What are H2 Blockers and GERD

Many of us run to the pharmacy as soon as we feel any kind of heartburn. When we get to the pharmacy, we're bombarded by different remedies.  One type of remedy we can take are called H2 Blockers.

I thought maybe you'd like some more information on these drugs:

Examples of H2 Blockers

Generic Name	Brand Name
cimetidine	Tagamet
famotidine	Pepcid
nizatidine	Axid
ranitidine	Zantac

H2 blockers (also sometimes referred to as acid reducers or H2 receptor antagonists) are available in nonprescription and prescription forms. Prescription forms are stronger than the nonprescription forms.
H2 blockers are usually taken by mouth, although some can also be given as an injection. Two doses (morning and evening) are generally recommended to control both daytime and nighttime symptoms. Doctors sometimes recommend a single dose, taken at bedtime, for people who have difficulty remembering to take their medicines.

How It Works

H2 blockers reduce the production of stomach acid. This makes the stomach juices less acidic so that any stomach juice that gets into the esophagus is less irritating. This relieves symptoms and allows the esophagus to heal.

Why It Is Used

H2 blockers are used to treat the symptoms of gastroesophageal reflux disease (GERD). They may be prescribed for your symptoms without any diagnostic testing if your symptoms point to GERD.

• H2 blockers may be used together with antacids.
• Nonprescription H2 blockers may be used for up to 2 weeks for short-term symptom relief. But if you have been using nonprescription medicines to treat your symptoms for longer than 2 weeks, talk to your doctor. If you have GERD, the stomach acid could be causing damage to your esophagus. Your doctor can help you find the right treatment.
• H2 blockers may be used on a long-term basis to relieve persistent GERD symptoms.

How Well It Works

All of the H2 blockers in this class are about equally effective.
H2 blockers heal the damage done to the esophagus by GERD (esophagitis) in about 5 out of 10 people.

H2 blockers also work to help symptoms of GERD. But the number of people who take H2 blockers and who have no GERD symptoms is usually less than 5 out of 10 people. That means that of the people taking H2 blockers, more than 5 out of 10 still have some GERD symptoms.

Side Effects

H2 blockers have been in use since the late 1960s. H2 blockers are well studied and are considered very safe.
Minimal side effects occur with use of H2 blockers. Side effects may include:

• Headache.
• Dizziness.
• Diarrhea.
• Constipation.
• Nausea.
• Vomiting.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Enjoying Nexium

I have read a lot of blogs the last few weeks and currently feel quite fortunate that Nexium did work for me.  It seems there's many out there that take PPIs twice a day, in addition to other medicines but nothing works.  I was lucky in that 1 Nexium in the morning was enough to keep me, mostly, symptom free all day.

Alright, so what is Nexium and what are PPIs?

Nexium:

Nexium (esomeprazole) belongs to a group of drugs called proton pump inhibitors. Nexium decreases the amount of acid produced in the stomach.
Nexium is used to treat symptoms of gastroesophageal reflux disease (GERD) and other conditions involving excessive stomach acid such as Zollinger-Ellison syndrome. Nexium is also used to promote healing of erosive esophagitis (damage to your esophagus caused by stomach acid).
Nexium may also be given to prevent gastric ulcer caused by infection with helicobacter pylori (H. pylori), or by the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
Nexium is not for immediate relief of heartburn symptoms.
Nexium may also be used for other purposes not listed in this medication guide.

Nexium Side Effects:

Get emergency medical help if you have any of these signs of an allergic reaction to Nexium: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Stop using Nexium and call your doctor at once if you have any of these symptoms of low magnesium such as:

• dizziness, confusion;
  
• fast or uneven heart rate;
  
• jerking muscle movements;
  
• feeling jittery;
  
• diarrhea that is watery or bloody;
  
• muscle cramps, muscle weakness or limp feeling;
  
• cough or choking feeling; or
  
• seizure (convulsions).
  

Less serious Nexium side effects may include:

• headache, drowsiness;
  
• mild diarrhea;
  
• nausea, stomach pain, gas, constipation; or
  
• dry mouth.
  

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Proton Pump Inhibitors (PPIs)

Proton pump inhibitors (PPIs) are medicines that work by reducing the amount of stomach acid made by glands in the lining of your stomach.

