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Nope. He didn't say anything about weaning. How would you wean since it's only 1 pill a day? Cut it in half for a few days? Excess acid wouldn't cause diarrhea?
 
We had to cut the pill in half with a h2 blocker added twice a day
For a few weeks
Then lower the h2 slowly as well
Your body makes a certain amount of acid
When you take a ppi it tries to stop the body from making the acid it wants too
So the body is working twice as hard to make acid
Stop the ppi and nothing is blocking all that extra acid your body has been trying to making
So it goes overboard for a while


Make sure you check with her Gi before your do anything
This is just what our gi had us do for my kiddo
So you need your doctors input
 
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News & Perspective Multispecialty
Discontinuation of Proton Pump Inhibitors in Patients on Long-Term Therapy: A Double-Blind, Placebo-Controlled Trial
E. BjÖrnsson; H. Abrahamsson; M. SimrÉn; N. Mattsson; C. Jensen; P. Agerforz; A. Kilander | Disclosures
Aliment Pharmacol Ther. 2006;24(6):945-954.

DISCUSSION
During the last two decades, peptic ulcer as an indication for PPIs has decreased whereas GERD has become a major indication although dyspepsia and prophylactic therapy are also common indications.[1-7] In a recent study, approximately 60% of patients on long-term PPIs had GERD.[15] This is very similar to our original cohort of PPI users participating in our symptom survey.[16] However, 78% of patients willing to participate in the current study had GERD. We observed a positive association between GERD as an indication for PPIs and the need to resume PPIs. Consequently, the proportion of patients resuming therapy seems to depend to a great extent on the indication. At the end of follow-up 27% of patients were off PPIs in the current study but this proportion would probably have been larger if more non-GERD patients had participated. Our results do not permit firm conclusions to be drawn on the proportion of long-term PPI users in general who could do well without medication. However, it seems unlikely that the patients who were willing to participate were in less need of PPIs than those who did not, as GERD was more common in the participants than in those who chose not to participate.

Very limited data exist on the need for long-term acid-suppressive therapy in PPI users in general. Cooper et al.[17] carried out an audit of PPI prescribing in general practice in the UK and 12% of patients had their acid-suppressive therapy discontinued completely. However, the proportion of PPI users with a confirmed diagnosis of GERD was unclear, follow-up was short and no quality of life assessments was made.[17] In the current study, we found that 79% of GERD patients had resumed PPIs at the end of follow-up whereas 21% were off PPIs, although two patients used H2-receptor antagonists occasionally. Our results with 19% of GERD patients being asymptomatic without medication are similar to the 15% of GERD patients not needing medical therapy in a study of step-down management of PPIs.[8] However, no upper endoscopy was performed and their method of tapering down the PPIs for successful discontinuation was not evaluated.[8] In the current study 14% of the patients who had endoscopy had oesophagitis and had a very similar reflux score at baseline compared with those without oesophagitis. It would therefore appear to be reasonable to perform an upper endoscopy before a decision can be made in patients with GERD to discontinue PPIs completely as patients who are already on long-term PPIs but still have erosive disease should not have their PPIs discontinued.

The GERD patients who reinstituted PPIs shortly after discontinuation seem to have a truly acid-related disorder whereas the non-GERD patients resumed PPIs after a median of 95 days. One patient resumed PPIs just 4 days after the start of the study medication, choosing the same treatment that she was on previously. Psychological factors in these patients cannot therefore be ignored.[18]

Recent studies have shown that many GERD patients take PPIs on demand.[1, 19-22] In the current study, patients taking PPIs on demand were excluded. Most patients with GERD were willing to continue with PPIs on demand to control their symptoms but 50–60% of patients continued with placebo on demand.[21-22] The reasons for the different results of these trials compared with our results are unclear. Placebo treatment is not equivalent to absence of therapy. The recruitment of patients was also different and prior long-term therapy was not a prerequisite for inclusion but 'endoscopy-negative GERD as defined by symptoms'.[22] As our patients were strictly those who used PPIs every day it seems logical that it might be more difficult for these patients to discontinue PPIs completely.

We observed a significant improvement in the quality of life as measured by the PGWB index at all intervals in those who were off PPIs. The improved quality of life is probably not due to the absence of PPIs but rather associated with being in a clinical study with endoscopy, lab tests, being cared for by a study nurse and evaluation by a gastroenterologist with reassurance. Those who were off PPIs also had unchanged or fewer GI symptoms. Thus, most patients who were off PPIs at the end of follow-up had been prescribed PPIs for symptoms unlikely to be due to acid production.

