Reflux from medication

Hi everyone,

I was sleeved Oct 2016 and while I experienced GERD for the first few months I managed to get it under control and all was well. I take several medications for a chronic pain disorder but all ok'd with my surgeon.

On Feb 24th my partner & I got food poisoning and that is when the reflux really kicked off again with a good dose of daily nausea to boot. It was also around this time I had my new antidepressant (venlafaxine/effexor) upped to 300mgs daily. I take 40 mgs of Losec PPI twice daily but only really get relief from Gaviscon.

Has anyone experienced reflux while on antidepressants? I've done some reading and my bariatric nurse said research has come out that Losec and citalipram have shown to have bad effects on each other. Anyone know of studies etc on other antidepressants?

I just think it's weird that I was able to get things totally under control before yet they have gone pear shaped again and nothing seems to be helping (probiotics, kefir, careful diet etc). Plan b is to try a different PPI, plan c is to get an endoscopy done.

Would appreciate any thoughts or experiences anyone might have had with this. Thanks so much.

It could be a reaction from the meds. But it could be a LOT of other things too. There are a great many people who get uncontrolled reflux as they get further away from surgery. Even though you had it under control for a while, doesn't mean it was going to stay that way. You could very well be in for a lifetime of changes in PPIs and dosages trying to find a good combination.

Thanks for responding Grim. I'm having more bloods done today and will see how things progress.

First off, ditto what Grim said.

Here's my experience with reflux:

I've got Fructose Malabsorption. I had it before surgery, so this is not WLS related. However, pre-op if I'd accidentally "fructose myself" I never had an issue with reflux. Now, I do. (Reflux is not uncommon with VSG because decreased volume = increased pressure, yay Boyle's Law.)

I had my three year followup with my surgeon two weeks ago and talked with him about it. For me, since it's not a common thing, he recommended trying an H2 blocker like Pepcid instead of the PPI, which I don't want to take. So I've been doing Pepcid as needed and it's been great. Once I got things under control from that flare, I haven't had a problem and I've rarely needed to use Pepcid. I pretty much just take it if I'll be eating food that I haven't prepared myself.

So the take away from this is that lots and lots of things can cause reflux. Many of those things are diet related and VSG will exacerbate it. The "fix" action for this is revision to RNY. My advice would be to first investigate diet since most of the things that cause reflux are diet related. If I hadn't known about the fructose issue for myself, I would have started working on a serious elimination diet. I'd start with something safe, like chicken, and eat only that for a few days before adding other things in one at a time. (Other things includes EVERYTHING. Including spices. Assume nothing is safe.) And I'd track everything to see what triggered the issues.

Good luck to you!

Oh, and specifically on the topic of antidepressants - I recommend searching on PubMed if you haven't already!

Hi Gwen

Thanks for the interesting response it has given me lots to think about. I have tried to go back to basics with my food but yes cutting out spices and all additives too makes a lot of sense.

I can handle the reflux/nausea during the day it's annoying and unpleasant but I can get on with it but it is the lack of sleep that is driving me crazy it keeps me up I become so unwell. So I am going to discuss a H2 blocker with my surgical nurse as that may be another option to consider.

Many thanks.

Just remember that taking PPIs long term has health risks, but long term reflux/GERD also has health risks - like esophageal cancer. So don't ignore this!

I take Prilosec and Lexapro and was unaware of a possible issue with the two. I'll have to talk with my CNP tomorrow. I was having reflux everyday though two weeks ago and started the Prilosec and have felt a lot better. I also take Wellbutrin.

Is it not a good idea to only take Gaviscon? Because if it works better, I'd personally keep taking it assuming it was okay to.

Hi MonaLyssa33, thanks for responding. For now it is recommended by my bariatric nurse to continue on PPI but we may switch it up to a different one soon as see if that helps. Can I ask did you experience nausea with my your reflux?

I'm glad to hear yours has settled down, wishing you all the best.

I was diagnosed with 'silent GERD' pre-WLS. I didn't really believe I had it. ie. the silent part. :) Since surgery I was on PPI and couldn't get off for almost 2 years, part of that was an undiagnosed hernia... since the hernia repair I was able to wean off the PPI - again as others have said I didn't want to stay on long term... that being said I thought it would totally go away and it didn't, not silent anymore and I do have serious flare-ups sometimes... I have yet to figure out what triggers them. One this winter I did know was triggered by antibiotics- that just messes your digestive track all around.

But as far as food and triggers I am still clueless. Last Sunday I was doing an exercise video- started feeling nauseous and like I was going to vomit... ended up cancelling my plans...figured out mid-afternoon it was acid. ??? Luckily this time I got away with just a few days of meds. Sometimes, I need to go back on for several weeks and then wean myself again....

Honestly the food poisoning could have triggered it- anything that throws your digestive system off balance- like my bout with antibiotics- can do it...