Q: Love your column! Four years ago I took several vitamins all at once but not much water as we were on a fishing trip with no access to a bathroom. I did this several days straight and realized that I had a big lump in my chest. Thinking it must be all those vitamins lodged in my esophagus, I could not get food down so my doctor performed an esophagoscopy. By then it had cleared but the doctor told me I should take a Prilosec every day for the rest of my life. Since then I have heard that a person should not take Prilosec every day. Is it doing me more harm than good? I would like your advice and thank you so much.
A: Prilosec is in a group of drugs known as proton pump inhibitors. It decreases the amount of acid produced in the stomach and is used to treat symptoms of gastroesophageal reflux disease, otherwise known as GERD. It is also prescribed by physicians to promote the healing of erosive esophagitis and may be prescribed with antibiotics to treat gastric ulcers caused by infection with H. pylori.
It appears that you may have erosive esophagitis. If so, the recommended course of therapy is between four and eight weeks. Some individuals who take the medication for extended periods at high doses and those 50 or older may increase their risk of fractures of the hip, wrist or spine. So, while there are potential problems with chronic use, there are hypersecretory conditions that do call for long-term use of Prilosec. Even when following the recommended dosing, this medication can cause diarrhea.
It is difficult for me to determine if you suffered from reflux or more likely, erosive esophagitis when you swallowed pills without sufficient water while on your fishing trip. Reflux is a condition in which food and liquid leak backwards from the stomach into the esophagus, causing irritation, heartburn and other symptoms. Corrosive or erosive esophagitis is a condition in which the esophagus is damaged by harmful substances such as taking pills without sufficient water to wash them down. It can develop in chronic GERD patients. Symptoms may include bleeding in almost 10% of patients. If the bleeding is long-term, iron deficiency anemia can result and may be so severe it requires blood transfusions. Strictures can also develop if the esophagus is severely injured over time. These strictures may prevent other symptoms of GERD but may require surgery to restore the normal swallowing pattern. So, without knowing specifically why your physician recommended you take Prilosec every day for the rest of your life, I cannot determine if it is correct or not.
I recommend you make an appointment with your primary care physician to determine why he made the recommendation. Then, equipped with any X-rays or other testing reports, visit a top-notch gastroenterologist for a second opinion. Perhaps it’s even time for follow-up testing to determine if any strictures or other abnormalities are observed or if the condition has been eradicated. Then, based on your history and the results of your second opinion, a proper decision can be made. Your gastroenterologist may have other recommendations for taking you off the medication and getting you on the road to recovery.
