Andre Garcia

Linzess is for chronic idiopathic constipation...so is Trulance.

Why is it necessary to go off of the anti-GERD meds at all, if they work?

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So...I had a perforated intestine 3 months after having RNY...RNY was Nov 2016 and perforated intestine was late February 2017...well over a year ago. I tried 3 times to wean off Prilosec, each time trying something different. The pain got so bad, I nearly went into the ER, but met with my surgeon instead. He recommended I go back on the half dose of Prilosec until November for my two year checkup, and then we would revisit things. ry He also ordered a fresh set of labs to see how I was doing with vitamins, minerals, and other things. In the meantime, I went back on a full dose of Prilosec for the last few days, and sure enough, the intestinal pain is completely gone. I'm going to cut down to 50% again next week...I figured full dose for now to give my intestines some time to heal from whatever I had put them through on a 25% dose. I think one challenge I have is that I was water fasting while also trying to wean off of Prilosec...next time I try, I won't drink coffee or drink wine nor fast at all so I don't trigger things that could increase my acidity. Ugh.

It sounds like you are doing the right thing to wean off of them, but that your body isn't ready to, as if whatever underlying problem has not been resolved. This certainly isn't normal.
Typically we hear of VSG patients having problems with acid reflux and heartburn that sometimes can't be resolved, so an RNY revision is sometimes done, though reflux can hit the bypass too sometimes, though fairly rarely. The asnastomis between the pouch and intestine is sensitive and the typical location for ulcer problems - the intestine where the pouch joins isn't resistant to stomach acid like the duodenum is, hence the sensitivity. I would think that the endoscopy would have shown any problems there. That leaves the remnant stomach and upper bypassed limb as a possible problem area. The remnant stomach is where most of your acid production typically occurs, but that is usually neutralized by bile that's introduced into the duodenum. so perhaps there is something wrong there that is creating an imbalance. Unfortunately, that doesn't show up in an endoscopy with your bypass anatomy. You mention that you are following your surgeon's instructions on taper off the PPI, so I assume that he is in the loop on this problem and should be able to suggest the next step.
Does the omeprazole resolve the problem when you are on it, and this is just a problem when trying to taper off of it, or is this a continuing problem even with the omeprazole? Perhaps whatever quirk there is in your body isn't ready to give it up, as desirable as it may be to do so.
If you haven't found her already, maybe you can reach out to this gal who is having significant ulcer problems with her bypass - there may be some insight from her problem that can shed some light onto yours.

This is a puzzle, and as my PCP likes to say, you don't want to be an "interesting" patient - great for the MD's to have an interesting problem to solve, not so great for the patient. Perhaps this is your turn. Been there, done that myself on the interesting patient thing, with a different problem.
Good luck in getting this resolved.

I'm in a very similar situation except with nexium. The plan after my gastric bypass was that I would be able to come off the nexium completely since it would "cure" my GERD. No luck so far! I am down to 40mg every other day which is a significant decrease from what I was on pre-surgery. My doctor has me taking a pre-digestive enzyme before every meal which helps quite a bit. You can buy those over the counter so maybe consider that? I have the exact same pain you describe when I try and quit the nexium fully - and I was so freaked out about it the last time that I called my surgeon and got in for an endoscopy right away to make sure it wasn't an ulcer or anything. All clear thankfully. My surgeon and my GI doc are both ok with where I am for now and we will continue to try and wean as much as I can without pain. I will say that when I first dropped to every other day I felt a lot of pain on the in between days - but now that I've been doing that for about 2 months I don't notice anything. Not sure if that is due to the pre-digestive enzymes or if it is my body adjusting finally to the lower dose. I think it's probably time for me to drop my dose even further but I'm just not eager to go through the pain again...