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Richard John Torrens |
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As a child I had not infrequently suffered an "acid tummy" for which the cure was a dose of sodium bicarbonate (baking soda). My father was a consultant at the Bournemouth hospital and had done a lot of work on blood chemistry - pH and colloidal state. You can read his book on the subject. He was a firm believer in the benefits of sodium bicarbonate!
This acidity continued on and off but was rarely a real problem. Until October 1980 when I visited the doctor because of severe heartburn. My marriage was breaking down and I was worrying! The doctor prescribed Libraxin. The link is to an advert for it. Libraxin is basically a tranquilliser which is obsolete now, but it worked quite well! And although I was prescribed two doses per day, I tried taking it only when I felt the need - this worked fine and cut down on my intake of the drug - I have never been happy taking drugs!
It may well have been in 1980 that my Barrett's oesophagus started developing. There is no way to know!
By means of the acid reflux symptoms and the Libraxin, I even learnt to control my worry! The episode also proved to me that worry does indeed cause the stomach to secrete more acid. You can read Web MD on worry.
I was put on 40mG omeprazole, once a day, and was given another appointment 7 weeks later to check progress with the ulcers. 7 weeks later the ulcers had changed very little. The consultant endoscopist asked What PPI have you been prescribed?
When I told him 4mG once a day he said That's not enough - 40mG lasts about 20 hours. You need to take two of those a day.
This taught me two things: firstly that prescription of PPIs was very haphazard and correct dosage was very much a matter of differing opinion. Secondly that two 40mG doses per day was an over-prescription. This triggered my own experiments with PPI dosage.
At that time I regurgitated food quite often and could easily regurgitate gastric juice, so I knew what it tasted like. Under the influence of PPIs, it at first seemed to taste revoltingly sweet!
As a result of these dosage experiments I discovered that PPIs caused me bile reflux. The consultants simply would not discuss this very worrying side effect, dismissing it with such statements as:
So it seems that the medical profession has a particularly self-deceiving attitude towards bile reflux. There are no medicines that can control it, so they tend to ignore it.
My father (a consultant at Bournemouth hospital) warned my brother and I about doctors who would not openly discuss their prescriptions. A good doctor is always open to discuss the pros and cons and to consider alternative points of view: in essence they are prepared to listen to their patients, and are quite prepared to say they do not know, when they do not know. So this refusal of the consultants to discuss the worrying side effect of PPIs made me highly suspicious of them. As a result I started searching web-available medical technical papers for findings that would explain my own bile reflux, or prove to me that it was not a problem.
What I found was convincing evidence that, not only was bile reflux a severe problem, but also that it was likely to be common in about 75% of PPI users. Now PPIs are the magic drug of choice and there is no doubt that they do relieve much suffering in many, so current medical opinion seems to be that they can do little real harm. Doctors seem to prescribe them for any stomach upset, as if they are sweets!
But I did manage to find a few dissenting papers. And to find papers that explained why I suffered bile reflux, and ones that confirmed how dangerous this was.
Now the doctors are in agreement that the incidence of adenocarcinoma has been rising in the past 40 years and has been tracking almost exactly the increasing use of PPIs. My researches have convinced me that this is direct cause and effect - PPIs can and do cause Barrett's oesophagus and progression to adenocarcinoma! The mechanism is via bile reflux. But why are there so few medical papers that give any clues? See my page on Learned Papers.
The fact that bile reflux can and does cause Barrett's oesophagus to progress does not mean that progression is not possible without bile, but two papers I found say, in passing, that unmedicated Barrett's is much less likely to progress, it seems that there is nearly a 3-fold increase in progression amongst those on medication. See my list of references.
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