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logseq/bak/pages/GERD/2025-08-02T12_41_19.941Z.android.md
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logseq/bak/pages/GERD/2025-08-02T12_41_19.941Z.android.md
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- [[Approach to refractory GERD in adults]]
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id:: 65bd6219-3dc3-405c-9c77-14588e55497d
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- [[The Proton Pump Inhibitor Non-Responder - A Clinical Conundrum]]
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-
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- Artivles to read
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- [AGA Clinical Practice Update on the Diagnosis and Management of Extraesophageal Gastroesophageal Reflux Disease: Expert Review - Clinical Gastroenterology and Hepatology](https://www.cghjournal.org/article/S1542-3565(23)00143-X/fulltext)
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- **19:26** [[quick capture]]: [Extraesophageal GERD - ScienceDirect](https://www.sciencedirect.com/science/article/abs/pii/S0889855308000770)
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- **19:27** [[quick capture]]: https://www.cghjournal.org/article/S1542-3565(23)00144-1/fulltext
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- **19:56** [[quick capture]]: [Heartburn Solved: How to Reverse Acid Reflux and GERD Naturally - Case Adams - Google Books](https://books.google.com/books/about/Heartburn_Solved.html?id=uv3tEAAAQBAJ)
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- **20:20** [[quick capture]]: [How To Use a Low Histamine Diet for Histamine Intolerance](https://drruscio.com/low-histamine-diet/)
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id:: 65c23d1a-9005-4f67-bc08-0ee8422530f0
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- **20:21** [[quick capture]]: [Alternatives to Acid Suppression Treatment for Laryngopharyngeal Reflux - Mikayla J. Huestis, Katherine R. Keefe, Chase I. Kahn, Lauren F. Tracy, Jessica R. Levi, 2020](https://journals.sagepub.com/doi/10.1177/0003489420922870?icid=int.sj-full-text.similar-articles.8) #gerd
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- **21:31** [[quick capture]]: https://www.reddit.com/r/GERD/s/bdNdZHkPFo #gerd
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- # Meds tried
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Sucralafate
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Famotidine
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Dexlansoprazole
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Omeprazole
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Pantoprazole
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-
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- Stonehenge dynamic probiotics
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-
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-
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23
logseq/bak/pages/GERD/2025-08-12T17_03_40.137Z.android.md
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logseq/bak/pages/GERD/2025-08-12T17_03_40.137Z.android.md
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- [[Approach to refractory GERD in adults]]
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id:: 65bd6219-3dc3-405c-9c77-14588e55497d
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- [[The Proton Pump Inhibitor Non-Responder - A Clinical Conundrum]]
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-
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- Artivles to read
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- [AGA Clinical Practice Update on the Diagnosis and Management of Extraesophageal Gastroesophageal Reflux Disease: Expert Review - Clinical Gastroenterology and Hepatology](https://www.cghjournal.org/article/S1542-3565(23)00143-X/fulltext)
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- **19:26** [[quick capture]]: [Extraesophageal GERD - ScienceDirect](https://www.sciencedirect.com/science/article/abs/pii/S0889855308000770)
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- **19:27** [[quick capture]]: https://www.cghjournal.org/article/S1542-3565(23)00144-1/fulltext
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- **19:56** [[quick capture]]: [Heartburn Solved: How to Reverse Acid Reflux and GERD Naturally - Case Adams - Google Books](https://books.google.com/books/about/Heartburn_Solved.html?id=uv3tEAAAQBAJ)
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- **20:20** [[quick capture]]: [How To Use a Low Histamine Diet for Histamine Intolerance](https://drruscio.com/low-histamine-diet/)
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id:: 65c23d1a-9005-4f67-bc08-0ee8422530f0
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- **20:21** [[quick capture]]: [Alternatives to Acid Suppression Treatment for Laryngopharyngeal Reflux - Mikayla J. Huestis, Katherine R. Keefe, Chase I. Kahn, Lauren F. Tracy, Jessica R. Levi, 2020](https://journals.sagepub.com/doi/10.1177/0003489420922870?icid=int.sj-full-text.similar-articles.8) #gerd
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- **21:31** [[quick capture]]: https://www.reddit.com/r/GERD/s/bdNdZHkPFo #gerd
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- # Meds tried
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Sucralafate
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Famotidine
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Dexlansoprazole
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Omeprazole
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Pantoprazole
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-
