Share Facebook


 
10-18-2017, 06:42 AM   #1
Pilgrim
Senior Member
 
Pilgrim's Avatar
 
Join Date: Jul 2014
Location: Ontario

My Support Groups:
H's Brother

He's had weird issues pop up, but lately over the summer and getting much worse over the past several weeks is abdominal pain.
He was prescribed Zantac for possible GERD which just doesn't make a dent in the pain.
We're getting a referral to GI, labs (not fcal unfortunately ),and an abdominal ultrasound. He is also going to try a PPI for the possible GERD.
Anyone have experience with GERD? Did the meds help? Did it end up being Crohn's?
We're having a hard time over here.
I think I jinxed it by trying to start an exercise class, lol. Now I have some kid home from school every day.
10-18-2017, 08:29 AM   #2
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
Meds really help
Oldest has Gerd but not ibd
Diet is also key
You often need a combo of both
Not laying down after eating
No spicy foods
Soda pop or carbonated drinks are a big no
No tomatoes/sauce etc...,

A lot of trial and error
__________________
DS - -Crohn's -Stelara -mtx-IVIG
10-18-2017, 10:00 AM   #3
Pilgrim
Senior Member
 
Pilgrim's Avatar
 
Join Date: Jul 2014
Location: Ontario

My Support Groups:
Thanks. It's good to know it might not be more than GERD. We'll try the next med.
10-18-2017, 11:32 AM   #4
Maya142
Forum Monitor
 
Maya142's Avatar
 
Join Date: Jul 2013

My Support Groups:
My kiddo needed a PPI for GERD - Zantac didn't work well enough. Like MLP said, diet changes also really help.

How old is he? The other thing that bothers my daughter is caffeine - in coffee or tea. He may not be old enough for that but wanted to mention it. Also chocolate! And tomatoes.
__________________
Mom of M (20)
diagnosed with Crohn's Disease at 16
Juvenile Idiopathic Arthritis at 12
Juvenile Ankylosing Spondylitis at 16

Mom of S (23)
dx with JIA at 14
Ankylosing Spondylitis at 18
10-18-2017, 12:43 PM   #5
Pilgrim
Senior Member
 
Pilgrim's Avatar
 
Join Date: Jul 2014
Location: Ontario

My Support Groups:
He's 9. He doesn't have coffee or tea, or soda. Tomatoes and sauce really bother him. Good mention on the chocolate right before Halloween. I will pull it from his bag. We saw a dietitian and she said garlic could be a problem too. We cut out orange juice.
10-18-2017, 12:43 PM   #6
Pilgrim
Senior Member
 
Pilgrim's Avatar
 
Join Date: Jul 2014
Location: Ontario

My Support Groups:
Any side effects from the PPI?
10-18-2017, 02:06 PM   #7
Maya142
Forum Monitor
 
Maya142's Avatar
 
Join Date: Jul 2013

My Support Groups:
Yes, garlic is definitely a trigger for my daughter. No side effects from a PPI for us. My daughter has been on one for years. There are risks with being on them - they prefer using Zantac or Pepcid now, but we tried those and they didn't work for M.

She is also on an NSAID, so it's very important for us to protect her stomach.

Gastritis can also cause stomach pain and can be caused by reflux. For that, we use Carafate. M takes Carafate regularly to prevent gastritis, but it is often given for a short period of time if gastritis is suspected or found on a scope.

Have you tried something like Maalox or Tums for the pain? If it's acid, that should help. We find Maalox works better, so M takes that when she has really bad reflux. It works pretty quickly.
10-18-2017, 04:52 PM   #8
Optimistic
Senior Member
 
Optimistic's Avatar
 
Join Date: Oct 2014

My Support Groups:
Hi. From birth my son was always a weird throw up kid, usually on airplanes or school plays or malls. Every time he got sick it included a stomach issue. He would get nauseous at times. We just thought he was different! He was - he had Crohnís! Tums never did much.

He started a PPI when first hospitalized as an off label treatment for inflammation he had in duodenum, along with steroids and EEN. He stayed on the PPI when he moved to some food. Still on it years later. No side effects.