• Relieve symptoms of acid reflux, or gastroesophageal reflux disease (GERD), a condition where food or liquid travels backwards from the stomach to the esophagus (the tube from the mouth to the stomach)

• Treat a peptic or stomach ulcer

• Treat damage to the lower esophagus caused by acid reflux

Types of PPIs

There are many different names and brands of PPIs. Most work as well as another. Side effects may be different for different ones.

• Omeprazole (Prilosec), also available over the counter without a prescription (Prilosec OTC)
• Esomeprazole (Nexium),
• Lansoprazole (Prevacid),
• Rabeprazole (AcipHex)
• Pantoprazole (Protonix)
• Dexlansoprazole (Kapidex)

Although I was scared, I started taking the Nexium every morning as soon as I got up.  At first, I felt just as sick, like the side effects were worse than the disease; within a week most side effects were gone.  It became a habit, something I just didn't think about.  I just knew I had to take my medication and couldn't drink too much.  Mainly limited my drinking to 1-2 drinks.  That definitely slowed my social life.  I wasn't 100% but I was close enough where I just didn't think I was sick anymore.

After 1 month on Nexium I tried to stop it.  I felt fine the first day, so I went on my usual super drinking and eating.  The following day I was so sick I ran to get another refill.  As the end of my 3rd month approached, I realized I had to some how find a cure for whatever was wrong with me.  At least that's how I was thinking: I just need to cure myself naturally.  No more drugs.  No more risk of 101 side effects.

GERD Doctors - The Gastroenterologist

After ending up in the hospital twice during the same week of New Years Eve (quite the beginning for the year), I went to 2 gastroenterologists.

A gastroenterologist is a physician who specializes in disorders and conditions of the gastrointestinal tract. Most gastroenterologists are board-certified in this subspecialty. After completing the same training as all other physicians, they first complete at least two years of additional training in order to attain board certification in internal medicine, then gastroenterologists study for an additional 2-3 years to train specifically in conditions of the gastrointestinal tract.

The first one of these that I went to said he thought it was an ulcer, so to schedule an appointment.  Due to health insurance issues (surprise surprise), I had to switch to another doctor so I scheduled another appointment.  This time I was prepared, though swearing this had to be an ulcer, and had a list of questions:

1. What's the most likely cause of my symptoms?
2. Are there other possible causes for my symptoms?
3. What kinds of tests do I need, and how do I need to prepare for them?
4. Is my condition likely temporary or chronic?
5. What treatment do you recommend?
6. How quickly will I start to feel better?
7. What if my symptoms don't improve?
8. What are the alternatives to the primary approach that you're suggesting?
9. Are there any dietary restrictions that I need to follow?
10. Is there a generic or over-the-counter alternative to the medicine you're prescribing me?
11. Are there any brochures or other printed material that I can take with me? What websites do you recommend?
12. What caused me to develop this ulcer?

I think I got this list from a website.

The second doctor right away said she thought I had IBS ("Irritable Bowel Symdrome") and gave me materials.  I read the materials and they pretty much said this of IBS:

Irritable bowel syndrome (IBS) is a common disorder that affects your large intestine (colon). Irritable bowel syndrome commonly causes cramping, abdominal pain, bloating gas, diarrhea and constipation. Despite these uncomfortable signs and symptoms, IBS doesn't cause permanent damage to your colon.  

Now, I that point I had a long list of symptoms I carried with me for my doctor's information.  However, I absolutely knew I did not have IBS.  The only time I had ever been constipated was during my first "GERD Episode."  Otherwise, I have always been very regular, have had normal movements, and my symtoms were more like an ulcer if anything.

However, she said I needed to change my diet.  I read but dismissed her diagnosis, though I did make the appointment for the endoscopy, after much haggling with my insurance.  She also gave me a 3 month prescription for Nexium.  I read about PPIs, about how they have a million side effects.

During that time, I was eating every two hours and more like a bird.  I resented this change in eating.  I complained to everyone I could.  I did not want to fill the prescription because I hated drugs.

Finally, I went in for the endoscopy and all they found was inflammation around my lower esophageal sphincter. The doctor told me that was it, no ulcer, so I started to take the Nexium.