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- Stonehenge dynamic probiotics
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-
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-
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logseq/bak/pages/GERD/2025-12-10T17_56_58.313Z.Desktop.md
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logseq/bak/pages/GERD/2025-12-10T17_56_58.313Z.Desktop.md
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tags:: health
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- [[Approach to refractory GERD in adults]]
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id:: 65bd6219-3dc3-405c-9c77-14588e55497d
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- [[The Proton Pump Inhibitor Non-Responder - A Clinical Conundrum]]
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-
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- Artivles to read
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- [AGA Clinical Practice Update on the Diagnosis and Management of Extraesophageal Gastroesophageal Reflux Disease: Expert Review - Clinical Gastroenterology and Hepatology](https://www.cghjournal.org/article/S1542-3565(23)00143-X/fulltext)
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- **19:26** [[quick capture]]: [Extraesophageal GERD - ScienceDirect](https://www.sciencedirect.com/science/article/abs/pii/S0889855308000770)
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- **19:27** [[quick capture]]: https://www.cghjournal.org/article/S1542-3565(23)00144-1/fulltext
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- **19:56** [[quick capture]]: [Heartburn Solved: How to Reverse Acid Reflux and GERD Naturally - Case Adams - Google Books](https://books.google.com/books/about/Heartburn_Solved.html?id=uv3tEAAAQBAJ)
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- **20:20** [[quick capture]]: [How To Use a Low Histamine Diet for Histamine Intolerance](https://drruscio.com/low-histamine-diet/)
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id:: 65c23d1a-9005-4f67-bc08-0ee8422530f0
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- **20:21** [[quick capture]]: [Alternatives to Acid Suppression Treatment for Laryngopharyngeal Reflux - Mikayla J. Huestis, Katherine R. Keefe, Chase I. Kahn, Lauren F. Tracy, Jessica R. Levi, 2020](https://journals.sagepub.com/doi/10.1177/0003489420922870?icid=int.sj-full-text.similar-articles.8) #gerd
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- **21:31** [[quick capture]]: https://www.reddit.com/r/GERD/s/bdNdZHkPFo #gerd
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- # Meds/Diets tried
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- **Diet modification (2023)**
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- Modifications:
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- Removed Alcohol / caffeine from diet
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- added watermelon and cucumber juice
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- added algae raft
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- No lasting change to symptoms. Some short-term benefit after taking raft
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- **Omeprazole (2023)**
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- worsening of reflux symptoms, notably the 'sore throat' and sore esophagus.
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- symptoms worse within 1-2hours of taking a dose.
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- **Pantoprazole (2023)**
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- similar side effects to the Omeprazole (decreased heartburn, but increased coughing, extreme agitation, and severe brain fog).
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- As an experiment, I stopped the Pantoprazole for the last 2 days and saw an immediate improvement in the agitation, brain fog, and coughing, but the heartburn and sore throat returned.
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- **Sucralafate + Famotidine (2023)**
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- symptoms worsened + constant heartburn
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- **Stonehenge Health Probiotics (2023-25)**
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- reduced symptoms by 70-80%
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- ENT scope of vocal cords showed 90% reduction in inflammation
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- Reverts if I stop taking it
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- SUPPLEMENT Info
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- Dynamic 16 Strain Probiotic Blend (55 Billion CFUs)
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- L. casei Lc-11®, B. breve Bb-18, L. rhamnosus GG,
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- B. lactis Bl-04®, B. lactis HN019,
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- B. bifidum Bb-06 M, L. plantarum Lp-115®,
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- L. fermentum SBS-1, L. acidophilus La-14®,
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- L. rhamnosus Lr-32, L. brevis Lbr-35 TM,
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- B. longum BI-05 M, L. reuteri 1E1, L. gasseri Lg-36M,
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- L. paracasei Lpc-37®, L. salivarius Ls-33®
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- Prebiotic Fiber Blend
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- Inulin (Chicory Root Extract), Fructooligosaccharides (FOS, as NutraFlora®)
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- Other Ingredients: Capsule (Hypromellose, Water, Gellan Gum), Microcrystalline Cellulose, Silica, Calcium Laurate.