Last edited by Optimistic; 10-18-2017 at 05:23 PM.
10-18-2017, 05:33 PM   #9
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
Our GI will NOT use ppi in kids anymore
They know ppi lower magnesium and cause polyps to grow
The GI will use carafate / zantac etc...
10-18-2017, 05:54 PM   #10
Optimistic
Senior Member
 
Optimistic's Avatar
 
Join Date: Oct 2014

My Support Groups:
No magnesium or polyps here. In fact, the one time I convinced - well I wonít say name bc it might show up in a search 😘 - a GI IBD specialist at Boston to switch to carafate, which he said would not work, horrible reflux returned but worse...the next biopsy showed trace inflammation in duo. Coincidence? Maybe. But after returning to PPI, next one was clear. So PPI it will be!
10-18-2017, 06:03 PM   #11
Maya142
Forum Monitor
 
Maya142's Avatar
 
Join Date: Jul 2013

My Support Groups:
We haven't had issues with PPIs either. Our GI still uses them when necessary - at one of the big children's hospitals, which has one of the biggest pediatric IBD centers in the US.

I do worry about them long-term but I also worry about inflammation in her stomach long-term.

M also has moderate/severe Gastroparesis and severe reflux is very common with that. It actually has taken a double dose of a PPI (we had to really fight insurance to get them to pay for a double dose), daily Carafate, Pepcid and Maalox as needed to control it.

It is a LOT of medication, but like Optimistic's son, if we step back even a little bit, her scopes show inflammation in her stomach.

Long-term PPIs do put you at risk for low bone density, and while M has that, it has actually improved in the last year as she has gained weight and has become a healthy weight. They also put you at risk for CDiff. which she has had twice.

Both times she had CDiff it was after antibiotics, so not sure if it was related to PPIs at all, just wanted to mention it.

I don't see us stopping her PPI any time soon.
10-18-2017, 06:15 PM   #12
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
Go to:
Abstract
Fundic gland polyps are now commonly recognized during endoscopy. These polyps are benign, often multiple and usually detected in the gastric body and fundus. In the past, these polyps were sometimes associated with familial adenomatous polyposis. In recent years, it has become evident that increasing numbers of these polyps are being detected during endoscopic studies, particularly in patients treated with proton pump inhibitors for prolonged periods. In some, dysplastic changes in these polyps have also been reported. Recent studies have suggested that there may be no increase in risk of colon cancer with long-term proton pump inhibitor therapy. While temporarily reassuring, ongoing vigilance, particularly in those genetically predisposed to colon cancer, is still warranted.

Keywords: Gastric polyps, Fundic gland polyposis, Gastric dysplasia, Gastric cancer, Colon polyps, Familial polyposis coli, Adenomatous polyposis coli gene mutation



Published online 2008 Mar 7. doi: 10.3748/wjg.14.1318
PMCID: PMC2693675
Proton pump inhibitors and an emerging epidemic of gastric fundic gland polyposis
Hugh James Freeman



From
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693675/
10-18-2017, 06:19 PM   #13
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214735/

Stomach polyps form in response to damage to your stomach lining. The most common causes of stomach polyps are:

Chronic stomach inflammation. Also known as gastritis, this condition can cause the formation of hyperplastic polyps and adenomas. Hyperplastic polyps are unlikely to become cancerous, although those larger than about 2/5 inch (1 centimeter) carry a greater risk. Adenomas are the least common type of stomach polyp but the type most likely to become cancerous. For that reason, they are generally removed.
Familial adenomatous polyposis. This rare, inherited syndrome causes certain cells on the stomach's inner lining to a specific type of polyps called fundic gland polyps. When associated with this syndrome, fundic gland polyps are removed because they can become cancerous. Familial adenomatous polyposis can also cause adenomas.
Regular use of certain stomach medications. Fundic gland polyps are common among people who regularly take proton pump inhibitors to reduce stomach acid. These polyps are generally small and aren't a cause for concern. Fundic gland polyps with a diameter larger than about 2/5 inch (1 centimeter) carry a small risk of cancer, so your doctor might recommend discontinuing proton pump inhibitors or removing the polyp or both.
From

https://www.mayoclinic.org/diseases-...s/con-20025488
10-18-2017, 06:31 PM   #14
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
No clear mechanism has been found to explain the possible pathogenesis of FGPs due to PPI use. Hypergastrinemia due to PPI use was thought to be a probable cause of gastric mucosal hypertrophy and polyp formation. However, a study by Fossmark and colleagues found no relationship between FGP formation and serum gastrin levels due to PPI use.16 Our patient had serum gastrin levels within normal limits.