Acid rebound hypersecretion after discontinuation of acid-suppressive therapy has been well documented with acid output measurements.[9-11] The clinical implication of the acid rebound hypersecretion after discontinuation of PPIs is still unclear. It is conceivable that this might lead to exacerbation of reflux symptoms and explain the clinical experience of many doctors that discontinuation of PPIs is difficult due to symptom recurrence. The short period of tapering did not seem to make it easier for patients to be off PPIs compared with patients who discontinued therapy promptly. It is possible that a more prolonged tapering would have been more effective in order to step down from a PPI to no therapy. Very limited data exists on symptoms associated with discontinuation of PPIs. A pilot study with a short-term course of omeprazole 20 mg in healthy volunteers induced significant rebound heartburn symptoms.[23] The current study is the first to test the hypothesis that tapering might be helpful in stepping down from a PPI to no therapy. Withdrawal of ranitidine induced dyspeptic symptoms that lasted for only a few days[12] and in a previous uncontrolled study tapering was performed in 2 weeks.[8] However, the results of the current study put the question of tapering into a new perspective. Gastrin at baseline was significantly higher in GERD patients who resumed PPIs vs. GERD patients who were off PPIs and was independently associated with PPI requirement. Long-term hypergastrinaemia is associated with increased gastric acid secretion.[24] Furthermore, Gillen et al.[10] demonstrated that the degree of increase in maximal acid output after discontinuation of omeprazole was related to fasting gastrin levels. It thus seems likely that GERD patients with high fasting gastrin might be more prone to develop symptomatic acid rebound and would therefore experience more difficulty in discontinuing PPIs. It is conceivable that only patients with high gastrin levels would need tapering in order to decrease the risk of a clinically significant acid rebound. We found gastrin levels above the upper limit of normal in a minority of our patients, which is in line with other studies.[1, 25-26]

In conclusion, discontinuation of PPI was successful in 27% of long-term PPI users. GERD patients had more difficulty discontinuing PPI than non-GERD patients. Hypergastrinaemia seems to be an important predictor of PPI requirement in GERD patients. Discontinuation of these drugs might be possible in some PPI users without a strong indication for the drug, especially if they do not have symptoms of GERD, although recommendations on the mode of discontinuation can not be made at the present time.
Click to expand...

From
http://www.medscape.com/viewarticle/545104_4
 
Taper off the PPI slowly.

The higher the dose, the longer the taper. Expect rebound symptoms.
Decrease the current PPI dose by 50% each week until patient is on the lowest dose once daily.
In 2 weeks, change to H2 blocker. If symptoms flare, can alternate H2B every other day with omeprazole.
After 2-4 weeks on H2 blocker, try stopping or weaning.
After 2 weeks off H2 blocker, try tapering off supplements.
Continue lifestyle modifications.
Click to expand...


From
http://www.nbcms.org/about-us/sonom...d-patients-off-ppis.aspx?pageid=668&tabid=747
 
Step down approach to wean off daily use of PPIs

RefluxMD’s medical advisors developed a set of guidelines to reduce the use of daily PPIs via a step down approach. The following infographic provides an overview of their approach:



There are several important things to note before starting this step down program:

Before you make medications changes, please consult with your physician.
Make small and gradual changes to your medication.
Remember your goal: stop the use of daily PPIs and find the least potent medication (H2 blocker or antacid) used at the lowest dose that will effectively control your symptoms.
It is critical to implement both diet and lifestyle changes before you attempt to wean off these medications. Both diet and lifestyle changes are discussed on our website and in our free GERD guide.
Your weight has an impact on GERD symptoms. If your BMI is not at 25 or less, consider a weight loss program prior to elimination of daily PPIs.
Take it slow. Your body is adjusting to major changes so do not go too fast.
There are no hard and fasts rules here. Since each of us is different, we will all respond differently to this process.
If you find that your symptoms increase, take a step back or stop the process.
Click to expand...

From

http://m.refluxmd.com/?url=http://w...ean-myself-ppi-medications&utm_referrer=#2451
 
Thank you for the information. She's been on Omeprazole several times before and we've never weaned and never had an issue. I didn't even know to ask about that. Her study is scheduled 2 weeks out so that doesn't leave much time for a taper. I'll email GI on Monday if she's still having issues.
 
If she is having a test then that may be why the Gi is having her push through
Rebound is common when there is a fast wean but eventually it does get better

Rebound can be avoided if it's done slower that's all
 
Throat swabs were negative. Can reflux cause a sore red throat? Allergies? Can't be a virus because it stays red.
 
Yes Reflux can cause a sore throat and hoarseness. I second MLP that you should wean it if you have enough time. How long does she have to be off of it? If you can't do a slow wean do a fast wean. This is the fast wean schedule. Open the capsules and take out 1/4 of the little balls inside, then after three days take out half, then another three days and take out 3/4's. It is miserable to come off them. I did it over the summer. Did great for six months took methyl prednisone for an ear issue and reflux came back horribly. It is a nightmare.
 
kimmidwife said:
Yes Reflux can cause a sore throat and hoarseness. I second MLP that you should wean it if you have enough time. How long does she have to be off of it? If you can't do a slow wean do a fast wean. This is the fast wean schedule. Open the capsules and take out 1/4 of the little balls inside, then after three days take out half, then another three days and take out 3/4's. It is miserable to come off them. I did it over the summer. Did great for six months took methyl prednisone for an ear issue and reflux came back horribly. It is a nightmare.
Click to expand...