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- **Florastor (2025)**
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- some benefit, but not as effective as Stonehenge
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- Stopped as avoiding dairy fillers
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- potential alternative?: Klaire Labs SFI Health Ther-Biotic Saccharomyces Boulardii
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- **Diet modification (2025)**
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- Removed foods identified by FIT test
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- Chicken, Eggs, Wheat, Dairy, Pecans, Cashews, etc
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- No change to existing symptoms - added symptoms of increased gas (burping)
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- Glick Notes:
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- Oct 6 2023
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- Dr Glick, I have now been on the Omeprazole for 2+ weeks. During this time I have seen a worsening of my reflux symptoms, notably the 'sore throat' and sore esophagus. I've noticed that the symptoms are worse with 1-2hours of taking a dose. Is this normal or should be seeing signs of improvement by now? Regards, Stuart
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background-color:: blue
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- [Glick] Hi Mr. Stent, I'm sorry to hear this, it's unusual to have this but it can occur. Let's change the brand to pantoprazole. I'll send it through now, hopefully this takes care of the issue. Let me know how it goes. Best, Michael
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background-color:: green
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- Thank you. I assume this means I should also stop the OTC version (prilosec)? I see this new prescription is for 40mg. Do I need an OTC for the other 40mg?
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background-color:: blue
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- [Glick] Yes we'd have to stop that too. Although this is the standard 40 mg dose and not twice a day, let's start at this lower dose given your reaction to 80 mg of omeprazole. If not improving within a couple weeks, let's try to increase to 80 mg if your insurance will allow this. There is no OTC version of this one.
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- Oct 17 2023
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- Dr Glick, I have been on the Pantoprazole 40mg 1xd for just over a week, and have experienced similar side effects to the Omeprazole (decreased heartburn, but increased coughing, extreme agitation, and severe brain fog). As an experiment, I stopped the Pantoprazole for the last 2 days and saw an immediate improvement in the agitation, brain fog, and coughing, but the heartburn and sore throat returned. What is the next thing to try?
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background-color:: blue
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- [Glick] Sorry to hear you're continuing to have reactions to these meds. Let's use a different class of medicine that's gentler. It's called famotidine and it's twice daily. Let me know how this goes. Sending through now - Michael
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background-color:: green
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- Feb 5, 2024
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- Dr Glick, My symptoms are still not improving, if anything they are worse and now getting actual heartburn feelings. I have removed any alcohol (stopped last year) and caffiene (Feb 1st) from my diet, and have been taking the Sucralfate and Famotidine every day. What else can I try? I don't feel like the PPIs are doing anything that will help long term.
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background-color:: blue
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- [Glick] To confirm, are you taking sucralfate four times a day and famotidine 40 mg twice a day?
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- That's correct. I take the first Famotidine at 7am and 5:30pm, and the Sucralfate at 8am, 11am , 4pm and 8pm
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background-color:: blue
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- [Glick] We've cycled through several PPIs (not all) and you're now on the max of H2 blockers and cytoprotective meds (sucralfate). At this point I would recommend considering Elavil, which is an anti-depressant shown to help with numerous GI issues. We'd just use a low dose at night, as sometimes it causes drowsiness. This would take a few weeks to work but for some can really help. Let me know if you're interested in this as a next step - Michael
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background-color:: green
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- No, I am not interested in Elavil as a next step. What other options/tests are there?
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background-color:: blue
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- [Glick] I understand. One option is to switch to yet another PPI like lansoprazole, although we're both hesitant to try those again at this time. Another is to have you undergo manometry and pH testing, which are invasive and potentially uncomfortable, to determine the extent of acid reflux. These are reasonable to consider but even if they don't clearly show acid reflux, we might not trust the result and would likely still treat you. A third option is to have you see a thoracic surgeon to discuss acid reflux surgery, but I think you'd agree this would only be a last resort. Let me know your thoughts - Michael
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background-color:: green
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