The Value of A Second Opinion Consult for Reflux and other Digestive Disorders
Seeking a Second Opinion Consult
Have you had gastrointestinal issues, such as acid reflux, that have not been resolved? You may want to consider seeking a second opinion consult. Dr. Rudert specializes in helping patients from all over the United States for second opinion consults on a variety of gastrointestinal disorders. Dr. Rudert’s focus is identifying the core causes of gastrointestinal issues with a comprehensive evaluation enabling her to treat underlying medical conditions that may have previously been undetected. Dr. Rudert then creates an individualized course of treatment tailored to each patient’s unique set of needs. Rather than just treating the symptoms of the disease, Dr. Rudert believes the best results are achieved by getting to the core cause of the problem and treating the disease accordingly.
What is Reflux?
Dr. Rudert answers:
Typically reflux is assumed (not always correctly) to be from stomach acid that is causing inflammation, burning and sometimes ulcerations in the lining of the esophagus. Often the symptoms may occur in relationship to a meal or specific foods. It is commonly referred to as heartburn and may also be diagnosed as GERD or Gastroesophageal Reflux Disease.
What is the treatment?
Dr. Rudert answers:
Many individuals self medicate with a variety of OTC (over the counter) products such as chewable or liquid antacids in addition to a variety of acid suppressing medications called H2 receptor antagonists. Many physicians and other healthcare providers often prescribe medications known as PPI's (proton pump inhibitors). PPI's significantly decrease the gastric parietal cell's ability to produce acid. Gastric acid plays an important role in digestion and it is one of your bodies first defenses against bad bacteria that may be present in food, liquids and the environment.
How long should you take PPI's?
Dr. Rudert answers:
Usually it is recommended to take acid suppressing medications for only short courses of therapy, generally for 4 to 8 weeks. Your doctor may elect to repeat the recommended course depending on your symptoms. These medications were not intended to be taken indefinitely. I have seen many individuals that come to me for second opinion evaluations that have been taking these medications for years and sometimes over a decade.
Is there a problem with long term use?
Dr. Rudert answers:
Some worrisome data has been published linking long term use in some individuals to a variety of complications. These may include vitamin and mineral deficiencies such as Magnesium and B12, osteoporosis and bone fractures, kidney disease, memory loss and SIBO (small intestinal bacterial overgrowth). In fact, patients with SIBO often have symptoms identical to reflux so, unfortunately, if they are given PPI's their symptoms may worsen. I also have had patients that had autoimmune diseases triggered by these medications.
Is it possible to stop the medication?
Dr. Rudert answers:
Most people cannot stop them suddenly because of rebound hyperacidity. The stomach produces even more acid so these meds have to be gradually tapered. Over the years, I have developed a protocol that works for most individuals. Everyone is different however the longer you have been on these drugs the longer it may take before they can be stopped.
A Fourth Opinion Consult Leads To A New Approach:
Mrs. T is a retired 82 year old teacher, mother and grandmother. She came to see me for longstanding gas, bloating episodic abdominal pain and diarrhea. Sometimes she said she could hardly make it to the bathroom. Her life understandably was not predictable so like most patients she gradually wanted to go out less and less.Her symptoms were worsening. She had had 3 prior evaluations and was told that she had IBS. Review of her medications included a PPI for acid reflux which she had been taking for years.
I'll shorten the story and get right to the point (I generally spend over an hour with patients including their history, physical and record review). Rarely if ever do older individuals have overproduction of acid nor do they have IBS. As we age our ability to produce acid lessens and sometimes it is minimal or even absent. Her problem was that she was taking an unnecessary medication that caused her "IBS" symptoms. The good news? She didn't have reflux nor did she have IBS. She did, however, have a bacterial imbalance from chronic acid suppression and her SIBO (small intestinal bacterial overgrowth) was confirmed by Lactulose Breath Hydrogen Testing and easily treated.
The importance of getting a proper evaluation and diagnosis for symptoms cannot be overemphasized since worsening diarrhea and incontinence is one of the main reasons some elderly patients wind up in assisted living.
It is important not to self-diagnose as symptoms can be varied and confusing. It is crucial to obtain a professional evaluation to ensure a proper diagnosis in order to obtain proper treatment to optimize long term health.
Contact our office for more information.
