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Gastroenterology (Expert Forum)
can nexium stop working?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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can nexium stop working?
by joi, Feb 03, 2003 12:00AM
I have been on nexium for almost 3 months and it was working great..before I had a constant lump in my throat and my food would comeup when I bend over..the nexium worked well but last week I came down w/ a virus and was vomiting constantly for 24 hrs ..since then I have had the reflux again and also a heaviness around the upper right rib area..can the nexium stop working..I am taking 40 mg 1x a day..
Doctor's Answer
by Kevin Pho, MD, Feb 03, 2003 12:00AM
, Feb 03, 2003 12:00AM
Hello, thanks for asking your question.
I am not aware that a PPI can suddenly stop working. However, there are cases where GERD are refractory to optimal PPI treatment. For intance, GERD can "breakthrough" optimal PPI therapy. Up to 70 percent of patients taking PPIs twice daily will have periods of gastric pH <4 lasting for more than 60 minutes, particularly at night. Nocturnal acid breakthrough may be responsible for the majority of patients with refractory GERD.
Patients with increased gastric acid production, defined as basal acid output above 10 meq/h, may be predisposed to refractory GERD. Although some of these patients have the Zollinger-Ellison syndrome, others have no apparent cause. Thus, gastric acid hypersecretion should be considered in patients who are refractory to standard or relatively high-dose PPI therapy.
Patients who have heartburn without endoscopic or pH evidence of GERD may have esophageal hypersensitivity to physiologic acid reflux. Patients with functional bowel diseases (such as irritable bowel syndrome, dyspepsia, or globus sensation) may have clinical features that overlap and can be confused with GERD. Other diseases that should be considered are achalasia, esophageal cancer, esophageal stricture, other causes of esophagitis, and gastric stasis.
So the bottom line is, if you are still experiencing symptoms of GERD while on optimal PPI therapy, you should promptly see a physician to rule out any "non-GERD" causes of your symptoms.
Thanks,
Kevin, M.D.
I am not aware that a PPI can suddenly stop working. However, there are cases where GERD are refractory to optimal PPI treatment. For intance, GERD can "breakthrough" optimal PPI therapy. Up to 70 percent of patients taking PPIs twice daily will have periods of gastric pH <4 lasting for more than 60 minutes, particularly at night. Nocturnal acid breakthrough may be responsible for the majority of patients with refractory GERD.
Patients with increased gastric acid production, defined as basal acid output above 10 meq/h, may be predisposed to refractory GERD. Although some of these patients have the Zollinger-Ellison syndrome, others have no apparent cause. Thus, gastric acid hypersecretion should be considered in patients who are refractory to standard or relatively high-dose PPI therapy.
Patients who have heartburn without endoscopic or pH evidence of GERD may have esophageal hypersensitivity to physiologic acid reflux. Patients with functional bowel diseases (such as irritable bowel syndrome, dyspepsia, or globus sensation) may have clinical features that overlap and can be confused with GERD. Other diseases that should be considered are achalasia, esophageal cancer, esophageal stricture, other causes of esophagitis, and gastric stasis.
So the bottom line is, if you are still experiencing symptoms of GERD while on optimal PPI therapy, you should promptly see a physician to rule out any "non-GERD" causes of your symptoms.
Thanks,
Kevin, M.D.
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I believe what she said and keeps taking Protonix and keep having dizzy problem.
Finally I tried Nexium, another doctor let me try. It is great. I don't feel dizzy any more. Hope it can cure my Gerd soon too.