Concerns About Long-term PPI Use and Diagnosis
My husband, a healthy 42-year-old, sought medical advice due to ongoing throat discomfort. Following his visit, the general practitioner conducted a barium swallow test, which indicated that his esophageal flap is malfunctioning, leading to silent acid reflux. Consequently, he was prescribed a daily proton pump inhibitor (PPI). Three years have passed since he began this medication, during which he has experienced changes in his bowel movements, particularly an uptick in bloating and general discomfort. We recently learned more about the potential long-term side effects of prolonged PPI usage. Concerned, my husband revisited the doctor to discuss his bowel concerns and to inquire about the possibility of a re-evaluation. The GP dismissed his inquiries, stating that due to the malfunctioning flap, he would need to remain on PPIs indefinitely without any need for further testing. To date, he has not been referred to a gastroenterologist, nor has he undergone endoscopy or colonoscopy. The physician suggested increasing his fiber intake, yet this adjustment has not alleviated his symptoms. For context, my husband previously underwent treatment for severe acid reflux in his early twenties, which involved frequent vomiting, although those issues seemed to improve at that time. Currently, we are worried that the long-term use of PPIs could be contributing to irritable bowel syndrome (IBS) or disrupting his gut microbiome. Additionally, he harbors concerns about potential esophageal damage resulting from years of unmanaged reflux. Is the doctor accurate in believing that lifelong PPI therapy is the sole course of action? Is it unreasonable for us to request a referral to a gastroenterologist? Thank you in advance for your insights!
Answers (1)
9/8/2025, 7:20:55 PM
OpenHealth AI
It's understandable to have concerns about long-term PPI use and its effects, especially considering your husband's ongoing symptoms and potential side effects. While proton pump inhibitors are essential for managing conditions like silent acid reflux, their long-term use can sometimes lead to complications, and it’s wise to reassess treatment options periodically.
Key Points:
- Long-term PPI Use: Prolonged use of PPIs can lead to side effects, including changes in gut microbiota, risk of gastrointestinal infections, and potential increased risk of gut issues (like IBS).
- Need for Reevaluation: It is reasonable to seek a second opinion or a referral to a gastroenterologist, especially given his persistent symptoms and changes in bowel movements.
- Throat and Esophageal Concerns: The concern about possible esophageal damage from untreated reflux is valid, and further evaluation through an endoscopy may be beneficial.
Explanation:
Your husband has been on PPIs for three years primarily due to the malfunctioning esophageal flap. While these medications are effective for managing acid reflux, they are not typically intended for indefinite use without ongoing evaluation. Symptoms like increased bloating and discomfort, especially after dietary changes, should be addressed.
The general practitioner might believe that PPIs are necessary for managing his condition, but that does not discourage you from seeking further opinions. A gastroenterologist can provide a comprehensive assessment, including possible tests like endoscopy or colonoscopy to understand his gastrointestinal health better.
Next Steps:
- Request a Referral: Firmly request a referral to a gastroenterologist for a thorough evaluation of his symptoms and treatment options. It is reasonable to advocate for your husband's health and seek specialized care.
- Document Symptoms: Keep a detailed record of his symptoms, including timing, severity, and any triggers. This information will be helpful for the gastroenterologist.
- Explore Dietary Adjustments: While you mentioned that increasing fiber intake hasn't worked, consider consulting a dietitian who specializes in gastrointestinal health. They can assist in identifying any food intolerances or better dietary choices to alleviate symptoms.
- Discuss Medication Alternatives: When consulting the gastroenterologist, discuss possible alternatives to long-term PPI use or adjunct therapies that can maintain the balance of managing acid reflux while addressing his gastrointestinal symptoms.
It's essential to voice concerns about ongoing treatments, and prioritizing your husband’s comfort and well-being is a valid approach. Please feel free to share any further questions or updates!
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7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options
# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - **Portocaval shunt size: 9.9 mm** (blood bypassing the liver into the inferior vena cava) - **Arteriovenous shunt size: 4.4 mm** - **Portal vein size: 6.1 mm** (patent) - **Three nodular cystic lesions** located in the perivascular area, with largest measuring 11.6×20.7 mm, enhancing during the venous phase - Liver features a heterogeneous architecture, exhibiting irregular enhancement - Gallbladder appears elongated and slightly enlarged - Other abdominal organs exhibit normal findings **RADIOLOGIST’S ASSESSMENT:** "Congenital portosystemic shunt indicative of Abernethy malformation; less likely arteriovenous malformation (AVM); cannot dismiss the possibility of localized liver lesions." **ADVICE:** Seek consultations with an abdominal and vascular surgeon. ### Blood Tests (August 1, 2025): **Complete Blood Count:** - WBC: 10.44 × 10⁹/L (normal range) - **RBC: 2.1 × 10¹²/L** (LOW - indicating severe anemia) - **Hemoglobin: 69 g/L** (CRITICALLY LOW; normal is 117-166) - Platelets: 403 × 10⁹/L (elevated) **Biochemistry Analysis:** - 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**Portocaval shunt: 9.9 mm** (no change, continues to drain directly into the inferior vena cava avoiding liver acinus) - **Arteriovenous shunt: 4.4 mm** (no alteration) - **Three nodular cystic lesions** in perivascular space, maximum size 11.6×20.7 mm, enhancing in the venous phase - **Portal vein: 6.1 mm** (noted during porto-venous phase) - Arteries show no filling abnormalities - Intrahepatic bile ducts remain non-dilated - Gallbladder is elongated and slightly bigger, free from stones - Pancreas: normal - Spleen: measures 66.9×38.5 mm (not enlarged), splenic vein is 3.6 mm - Kidneys: normal placements and structure - No excess fluid detected in the abdominal cavity - No visible changes in lymph nodes **MSCT ANALYSIS:** "Congenital portosystemic shunt indicative of Abernethy malformation, unlikely to be AVM, presence of focal liver lesions cannot be ruled out." **RECOMMENDATION:** Engage with an abdominal and vascular surgeon. --- ## RECENT BLOOD WORK (December 2025 - January 2026) ### Complete Blood Count (January 19, 2026): - WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 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