Can proton pump inhibitors cause gastroparesis?

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Clematis

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I was DXed with "silent" reflux in mid-September after I went to an ENT complaining of nose mucous in the back of my throat that I could not swallow. (I had no heartburn.) I was given a script for 40mg Omeprazole which I was told I'd have to take "forever". I bought a bed wedge to elevate my head during sleep. The sense of mucous in back of throat went away.

A month later, I gagged on a giant calcium pill at 8 am and up came the undigested hamburger I had eaten for dinner 14 hours before, no acid or bile, just the burger. (How was it still in my stomach??) After that, a few times I was awakened at night with the distinct feeling of food coming up in my lower esophagus. I'd cough, choke and swallow it down. (I had never experienced this before in my life.)

DS surgery was Nov 12 and, as I have posted elsewhere, I cannot keep down any solids (and we're talking rice-sized solids). If whatever I eat is not liquid or fine enough to slip by the pylorus without it "noticing", I feel pain that grows (and never goes away, even many hours later) until I vomit up first a jellyfish of mucous and then later the offending food.

But I also continue to have an episode of middle of the night reflux which is now occurring nearly every night — and I no longer eat after 8 pm. Most times I awake coughing and gagging. On occasion I am semi-awake when it begins, and it seems to be an eruption, not gravity-seeping. (My head is elevated on the bed wedge.) The sensation is that nothing has been digested -- it does not feel liquid-y. It’s a miracle I haven’t developed aspiration pneumonia.

So today I'm wondering: has the PPI given me some measure of gastroparesis? Food, other than liquids, is not emptying? Perhaps the surgery damaged the vagus nerve and has taken the sluggish emptying to a more dire level? Is that a part of why I can't keep down solids? (The nighttime reflux and sense of non-digestion was present pre and post op with the PPI; the vomiting is only post op.)

Otherwise, I feel OK. I’m resisting going to a gastroenterologist until I’m sure I have a serious problem. No doubt my insurance will blame it on the unapproved DS surgery and I will be stuck paying thousands of dollars for the tests so if I go, they'd better turn up something!

Has anyone heard of PPIs causing this? Googling shows some anecdotal evidence but not actual data.
 
NOT to my knowledge but then I am not a medical professional.

What surgery does is cut the nerves in the system...THEY are still healing and do so slowly. Damaged nerves are part of gastroparesis. BUT you also may need a different PPI. Omeprazole does absolutely NOTHING for me, even prescription strength. I have to use Prevacid or Protonix. Some have to use Dexilant.

Okay, only found ONE study from a source that is medical in nature: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886367/

Interestingly, gastroparesis disproportionately affects females. A study of 146 gastroparesis patients reported 82% as female.3 In 2009, a study from the Olmstead County, Minnesota medical database reported the age-adjusted prevalence of gastroparesis between 1996 and 2006 was nearly 4-fold higher for women compared with men (37.8 versus 9.6 cases per 100,000 persons).4 Although the reason for this increased prevalence in women is unknown, it is noted that women often experience slower gastric emptying rates when compared with men, particularly during the luteal phase of their menstrual cycle.5,6 Several studies have investigated a potential relationship between gastroparesis and the female hormones estrogen and progesterone, although this association remains unproven.7,8

Now, during your very early weight loss phase, you are dumping hormones like crazy. Hormones are stored in fat. And when fat is lost, the hormones have to go somewhere. IF and that is a BIG IF, hormone changes are why, then it makes sense that our system slows down while in the weight loss window.
 
PPI's are one of the most commony prescribed classes of drugs in the USA and the world. If they were known to cause gastroparesis I think we would have heard more about it, and given that almost all of us around here take one (or did for awhile), we would have seen it here as well. I think it's far more likely, as @southernlady said, that one or both of the vagus nerves was stretched and/or bruised during surgery, in which case things should improve, albeit slowly. It seems less likely to me that a vagus nerve would have been cut given the shape of the sleeve.
I also had major problems eating after my DS, though not as bad as yours. At the insistence of my surgeon I had an upper endoscopy and upper GI x-rays. Everything looked perfect - textbook DS. My problems resolved after about 8 months and have never returned. Of course that doesn't mean your problems are the same as mine. For example, you could have a stricture of your sleeve. They aren't common but they do occur. If you can get some kind of diagnostic testing without spending a fortune, it would be a good idea. Hopefully yours will show as little as mine did.
 
NOT to my knowledge but then I am not a medical professional.

What surgery does is cut the nerves in the system...THEY are still healing and do so slowly. Damaged nerves are part of gastroparesis. BUT you also may need a different PPI. Omeprazole does absolutely NOTHING for me, even prescription strength. I have to use Prevacid or Protonix. Some have to use Dexilant.

