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PPI may not be working for some of US

There are several types of tests for H.pylori. The major ones have a their own forum.

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shid0x
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PPI may not be working for some of US

Post by shid0x » Thu Jan 05, 2017 1:50 am

Hey everyone, its been a while ~

Lately i've been talking with a General practitioner and some DNA specialists about the efficiency of PPI and especially why they don't seem to work on some people. And why would it be the reason some people take forever to recover even through H.Pilory has been eradicated.

This theory could be a hint to why. But please be advised that DNA is still a complex field and we (still) don't have enough data to call definitive results yet this idea should be interesting.

Ok so here we go :

The situation :
Some people take a long time to recover after a successful helicobacter eradication, most of them put this on the fact that the antibiotics are really powerful and nuked their stomach. Symptoms are described as gastritis,ulcer pain, gas and bloating ( at least from the data i could gather on these forums )

Fact on the matter is that people experiencing this post helicobacter symptoms are a minority, i think its a fair guess to say that its about ~5% ?
Doctors usually do prescribe PPI for an extended time and just wait.

The idea :
When helicobacters ( or other factors NSAID, alcohol...) are eradicated any stomach should be able to heal, regardless of the gravity ( we know for a fact that some duodenal gastritis do take longer than other ).
Yet for some people despite taking months and months of PPI the improvements are slow to non-existent and doctors usually double the recommended dosage (some Gastro do to be fair really go overboard about it ).

The answer could be simple : You aren't healing because your stomach is still acid and your inflammation has no time to ever recover.
PPI should be able to help you with that and neutralize the excess of acidity but it may not be the case all of the time.
All of that could be because of the CYP2C19 gene. The CYP2C19 gene encodes an enzyme that metabolizes PPIs and polymorphism of this gene affects the therapeutic outcome of GERD and duodenal ulcers.

Now you have slow and fast metabolizers of it.
CYP2C19 rapid metabolizers break down Proton Pump Inhibitor s too quickly, leaving too little active medication to be effective, potentially reducing their effectiveness. This trait is more common in people of European, East Asians or African ancestry.
People with little or no CYP2C19 activity, who metabolize PPIs more slowly (slow metabolizers), demonstrated significantly higher eradication rates (of H. Pylori) compared to extensive metabolizers.

To make a long story short, PPI just might not be working for you, hence why you feel the same symptoms as you did before and why the recovery is slow.

What can you do about it ?
The answer is actually quite simple, instead of tripling the amount of PPI you are taking you should simply switch to another type of medicine such as H2 blockers ( rantidine being one of the most efficient, 300MG per day should be enough ) along with a stomach solution ( aluminium + magnesium ).

And this HAS actually been tested on few occasion by scientist. The results have been very encouraging as slow PPI metabolizers found relief when using this other "older" treatment.

It is estimated that 20% of people are slow metabolizers of PPI
Now what if we consider that people getting ulcer is about 20% of the population and if by any chance you are among the other 20% who can't metabolize PPI seeing people complain about the helicobacter recovery doesn't seem to crazy after all.


Some sources ( buckle up because its quite complex ) :
links.txt
(717 Bytes) Downloaded 108 times
( text file because there are multiple links and the forum only allows 2 max, just read it )

this last one is actually a fanstastic book, read it if you have time you'll learn so much about guts and drugs that goes with it.

PS : Getting your DNA sequenced and analysed is not expensive about 150 dollars will do.

RandomUser
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Re: PPI may not be working for some of US

Post by RandomUser » Tue Feb 21, 2017 11:25 pm

Thanks for this great post! Very good info. If you get your personal DNA sequenced, do you think you will get the results in a form that allows you to easily see whether you have this Gene or not? So would it be worth to do that for people who are feeling they don't benefit from the PPI as much as they should?

shid0x
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Posts: 61
Joined: Wed Sep 02, 2015 9:38 pm

Re: PPI may not be working for some of US

Post by shid0x » Thu Mar 02, 2017 7:11 pm

RandomUser wrote:
Tue Feb 21, 2017 11:25 pm
Thanks for this great post! Very good info. If you get your personal DNA sequenced, do you think you will get the results in a form that allows you to easily see whether you have this Gene or not? So would it be worth to do that for people who are feeling they don't benefit from the PPI as much as they should?
Its actually fairly easy to check.
A very mainstream such as 23 and me allows you to browse your gene variation just by typing them.

what you want to look for in this case is
rs12248560 CC
rs4244285 GG
rs4986893 GG
rs28399504 AA
rs41291556 TT

If any is positive then you are at risk.
Of course keep in mind genetics are not always the answer and the end results is influenced by a lot of factors.

So would it be worth to do that for people who are feeling they don't benefit from the PPI as much as they should?
I would advise you to switch to something else first such as ranitidine / sucralfate and see if you get any improvement.

Although if you are interested in more than just PPI (gluten intolerance, lactose, fructose, vitamin b12 deficiency ) a DNA test can be quite useful for you (pretty cost efficient ).

I'm not a doctor but merely a person who has a big interest in DNA and bio-technologies so my opinion may not be always correct tho.

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