GI said to discontinue 7-10 days before procedure (we did not have procedure scheduled until after appointment). Procedure is 10 days away so no time for a wean. I truly didn't know this was to be weaned. She's taken it at least 5 different times over the years and never had a problem coming off until now. I feel terrible for her but we've got to get answers so we can help her. She's gasping every 20-30 seconds now. She just says her chest burns and is so tight it feels like her lungs won't fill up enough. Very frustrating.
 
Have they looked at vocal cord dysfunction as well ???
Looks sounds and feels like asthma shortness of breathe etc...
But it's vocal cords spasming ( so real just harder to prove medically )
 
Wow. I'm really intrigued by this info about weaning Omeprazole! I'm sorry Dancemom this is adding another thing to all she is dealing with. Enough already!

I read your note that she had explosive diarrhea when she came off Omeprazole. My son has been taking Omeprazole for a year and a half. It has been so long I forgot all the details (can check) but he was in a study for it and IBD. He didn't take it for a week or so early on before a scope and had similar experience as your daughter.

I hope this reaction is short and wish her the best for her procedure.
 
Sorry to hear how much she is suffering, wish there was an easier way to get the tests done!
 
my little penguin said:
Have they looked at vocal cord dysfunction as well ???
Looks sounds and feels like asthma shortness of breathe etc...
But it's vocal cords spasming ( so real just harder to prove medically )
Click to expand...

Doctors haven't mentioned this but I have come across it in my searches. Could be, but her breathing is never noisy and her voice is never affected. She breathes normally during sleep though which has me wondering.
 
My oldest has it- officially dx
As well as asthma
No noisy breathing or changed voice either

His allergist did a test
 
What are his symptoms? Does it last for months with no relief? Did they determine a cause?

I've even wondered if her spleen is pushing on her diaphragm giving her the sensation that her breaths aren't adequate. I haven't been able to schedule the ultrasound yet but hope to try again tomorrow.
 
Similar to asthma exterbations
Shortness of breath
Feeling he wasn't able to breathe deep enough
Increase asthma meds
Gave albuterol a lot etc for months

Finally got bad enough allergist pulled him in for a lung function test while he was having trouble
Lung function was perfect
No improvement with albuterol and pulse oxy was fine
Dx was made although there is a more invasive test
Had an appt with a speech therapist who specialized in VOC
Taught him everything to do to handle it
After a few weeks to a month
With the proper exercises things dramatically improved
 
We've tried several relaxation/breathing techniques given to us by our GI and my friend who is an SLP. They just haven't helped, not even a little bit.

Today she's complaining of a severe headache, not relieved by Ibuprofen (didn't have Tylenol). Thinking she may be coming down with something. Just in time to go back to school....
 
We tried normal breathing things prior
And with others no relief
You need someone who works with Voc kids on a regular basis at a major hospital
Not sure how the Gi who is a gut specialist would be an expert in a breathing disorder
Regular slp did not help at all
Just saying
I was beyond skeptical when the allergist said we had to see one specific slp
Not any other the others would do
At all

But it worked
 
Our GI diagnosed A's immune deficiency so I trust him on many levels. He recommended yoga and specific breathing techniques that have been helpful for other patients he sees. My friend is an SLP at the children's hospital we go to for immunology. She specializes in feeding disorders and vocal cord disorders. I didn't just Google breathing techniques and wing it. We tried these techniques from July-September with no improvement. Only got relief after 2 weeks on Omeprazole, then all symptoms resolved. GI thinks that was a coincidence, and it could be, but it is worse now than ever. Started techniques back up and no improvement. We're both frustrated so I've told her she can quit them until after tests are complete. She wants to continue yoga because she enjoys it and finds it helpful for dance. If this is all caused by anxiety/stress we will definitely get counseling and probably meds, at least for the short term. She is happy, energetic, and full of life, but this breathing issue is just a nagging problem.
 
I have no advice but just wanted to send hugs! My older daughter stopped Prevacid without weaning once and she was SO miserable. After that experience, we always weaned, even if it was just by dumping some of the little balls out of the capsule and reducing them over a few days.

Sounds like at least part of this might be reflux since the Prilosec was helping?
 
Prilosec gives my daughter diarrhea - profusely. I don't know why she'd have it worse off of it. Acid reflux can cause asthma-like symptoms. This doesn't surprise me at all. Is it possible for your daughter to use Tums or Maalox for a few days until she is in the 7-10 days prior to test window?
 
Emailed GI nurse today. A's diarrhea has gotten worse with 4 accidents in the last week and waking once at night. Been a long time since she's done this. She's frustrated that she isn't dancing to her full potential because she isn't feeling well. She cried about it last night which breaks my heart. Hopefully we get some answers soon.
 
I emailed late Friday afternoon so I figured I wouldn't hear back until Monday. Her appointment is Thursday so I'm sure they won't make a plan until then.
 
Is the pH probe on Thursday too?
I hope A feels better. It's really just the worst when it affects all aspects of their lives :ghug:.
 
She will be admitted Thursday morning for upper scopes and the ph probe. Insurance wouldn't cover the ultrasound inpatient so we'll have to come back Monday for that. Follow-up visit is at the end of the month.
 
They can discharge her and schedule you for the ultrasound right after the discharge
The docs can make it happen
--they did that for ds
Much better than an extra trip ;)
 

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