Q: I have a hiatus hernia and my doctor has prescribed lansoprazole for me. I have read that these types of proton pump inhibitors (PPIs) can cause Alzheimer’s disease if taken for more than four years. Is there an alternative?
Simone Steele, Pembrokeshire.
Dr. Martin Scurr replies: With a hiatus hernia, part of the stomach is pressed into your chest through the diaphragm (the muscle that separates your chest cavity from your abdomen).
In some cases, stomach acid backs up into the esophagus (known as acid reflux), causing symptoms such as heartburn, chest or stomach pain, difficulty swallowing, recurring sore throat or an unexplained cough.
Patients with chronic symptoms are often given long-term prescriptions for a proton pump inhibitor, such as lansoprazole, which reduces the amount of acid the stomach produces.
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 symptoms. Research shows that up to 40 percent of symptoms can be reduced with diet and lifestyle changes
But all medications have potential side effects, and long-term use of PPIs can cause complications: The drugs enter 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 found 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 symptoms. Research shows that up to 40 percent of symptoms can be reduced with diet and lifestyle changes. These, along with an over-the-counter antacid such as Gaviscon, are now considered the first-line treatment.
Lifestyle changes include weight loss for patients with a BMI near 30 or above (this does not apply to you as your longer letter shows you weigh eight stone). Common food triggers include caffeine, chocolate, spicy foods, carbonated drinks and peppermint; Smoking and alcohol should also be avoided. These all irritate the valve that prevents stomach acid from flowing into the esophagus. And don’t eat three hours before bedtime; by then the stomach contents will have moved, reducing the chance of reflux.
Patients who experience nighttime symptoms, such as coughing, also benefit from raising the head of their bed 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 that fails, a once-daily PPI may be prescribed until symptoms resolve. If that doesn’t work, you may be referred for surgery to permanently stop the reflux.
Q: I was told the pain in my neck and both shoulders was polymyalgia and I was given steroid tablets, but I didn’t feel well taking them. When I mentioned it to my GP I was told it wasn’t polymyalgia so to wean myself off the tablets. I still have neck and shoulder pain.
Rosemary Rose, Middlesex.
Dr. Martin Scurr replies: 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 based on a blood test and standard treatment is low-dose steroids, usually prednisolone. This should make the symptoms disappear within a few days. The fact that you have not improved is probably the reason that the doctor ruled out PMR.
I wonder if the problem might be wear and tear of the intervertebral discs in the neck. These need to support the weight of the head and over time this can cause arthritis, pain and stiffness as bone rubs on bone. The nerves can also become pinched, causing neck pain. Your shoulder pain could be the pain radiating down from the neck.
I suggest you ask your GP about a scan: x-rays may be sufficient, although an MRI would provide even more detail. If this is the problem, physical therapy would help, but unfortunately there is no permanent cure.
- Write to Dr. Scurr from 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. If you have health problems, consult your own doctor.
As far as I’m concerned… Another nail in the coffin for general practitioners
At a time when inflation is around 4 percent, funding for GPs will increase by just 1.9 percent in 2024/2025. What many people do not realize is that the GP service is provided by approximately 7,000 small businesses. Unlike hospital specialists, GPs are individual subcontractors who derive most of their income from a monopolistic employer: the NHS.
The paltry increase in overhead costs when energy prices alone have doubled – increases borne by your local practice – will put further pressure on these small businesses. Doctors move abroad, others move to the private sector or take early retirement. Either way, it’s patient care that suffers.
I wonder if the current shift will be welcomed by the government so that GP care can be abandoned and doctors (who have little training) and nurses can take charge, aided by AI.
Doctors should limit themselves to hospital work. Am I paranoid? I do not think so.