What is a proton pump? Lemons for GERD

Digestive health
1

I have a hernia and I'm sure I have GERD, I am seeing my GP in two days time as I want to discuss what remedies I can use, currently I am on lanzoprazole and also ranitidine occasionally but still feeling a lot of indigestion, acid reflux and a nasty cough, and it is highly unpleasant.  Anyway, I've been googling as I feel the need to, to get a clearer perspective of what may be wrong and what treatments may be available before seeing my GP, and I have come across something called a proton pump but I don't know whether I am thick but I can't get to grips with what they/it are/is?  Anyone able to help?  I mean I presume they are not the same as conventional antacids?  Also wondered about getting an infuser bottle and knocking up some lemons in warm water, the bottles are only about £2.00 and lemons are cheap enough, but there are mixed reports of if this is successful but I read it can be a good remedy if you actually have, like me, a hernia, as well as plain old GERD.  Any thoughts on this, anyone, or has anyone tried it?

Thanks very much if you can get back to me with any advice.  Fiona

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Hi Fiona,

Proton pump meds are your Lantaprazole and all similar, omeprazole, pantaprazole etc, i was taking Esomeprazole aka Nexium. I was taking 40mg of Esomeprazole along with 300mg of Ranitadine when required which was most nights before bed.

I had hiatus hernia and reflux since childhood and when I was a teenager and in 20's I used to make up a bottle of bicarbonate soda to drink throughout the day and mostly the night as symptoms got worse at night.

I understand it all now, you need to sleep proped up so the acid doesn't leak up into throat. Some nights I would be awake all night coughing.

I now have no symptoms. Free from taking meds because I had fundloplication and Hiatus Hernia repair 8 weeks ago.

I still have a bit of discomfort from scar tissue which is getting better slowly, but no acid, no medication sleeping better at night, I can't eat big portions of food yet but I can eat what I want in small doses and not worry about acid aftermath.

Good luck with your visit to doctors.

Regards Margaret.

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Hi Fiona,

Acid Reflux has two elements: acid (which is a chemical concern) and reflux (which is a mechanical action). Both need to be tackled.

You may be able to reduce the acid you produce through dietary measures. If you keep a food diary, you may identify which foods cause you poblems. We are all different and react to foods differently. You will find lists of "banned" foods but take these only as suggestions: they're commonly reported triggers but yours may be different.

The normal treatments for acid reflux tackle the acid, as it's easier, and render reflux less harmful. If you visit the free book / website www DownWithAcid org uk and find the Medicines page in the Acid section, it describes the four different types of acid neutraliser:

1. Normal antacids (like Tums) will neutralise excess acid once it has been produced.

2. Alginates (like Gaviscon) neutralise whilst also forming a temporary coating to the oesophagus and floating like a blanket on top of the acid in the stomach to prevent it splashing back. Again, it works on the acid nce it has been produced.

3. A Histamine H2 Receptor Antagonist (H2 blocker like ranitidine / Zantac) blocks some of the signals from the brain telling the stomach to make acid. It is used pre-emptively and usually works for about 12 hours.

4. The most powerful acid suppressant medication is the family of Proton Pump Inhibitors (PPIs which includes omeprazole and Nexium). Proton Pumps are formed as required when the stomach makes acid. PPIs prevent some of them being made thus reducing the amount of acid available in the stomach.

However, although acid suppressants are excellent at their job and have been, and are, used by millions world wide for the last 30 years, they are not good at reducing the reflux element. For that lifestyle modifications may be required.

The cough is a symptom of the reflux rather than the acid. Refluxate doesn't have to be acidic to be dangerous: it can travel the full column of the oesophagus and breach the upper oesophageal sphincter whence it may aspirate into the lungs.

To reduce reflux, lose weight if necessary, avoid over-fillig your stomach by eating small portions and more froequently, avoid exercise after food (including bending) that will compress the stomach. Avoid tight clothing. Leave at least 3 hours between last meal and bed. Raise the head of the bed by 6 to 8 inches on blocks.

If lifestyle modification doesn't work, you may need to consider surgery (a fundoplication) to reduce the reflux.

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Thank you so much, Barrett, all of that was extremely helpful x

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Thank you Margaret for all that, very useful info, thanks for taking the trouble x