I remain very impressed with their remarkable benefits and safety.

A Grateful Patient

nospam@example.com (Kurt Barrett, D.O.) — Tue, 28 Apr 2009 20:24:06 -0700

This middle aged man was under the care of the department of gastroenterology at a major university here in Michigan for over four years when we met last year. I spoke to the local sleep apnea support group in Battle Creek, Michigan; he was in attendance because he was intolerant of his C-PAP. He now controls his GERD with a single daily dose of medication, wears his nasal C-PAP all night, every night and no longer develops nausea at the smell of fatty foods cooking as he had for years. He moved away two weeks after the removal of his gall bladder thus I wanted to know how things worked out. His situation indicates how crucial attention to detail is when confronted with multiple symptoms involving multiple systems.

Dr Barrett:

Thank you for your calls to check up on my progress. It seems unbelievable to think that my asthma symptoms have disappeared since removing the gall bladder. My new pulmonologist here in Ohio cannot accept that in my recent past I have had a full asthma diagnosis. Furthermore, I have not experienced the larynx spasms or laryngitis. This is the first winter in at least ten years that I have not had multiple bouts of pneumonia and bronchitis.

My first introduction to the concept of possible connection between my chronic sleep apnea, sleep deprivation, asthma, and esophageal reflux came to me through the sleep center physician and staff in Battle Creek, MI. After consultations with Dr Barrett, extensive reading and serious consideration of his recommendations, I accepted his proposed therapies. After several months of increasing and decreasing pharmaceuticals and laboratory testing, it was determined that my gall bladder was diseased and my team of medical professionals fully agreed that a cholecystectomy was necessary. Within a few months the asthmatic symptoms have dramatically diminished and my pulmonologist ordered that I totally discontinue the use of Symbacort.

Prior to the above discoveries I restricted my attendance in most all public gathering places and especially encountering fragrances, humid environments, any firesides, and airborne particles. In addition to sleep disorders and respiratory dysfunctions, to mention a few, I have cardio-vascular disease, celiac spru disease, degenerative bone disease, and minneres disease. It seemed very remote that I might find relief for my newest of diagnosis, asthma but I am delighted with my results to date. Furthermore, it has been a pleasure to work with Dr Barrett and his staff.

Sincerely,

Richard G.

Osteoporosis and PPI therapy

nospam@example.com (Kurt Barrett, D.O.) — Tue, 26 Dec 2006 20:06:13 -0700

-The Journal of the AMA* reports that long term, high dose PPI (proton pump inhibitor) therapy may increase the risk of hip fracture

-*1.75 x ordinary dose for over one year increased risk of hip fracture by 2.65-fold (in 1,000 non-users 1.8 individuals would expect hip fracture; in 1,000 users of PPI therapy at MORE than one a day for 1 year, 4 hip fractures would be anticipated)

-*"Physicians should be aware of this potiential association when considering PPI therapy and should use the lowest effective dose dose..."

-*"For elderly patients who require long-term and particularily high dose PPI therapy, it may be prudent to reemphasize increased calcium intake, preferably from a dairy source, and coinjestion of a meal when taking insoluble calcium supplements..."

-Bone density testing (DEXA scan) can be acquired or updated to estimate fracture risk

-Realizing that the benefit risk ratio may be influenced, therapy with PPIs can be interrupted, discontinued, reduced or used on an as necessary basis

_Poor absorption of calcium due to reduced stomach acid and resultant hip fractures have always been a "theoretical risk"

-BUT there also seems to be an effect from the same medication to maintain the bone; so the overall effect is not yet known

Patient Outcomes

nospam@example.com (Kurt Barrett, D.O.) — Sat, 05 Aug 2006 10:48:22 -0700

I have seen remarkable outcomes in patients as young as 3 week and in all age groups into the 90's when treated for reflux of stomach contents. Recently a delightful lady, MH, 88 years of age (that's only a number) was treated by her family provider for a "lump in my throat". Her initial therapy was discontinued after her symptom remitted. Her therapy was "tapered off" despite her objections. The lump feeling returned.
She complained to no avail.
She had knowledge of my philosophy from the newspaper. After my evaluation and therapy her condition improved (in days) and now after a few weeks she commented at her last visit, "Oh what a beautiful morning!". Her sleep is better than it has ever been and her bowels are vastly improved (constipation). MH volunteers,"My bowels are the best they have been in decades". My perspective is GERD was messaging to the digestive tract "STOP everything in its tracks; HYDROCHLORIC ACID has escaped from the stomach into the food tube and it MUST be stopped AT ALL COSTS!"
The result is sluggish movement through the intestinal tract hence constipation. Relieve the inciting wrong-doer and the constipation "gets better" seemingly by itself without "specific" anti-constipation therapy. Her improved sleep is likely for more than one reason. I am convinced that treating her GERD reduces the amount of adrenalin, the "fight or flee" hormone. Hence the person so treated can sleep and be more relaxed in general.