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From: christophe on 30 Sep 2007 04:10
Dear Pete, I know you have used Carafate before without success, but
have you used it in your new "burning under the ribs" phase"?

Your theory about bile reflux might not be that far off the mark.
However, I don't think it's a defective pylorus valve to blame, but
rather the long term or intensive use of PPIs. I have found several
articles about the deconjugation of bile acids following PPI use.
Basically, the articles suggest that (1) suppression of acid leads to
bacterial overgrowth which in turn leads to greater production of bile
(2) that the use of acid tablets changes (dangerously) the level of
bile contents in the refluxed mix.

I can only say that I did not have pain under the ribs before PPI use
and that I I did not demonstrate any indication that I had a
malabsorption syndrome.

I am amazed that GI theorists have made so little of the difference
between heartburn and waterbrash as symptoms of gerd. The former
indicates a high probability of acid reflux while the latter only
indicates reflux. In addition, while the former might be admissable to
PPI therapy; the latter certainly is not. However, both heartburn and
waterbrash should (in theory) be eliminated with the fundo surgery.

From: trigonometry1972 on 30 Sep 2007 07:19
Your reference would be interesting to look at.
Do you have the PMID to the related abstracts by
way of Pubmed. Perhaps the authors names as
that often works to get one to the proper paper
without too much trouble.

From: christophe on 30 Sep 2007 09:09

Here's a start:

http://books.google.com/books?id=qSx-vroexJ8C&pg=PA142&lpg=PA142&dq=ppis+and+deconjugation+of+bile&source=web&ots=ts1PWnp0PC&sig=rD00rY3fOK_pgMu5axxH7fdCmLk
[see p.142]

Abstract only
http://www.informaworld.com/smpp/content~content=a748020948~db=all

The relationship between community acquired pneumonia, bacterial
overgrowth and PPIs is long established:
http://www.uspharmacist.com/index.asp?show=article&page=8_1590.htm

From: Peter on 30 Sep 2007 18:09
christophe wrote:
> Dear Pete, I know you have used Carafate before without success, but
> have you used it in your new "burning under the ribs" phase"?

No Chris...and I never used the phrase "burning under the ribs". That is a
phrase you use. I have always said I burn all over including stomach,
esophagus, chest/lungs, throat, tongue and nose and that it even radiates
into my arms...Pete

PS - I sent this five hours earlier and it didn't show up in my computer.
Did it show up at your end?


>
> Your theory about bile reflux might not be that far off the mark.
> However, I don't think it's a defective pylorus valve to blame, but
> rather the long term or intensive use of PPIs. I have found several
> articles about the deconjugation of bile acids following PPI use.
> Basically, the articles suggest that (1) suppression of acid leads to
> bacterial overgrowth which in turn leads to greater production of bile
> (2) that the use of acid tablets changes (dangerously) the level of
> bile contents in the refluxed mix.
>
> I can only say that I did not have pain under the ribs before PPI use
> and that I I did not demonstrate any indication that I had a
> malabsorption syndrome.
>
> I am amazed that GI theorists have made so little of the difference
> between heartburn and waterbrash as symptoms of gerd. The former
> indicates a high probability of acid reflux while the latter only
> indicates reflux. In addition, while the former might be admissable to
> PPI therapy; the latter certainly is not. However, both heartburn and
> waterbrash should (in theory) be eliminated with the fundo surgery.


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