There is no evidence that any PPI increases the incidence of FGPs. In most studies, the most common PPI was omeprazole, which could be because it was one of the earliest PPIs to be marketed and it is commonly prescribed.

However, the use of PPIs for more than 2 years may increase the risk of FGP formation.11,12 Ally and colleagues demonstrated that PPI use of less than 1 year did not increase the development of gastric polyps, while PPI therapy for more than 2 years was an independent risk factor.17 No dose-dependent association has been described in the literature. Our patient reported the use of PPIs for approximately 12 years.

No surveillance is required for FGPs because they are not premalignant lesions.18 Genta and colleagues found no increase in gastric neoplasia in patients with FGPs.19 There was an inverse correlation between the FGPs and gastric neoplasia.19 In our patient, we repeated the endoscopy within 6 months because of worsening GERD symptoms.

In conclusion, this case demonstrates a possible association between long-term PPI use and large FGPs. Because many patients take PPIs for GERD and other conditions, doctors should be aware of this potential adverse effect. The use of PPIs should be limited to patients who need them, and the duration of treatment should be monitored.

A 42-year-old white man was referred to our center by his primary care physician for symptoms of chronic diarrhea associated with cramping, abdominal pain, and flatulence. The patient had chronic gastroesophageal reflux disease (GERD) and had been taking omeprazole 20 mg twice daily for the past 12 years.

A colonoscopy and esophagogastroduodenoscopy (EGD) were performed for symptom workup. The colonoscopy revealed no significant findings. The EGD showed approximately 30 large pedunculated polyps in the gastric body and fundus (Figure 1). The size of the largest polyp was approximately 2 cm. Biopsies of the polyps were obtained with cold forceps. Histologic examination of the specimens showed multiple fragments of fundic gland mucosa with occasional dilated glands. Based on the EGD and histology, the patient was diagnosed with fundic gland polyps (FGPs). The most likely etiology was thought to be the prolonged use of proton pump inhibitor (PPI) therapy. Therefore, omeprazole was discontinued, and ranitidine 150 mg bid was started. A repeat EGD performed 5 months later showed a significant decrease in the size of the polyps and no polyps were pedunculated (Figure 2). Pathology of the biopsy sample confirmed the presence of FGPs with no evidence of malignancy.

Large Fundic Gland Polyps in the Stomach

Download PDF
Gastroenterology & Hepatology
March 2016, Volume 12, Issue 3

Sonia Varghese, MD,1 Vu Le, MD,2 Tauseef Ali, MD2

1Department of Hematology and Oncology, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; 2Department of Gastroenterology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma


From

http://www.gastroenterologyandhepato...n-the-stomach/
10-18-2017, 07:55 PM   #15
Pilgrim
Senior Member
 
Pilgrim's Avatar
 
Join Date: Jul 2014
Location: Ontario

My Support Groups:
Yes, garlic is definitely a trigger for my daughter. No side effects from a PPI for us. My daughter has been on one for years. There are risks with being on them - they prefer using Zantac or Pepcid now, but we tried those and they didn't work for M.

She is also on an NSAID, so it's very important for us to protect her stomach.

Gastritis can also cause stomach pain and can be caused by reflux. For that, we use Carafate. M takes Carafate regularly to prevent gastritis, but it is often given for a short period of time if gastritis is suspected or found on a scope.

Have you tried something like Maalox or Tums for the pain? If it's acid, that should help. We find Maalox works better, so M takes that when she has really bad reflux. It works pretty quickly.
Thank you! We purchased Maalox tonight and he said it helped more than the tums. Said his pain went to a 4-5 from a 6.
10-18-2017, 08:03 PM   #16
Maya142
Forum Monitor
 
Maya142's Avatar
 
Join Date: Jul 2013

My Support Groups:
I'm so glad it helped!!
10-18-2017, 08:51 PM   #17
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
Woo hoooo!!!!
Glad you found something that helped
10-19-2017, 09:27 AM   #18
Farmwife
Forum Monitor
 
Farmwife's Avatar
 
Join Date: Apr 2012
Location: Michigan

My Support Groups:
∑ NG Tube
Both kids have been on PPI's, tums and such.
Along with myself. Green tea..... ya, sounds weird. But it works for us. I have to drink it for a week to work but it's worth it for us.

