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Acid Reflux / GERD Message Board

Acid Reflux / GERD Board Index


I've been there too - you are not alone.

Your physician may or may not have experience with chronic acid reflux. Often they are familiar with GERD (the heartburn type) and not so familiar with LPR (laryngeal reflux - when the acid goes even higher into your throat, hitting your larynx and causing chronic coughing). That said, you should visit an ENT (ear nose and throat doctor, also known as an otolaryngologist) and a Gastroenterologist as well.

The ENT will be able to provide you with quick confirmation that acid is affecting larynx and throat by scoping you. This is a quick, painless procedure that involves looking at your throat with a camera on a wire. You won't really be able to feel it because you will have inhaled a numbing spray first.

The gastroenterologist will be able to do an endoscopy. But this may be more time-intensive. You may need to wait anywhere from a few days to a few weeks to see the gastro, and from there you will have to schedule an endoscopy, which is usually performed in a hospital as an outpatient procedure. They put you under, then look at your esophagous with a camera and take biopsies to check for cellular changes. This is important if you have chronic reflux - be it GERD or LPR, because long-term exposure to stomach acid in the esophagous can produce cellular changes, leading to a condition called Barrett's esophagous, which is too often, but not always, a precursor to esophageal cancer. You don't want esophageal or layrngeal cancer.

If you are refluxing into your throat and have LPR, the reason you may not have experienced that much relief may be that you weren't taking enough Nexium. The standard treatment for treating LPR is 2 doses of a 40 mg PPI per day, for a total of 80 mg. GERD can usually be treated with 1 dose. I though my ENT was nuts the first time she told me this (I had been on 1 Nexium a day for 4 months with no relief) but I quickly took 2 pills after she informed me about this and my coughing stopped in 20 minutes and I have had nearly a complete recovery and it's 3 years later.

Nexium is made by AstraZeneca and debuted in 2001. Previously, AstraZeneca had been selling Prilosec as the "premier PPI", but the prescription patent on it expired around the same time, and it's now sold OTC. However, Nexium, in the words of my doctor, is "usually better metabolized by individuals with LPR than Prilosec". The drug is slightly different, but those differences are important. These subtle differences often don't matter in terms of treatment when the patient is a GERD sufferer. However, it seems that LPR patients need to take a more aggressive approach with PPI medicating, and what works for one person may not work for another. Nexium is expensive, but if it's the only one that works for you, it's not worth messing around with the ones that don't work. I personally have tried Prilosec OTC and Protonix (after already having been treated successfully with Nexium) and I relapsed on both occasions. I'm always willing to try something that might work better, but since Nexium works as well as it does, I'm sticking to it for now.

Let's look at the economics:
Nexium, purchased without insurance, in the quantity of 180 pills at a popoular US drugstore site, costs $720. You need 60 pills per month, so that comes out to U.S. $239 per month for 60 pills That can be a car payment - but it can also be a lifesaver. With insurance, it can be substantially less.

Purchased through a Canadian pharmacy and imported into the U.S., Nexium
costs about $219.84 US for 84 pills, which equals $156 per month for 60 pills - that's $83 a month less than in the U.S.!

Canadian pharmacies also offer a generic form of Nexium which isn't available in the U.S. The generic contains the same exact medication, Esomeprazole (Esomeprazole Magnesium Trihydrate), and is manufactured by Sun Pharma. The cost is $157.96 U.S. for 100 pills, which comes out to a total of $95 per month for 60 pills. That's a lot less than the $239 it costs in the U.S. without insurance.

Now let's look at Prilosec OTC. Prilosec is sold as 20 mg pills. If you have LPR, and respond to the 80 mg a day dosing, you would need to take Prilosecs a day. The cost of discounted Prilosec is $25.00 for 42 pills. Since you would need 120 pills a month, the cost would be about $71 per month. And insurance typically does not reiumburse for OTC meds.

I personally have no experience ordering from or using Canadian pharmaceuticals - I just wanted you to know there are options out there worth exploring.

In the meantime, the other PPIs that are commonly prescribed are Aciphex, Prevacid, and Protonix (though I may be missing a few in this list), and of course, Prilosec OTC.

Also, if you need to talk to a doctor about LPR and the doctor has never heard of it, a great reference article (which was given to me by my diagnosing physician) was published in the Offical Journal of the American Academy of Physician Assistants titled "Laryngopharyngeal reflux—It’s not GERD".

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