Okay, only found ONE study from a source that is medical in nature: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886367/



Now, during your very early weight loss phase, you are dumping hormones like crazy. Hormones are stored in fat. And when fat is lost, the hormones have to go somewhere. IF and that is a BIG IF, hormone changes are why, then it makes sense that our system slows down while in the weight loss window.

Thanks for your research, SL

Since my reflux is silent, I really have no idea if a PPI is working or not unless an ENT sticks a scope down my nose to see ulcers in my throat. (Curiously, when I asked ENT in September if I needed to come back to see if it was working he said no.) But I do know that there is no visual or olfactory evidence of acid or bile when I vomit. I also don't know that I have gastroparesis, only that common sense tells me that dinner eaten at 6pm should not still be in my stomach the next day at 9am.

Ah, hormones. I think I traded those for an AARP card.



PPI's are one of the most commony prescribed classes of drugs in the USA and the world. If they were known to cause gastroparesis I think we would have heard more about it, and given that almost all of us around here take one (or did for awhile), we would have seen it here as well. I think it's far more likely, as @southernlady said, that one or both of the vagus nerves was stretched and/or bruised during surgery, in which case things should improve, albeit slowly. It seems less likely to me that a vagus nerve would have been cut given the shape of the sleeve.
I also had major problems eating after my DS, though not as bad as yours. At the insistence of my surgeon I had an upper endoscopy and upper GI x-rays. Everything looked perfect - textbook DS. My problems resolved after about 8 months and have never returned. Of course that doesn't mean your problems are the same as mine. For example, you could have a stricture of your sleeve. They aren't common but they do occur. If you can get some kind of diagnostic testing without spending a fortune, it would be a good idea. Hopefully yours will show as little as mine did.

Thanks, Larra. I appreciate your knowledge.

Because I don't feel bad, other than the problem with solids, I am going to wait until after the holidays and see if there is improvement. If not, I will find a gastro to do a barium swallow. In the meantime, I'll whirr things up in the baby food blender.
 
You surgery was pretty recent? Are you sure you don't have a hernia? The puke you describe is what I go through daily with my hernia (Ernie the hernia). It's not acid or bile (yay for my teeth) but reverse eating isn't the highlight of my day :/ My reflux got worse with my hernia issue and if I eat within 2.5-3 hours of going to bed, it gurgles it's way back up.

Im on Omeprozole and Zantac together. It's not a sleeve issue with me as I had the sleeve first in 2010 as part of a 2 stage switch. It's only after Ernie decided to move in and take over my body that I started having these issue.

Good luck and keep us updated!
 
You surgery was pretty recent? Are you sure you don't have a hernia? The puke you describe is what I go through daily with my hernia (Ernie the hernia). It's not acid or bile (yay for my teeth) but reverse eating isn't the highlight of my day :/ My reflux got worse with my hernia issue and if I eat within 2.5-3 hours of going to bed, it gurgles it's way back up.

Im on Omeprozole and Zantac together. It's not a sleeve issue with me as I had the sleeve first in 2010 as part of a 2 stage switch. It's only after Ernie decided to move in and take over my body that I started having these issue.

Good luck and keep us updated!
Are you talking about a hiatal hernia? If it is causing you to reflux and vomit then it probably needs repaired..... And how do you know there is no acid or bile? Did you have testing with a probe up your nose and in esophagus for 24 hours? I would get on a PPI if you aren't and would really looking into a repair. That isn't good for you.

Good luck
 
Are you talking about a hiatal hernia? If it is causing you to reflux and vomit then it probably needs repaired..... And how do you know there is no acid or bile? Did you have testing with a probe up your nose and in esophagus for 24 hours? I would get on a PPI if you aren't and would really looking into a repair. That isn't good for you.

Good luck

No, not hiatal. It's inscional about 4 inches below my chest bone....right about where my stomach is lol.

They are going to repair it...but Im in England...its on the NHS timeline not mine lol. Should get a date soon :) Im on omperozole and zantac and eat tums like they are going out of style. Im alive and happy, just need to get Ernie evicted :)
 
The surgery report said there wasn't a hiatal hernia. I suppose that doesn't guarantee that there was one and the surgeon missed it.

Why aren't they repairing "Ernie" for you?

Hiatal isn't the only type of hernia...there are LOADS :( Mine is from being ripped open after I started to bleed out post DS. So my issues are from my DS directly lol just surgical nightmares! ugh!

I will be getting him out at some point next year, hopefully Jan/Feb time. My surgeon no longer refers to it as a hernia cluster but a 'major defect'...I am defected ;) I also look pregnant with alien triplets!
 
The surgery report said there wasn't a hiatal hernia. I suppose that doesn't guarantee that there was one and the surgeon missed it.

Why aren't they repairing "Ernie" for you?
that stinks.....sorry. Hopefully you get in soon.
 

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