Grace is no longer on any tummy meds.
But was on it for YEARS!


And my forum friend
You give me yet another reason not to exercise.
I lift my cherry fritter doughnut in appreciation to you! Your
__________________
I'm mom to............... Little Farm Girl 8 yr old
Ibd (microscopic)
(12/28/12),
dx Juvenile Arthritis
(12/13/13)
dx Erthema Nodosum
(8/13/14)
Bladder and Bowel Dysfunction
(10/14/13)
Ehlers-Danlos Syndrome dx (1/26/17)
Remicade started on (9/8/14)Every 4 wks
Azathroprine started on 10/9/15
EN/EEN- since (1/12/13)
Past Meds- LDN, Humira, Pred, MTX, Sulfasalazine
10-19-2017, 09:54 AM   #19
Jabee
Senior Member
 
Jabee's Avatar
 
Join Date: Oct 2016
Location: Massachusetts

My Support Groups:
my little penguin, thanks for the information about polyps. Like Optimisticís son I was first prescribed PPIs for crohnís in the duodenum. They worked very well and at that time I didnít need a stronger medication. I now take dexilant twice a day as well as Entocort since the inflammation popped up in my jejunum and ileum. I will definitely speak with my GI about polyps and PPIs at my next appointment. At one point I had Barrettís esophagus; the twice a day dexilant healed that so I do need to be careful. I may have to switch to Humira since Entocort varies in its effectiveness and I canít take 6MP or azathioprine because they give me pancreatitis.
10-19-2017, 10:01 PM   #20
kimmidwife
Forum Monitor
 
kimmidwife's Avatar
 
Join Date: Sep 2010
Location: Florida

My Support Groups:
Caitlyn has low bone density from being on PPIís for way to long. She is now on Zantac and carafate. Her last few scopes her esophagus has looked really good.
__________________

Crohn's Dx'ed Sept 08
Allerg Imuran Sept 08
Fail Remicade Jan 09
Methotrex Oct 09-Aug 11
Pentasa stopped - nosebleeds
EENOct 31 - Nov 28th. Too hard!
Retried Remicade Dec 11
Stopped due 2 Anaphylactic Reaction
LDN Jan 2012-June 2014 Got My daughter back!
New secondary diagnosis: Gastroporesis Dec 2013
Lost remission June 2014
Started Entyvio April 2015. Decreased to every 4 weeks October 2015. Praying for remission.
10-25-2017, 01:43 PM   #21
Pilgrim
Senior Member
 
Pilgrim's Avatar
 
Join Date: Jul 2014
Location: Ontario

My Support Groups:
My son has 2 weeks to wait for an ultrasound. I am going to try the Omeprazole for 3-4 days just to see if he gets any relief. Gave up on Tums and the Gaviscon (Maalox) as well as the Zantac. Nothing is working. They told me to stop the med if it isn't helping.
10-25-2017, 02:10 PM   #22
Farmwife
Forum Monitor
 
Farmwife's Avatar
 
Join Date: Apr 2012
Location: Michigan

My Support Groups:
∑ NG Tube
Grace's Omeprazole took weeks to work.
I think he'll need more if this episode doesn't pass.

Ironically my son is going thru another bout of abdominal cramps.
He was given a med for anti cramping.
10-25-2017, 02:43 PM   #23
Maya142
Forum Monitor
 
Maya142's Avatar
 
Join Date: Jul 2013

My Support Groups:
Yes, I'd check with your GI on how long it takes to work. I can't remember now, but I do think it was longer than a few days...
10-25-2017, 09:14 PM   #24
Jabee
Senior Member
 
Jabee's Avatar
 
Join Date: Oct 2016
Location: Massachusetts

My Support Groups:
Can you give him the omeprazole twice a day? I took nexium twice a day for years. You might need the two doses to make a difference.
10-25-2017, 09:23 PM   #25
Pilgrim
Senior Member
 
