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I was put om 40mG omeprazole once per day. 6 weeks later at a second endoscopy to check progress on the ulcers (not much!) I was told, by the consultant endoscopist "That's not enough - 40mG lasts about 20 hours. You need to take two of those a day." Which I did for some time - about 5 months. But then I thought If 40mG lasts 20 hours, can I take one every 16 hours?
Regime 1 (40mG every 16 hours): so I'd take 40mG at 8 in the morning on getting up, another at around midnight before going to sleep, and a third around 4pm the next day. Then back to 8:am the next day. This worked fine. But see 20mg every 16 hours
But then I thought If 40mG lasts 20 hours, this 16 hour regime is still a bit of an overdose. Let me try 20mg. Maybe it would enable me to do an 8 hour regime:
Regime 2: (20mG or 10mG every 8 hours) 8 am. 4 p.m and midnight. Slightly easier for me to do than regime 1.
So I tested - exactly how long would 20mG last? I was fortunate in this respect as I regurgitated stomach fluid easily, so could tell when it was starting to get acid. I was a little surprised to find that with a 20mG dose, acidity doesn't start until between 17 and 18 hours later! Drugs such as PPIs have a half-life - the time it takes for half the dose to be metabolised. See my list of references on PPIs - their half life.
So in fact 20mG every 16 hours (Regime 1) works as well as 40mG every 16 hours!
Having discovered the half-life effect, I was naturally curious. How long would 10mG last. Experiments showed it lasted about 15 hours. So 10mG every 12 hours (regime 3) is as effective for me as 40mG every 16 hours. Your timing may be slightly different - absorption and clearance (by the liver) can vary slightly from one person to another.
Regime 3: 10mG 8 am and a second at 8 p.m.
Bile reflux was something I had not experienced before except on rare occasions such as serious vomiting. So I knew the taste of bile (very unpleasant - far, far worse than acid reflux). It was extremely concerning. See My life with gastro-oesophageal reflux for more comments! My page on bile may help you determine if your problems are acid or bile related.
Bile reflux is also extremely dangerous: see my list of references regarding bile
I experienced these nocturnal reflux events:
Microdosing may have an effect on acid levels but, looking back on the notes I made at the time, the effect is unclear. Presumably this is why 5mG doses are not available. I had done the experiment by opening a capsule and taking half the grains therein. h
PPIs work by poisoning a particular enzyme in the the cells that produce acid. See my list of references to how PPIs work
At this time, I had an almost permanent tickly cough. I had also lost weight so regurgitating stomach fluid to taste was no longer easy. What symptom would I notice first?
The tickly cough stopped! That was enough - I have never taken another PPI (Proton-Pump Inhibitor).
But there was a heavy price to pay: as had happened when I reduced to 5mG doses, I again experienced a very severe and unpleasant series of nocturnal bile reflux events.
PPIs are metabolised by the liver. They are a chemical that the liver thinks should not be present - see my references to Liver metabolism of PPIs. In general with time the liver gradually learns to metabolises such xenotoxins more efficiently, so with time the minimum effective dose may well increase. Or with time, PPIs may well become less effective.
As yet, I have found no technical papers to confirm or contradict this.
And I still have an occasional bad night from reflux. When it gets into my airways it wakes me up, but it doesn't get into my mouth so I can't taste it. So initially I thought it was not bile but pepsin. See my list of references to Pepsin. It is very unpleasant and causes a burning sensation which makes me cough. On one occasion (16 March 2018) it was so bad that I photographed the expectorated phlegm which was chrome yellow, so it can only have been caused by bile -probably with other digestive fluids from the pancreas. This event took over half an hour for the burning to start to wear off. I was coughing badly for the rest of the day. I had another similar episode in November 2018 then December 2018 but so for (May 2019) no more.
I've not noted these bile/pepsin reflux events carefully, but now, after being off PPIs for over 4 years, I have a distinct feeling that these pepsin attacks have been less common recently. But I'm now logging them...
However this continuing series of bile reflux events implies that my gall bladder, though apparently operating normally most of the time, is going into occasional spasms and therefore its operation had been permanently damaged by the PPIs.
So I still have a hiatal hernia, so I have reflux. But I've lost weight and can cope with the symptoms I have. My symptoms are fewer without PPIs and the papers I have found give me adequate evidence that I am maximising my chances of a long and healthy life.
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