Q: I have a hiatal hernia and my doctor prescribed lansoprazole. I read that proton pump inhibitors (PPIs) like this can cause Alzheimer’s disease if taken for more than four years. Is there an alternative?
Simone Steele, Pembrokeshire.
Dr Martin Scurr responds: A hiatal hernia occurs when part of the stomach squeezes into your chest through the diaphragm (the muscle that separates your chest cavity from your abdomen).
In some cases, stomach acid spills into the esophagus (called acid reflux), causing symptoms such as heartburn, chest or abdominal pain, difficulty swallowing, recurring sore throat, or coughing. unexplained.
Patients with chronic symptoms are often given long-term prescriptions for a proton pump inhibitor medication, such as lansoprazole, which reduces the amount of acid produced by the stomach.
This is important because the acid can damage the cells lining the esophagus, causing a precancerous condition known as Barrett’s esophagus.
Treatment for reflux should be based on the severity of the symptoms. Research shows that up to 40 percent of symptoms can be reduced through diet and lifestyle changes.
But all medications have potential side effects, and long-term PPI use can cause complications: The drugs pass into the brain and have been linked to migraines and problems with hearing, vision and memory. .
And as you say, a study in the journal Alzheimer’s & Dementia showed that taking PPIs for more than four years is associated with a higher risk of dementia.
Treatment for reflux should be based on the severity of the symptoms. Research shows that up to 40 percent of symptoms can be reduced through diet and lifestyle changes – these, along with an over-the-counter antacid such as Gaviscon, are now considered the treatment of first intention.
Lifestyle changes include weight loss for patients whose BMI is close to 30 or more (this does not apply to you, as your longer letter reveals you weigh eight stone). Common food triggers include caffeine, chocolate, spicy foods, soda, and peppermint; tobacco and alcohol should also be avoided. All of these irritate the valve that prevents stomach acid from flowing back into the esophagus. And avoid eating three hours before bedtime; by then, the stomach contents will have disappeared, reducing the risk of reflux.
Patients who suffer from nighttime symptoms, such as coughing, also benefit from having the head of their bed raised (by about 6 inches).
The next step is to try an H2 receptor antagonist (for example, ranitidine), which reduces stomach acid but is less potent than a PPI. If this fails, a once-daily PPI may be prescribed until symptoms disappear. If this doesn’t work, you may be referred for surgery to stop the reflux permanently.
Q: I was told the pain in my neck and both shoulders was due to polymyalgia and was put on steroid tablets, but I didn’t feel well while taking them. When I spoke to my GP about it, I was told it wasn’t polymyalgia, so I had to stop taking the tablets. I still have neck and shoulder pain.
Rosemary Rose, Middlesex.
Dr Martin Scurr responds: Polymyalgia rheumatica (PMR) is a common condition that causes pain, aches and stiffness around the shoulder, neck and hips, which is usually worse in the morning.
Diagnosis is by blood test, and standard treatment is low-dose steroids, usually prednisolone. This should start to resolve the symptoms within a few days – the fact that you haven’t improved is probably why the GP ruled out PMR.
I wonder if the problem is not the worn discs in the neck. These have to support the weight of the head and over time this can cause arthritis, pain and stiffness as bone rubs against bone. Nerves can also be pinched, causing neck pain. Your shoulder pain may be pain radiating from the neck.
I suggest asking your GP for a CT scan: X-rays may be sufficient, although an MRI would provide even more detail. If this is the problem, physical therapy might help, but unfortunately there is no permanent cure.
- Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email: drmartin@dailymail.co.uk.
- Dr. Scurr cannot enter into personal correspondence. Answers should be taken in a general context. Consult your own GP if you have a health problem.
In my opinion… Another nail in the coffin for GPs
At a time when inflation is around 4 per cent, funding for GPs in 2024/25 will only increase by 1.9 per cent. What many people don’t realize is that the GP service is provided by around 7,000 small businesses. Unlike hospital specialists, GPs are individual contractors who derive most of their income from a monopolistic employer: the NHS.
The paltry increase in overheads when energy prices alone have doubled – increases borne by your local practice – will further squeeze these small businesses. Doctors go abroad, others move into the private sector or take early retirement. Either way, it’s patient care that suffers.
I wonder if the current decline is welcomed by the government, so that GP care can be abandoned, leaving GP associates (who have little training) and nurses in charge, aided by AI.
Doctors would be confined to hospital work. Am I paranoid? I do not think so.