Pilgrim's Avatar
 
Join Date: Jul 2014
Location: Ontario

My Support Groups:
The dose says 1 per day early morning. He weighs about 75lbs. Don't know if that makes a difference.
I had read on the internet that we should notice some improvement within 3-4 days, but it sounds like I should keep researching. It's just that I was told to stop if no improvement- unfortunately no time frame given.
10-25-2017, 10:08 PM   #26
Maya142
Forum Monitor
 
Maya142's Avatar
 
Join Date: Jul 2013

My Support Groups:
When we have tried PPIs, we've always tried them for at least a week or two (usually two), not just a couple of days.

Is there any way H's GI can weigh in? When does he see the GI? Has that been scheduled yet or am I getting confused with H's appt.?

I'm just thinking that the dose may not be right - our pediatrician put M on a PPI but once we finally got in to see M's GI, she doubled the dose immediately. M was on Prevacid, not Prilosec, but took it twice a day.

GIs tend to be more aggressive with these meds. M was immediately put on Prevacid twice a day plus Zantac once a day, so that she'd have something before each meal to prevent reflux.

It worked well for her, though it did take a while to work.
10-26-2017, 06:02 AM   #27
Pilgrim
Senior Member
 
Pilgrim's Avatar
 
Join Date: Jul 2014
Location: Ontario

My Support Groups:
I was able to get him in to GI on the same day as H but that will be about 3 weeks.
I don't mind limping along with this until the GI weighs in. We do get imaging in about a week or so.
10-26-2017, 10:22 PM   #28
Lady Organic
Forum Monitor
 
Lady Organic's Avatar
 
Join Date: Apr 2013
Location: Quebec

My Support Groups:
I have been prescribed PPI from an ENT for possible GERD and issues in my throat, but I decided not to take it considering the associated risks on stomach mucosa, which have been identified with endoscopy research (polyps, cubblestone mucosa, etc). As a CD patient I believe our mucosa is maybe even more vulnerable to possible side effects of PPI. I chose to adapt and change my lifestyle to minimize possible GERD eventhought that full change is not yet achieved
__________________
''UC-like Crohn's'' since 2001:
on: 25mg 6-MP (purinethol)+ B12 shots
minor hands/wrists chronic arthritis since 01/2013

Diet: ''IBD-AID'' : http://www.nutritionj.com/content/13/1/5+ organic food only
suppl Curcuminoid extract, Inulin,psyllium, apple pectin, Vitamin D

past meds:
pred 50mg, 5-ASA, cortifoam, Imuran (failed) Purinethol (success) methotrexate (failed CD and arthritis).
10-27-2017, 07:24 AM   #29
Pilgrim
Senior Member
 
Pilgrim's Avatar
 
Join Date: Jul 2014
Location: Ontario

My Support Groups:
I understand that, Lady Organic! It's even tougher maybe to make medication decisions for another person, and more so a young child.
For H's brother we have also: put the head of his bed up on blocks, limited food before bed, cut tomatoes, garlic, and citrus fruits, and totally eliminated dairy. He eats a plant based diet. We tried 3 less potent medications that didn't help.
If the omeprazole doesn't help after a few weeks then I will wonder if acid is the problem. Yesterday was day one and he still had an unreasonable amount of pain.
He can't live like that. He's missing some school, turning down some invites, and then sometimes he's ok.
10-27-2017, 10:18 AM   #30
Maya142
Forum Monitor
 
Maya142's Avatar
 
Join Date: Jul 2013

My Support Groups:
I think he probably needs to be scoped. Poor little guy.

We also worry about the side effects and long term effects of PPIs but the long term effects of GERD and inflammation in the stomach from reflux aren't good either. And like you, we have tried changing diet and all that without much success.

A PPI has made all the difference for my daughter - before she was on one, she had constant stomach pain, would not eat, lost 15 lbs (and she didn't have any extra weight to start with) and was just miserable. When we started Prevacid and got her on the right dose, it really improved her quality of life.
Reply

Thread Tools


All times are GMT -5. The time now is 07:08 PM.
Copyright 2006-2017 Crohnsforum.com