I’ve taken omeprazole for nearly 30 years. I’ve tried stopping it several times, but the acid reflux always comes back. Recently, I noticed changes in my bowel habit but blood tests and a colonoscopy were normal. I wonder if a lack of good gut bacteria could be behind this and if probiotics might help?
Bob McAusland, Paisley.
Dr Martin Scurr replies: A change in bowel habit can be linked to serious conditions, so it’s reassuring that your blood tests and colonoscopy were normal.
I suspect that omeprazole is the key here. This is a type of proton-pump inhibitor – drugs widely prescribed to treat reflux.
They work by suppressing stomach-acid production – but over time this can make you more vulnerable to small intestinal bacterial overgrowth (SIBO), where too many bacteria grow in the small intestine. Common symptoms include bloating, excessive gas and diarrhoea.
People on acid-suppressing drugs, such as omeprazole, are also more likely to develop constipation (partly because they can upset the balance of gut microbes). Stomach acid normally kills off bacteria that arrive in food. But if acid levels are low, bad bacteria can flourish where they shouldn’t – which increases the risk of SIBO.
I’ve taken omeprazole for nearly 30 years. I’ve tried stopping it several times, but the acid reflux always comes back
The drug works by suppressing stomach-acid production – but over time this can make you more vulnerable to small intestinal bacterial overgrowth
The only reliable way to confirm it’s SIBO is a breath test for traces of hydrogen or methane produced by the bacteria.
Your GP can refer you for this – or the gastroenterology team who did your colonoscopy should be able to arrange it. This should be your next step.
If SIBO is confirmed, it can be treated with antibiotics, such as rifaximin.
As for probiotics, there is no harm in trying one, although there is currently little hard evidence they’re effective for SIBO.
My husband began suffering with a severe headache a year ago. Scans have ruled out other problems and he’s been diagnosed with migraine. He’s been given Botox injections and the drug Aquipta but these didn’t help. He is in pain day and night. When he can, he still goes to work – but every day is a struggle.
Name and address supplied.
Dr Scurr replies: What you describe sounds like chronic migraine – essentially migraine occurring on 15 or more days a month. It is sometimes described more prosaically as chronic daily headache because the headaches occur so frequently.
Standard migraine drugs such as triptans can be helpful at easing symptoms – but taking them frequently and longer-term (ten or more days per month for several months, for instance) can lead to rebound headaches, where the treatment itself can make headaches worse.
Botox injections can be effective in preventing or minimising attacks. Exactly how it works is not known, but it appears to interrupt part of the network of nerves and blood vessels involved in migraine. The standard approach is to administer 30 or more Botox injections into the muscles of the head and neck, and repeat after 12 weeks. But this won’t work for everyone.
Then there is Aquipta, the drug your husband was prescribed. It’s one of a new group of migraine drugs which block calcitonin gene-related peptide, a protein linked to migraine pain.
Studies show the drug halved the number of migraine days in four in ten patients. Again, helpful but not perfect.
The fact that these two potent treatments have not worked for your husband does not rule out migraine, but I question whether this is the correct diagnosis.
My husband began suffering with a severe headache a year ago. Scans have ruled out other problems and he’s been diagnosed with migraine
What is needed is consultation with an expert, as there are other possibilities, such as giant cell arteritis, which causes inflammation of arteries in the head, neck and arms.
You say in your longer letter that he’s waiting to see an NHS neurologist. In the meantime, I’d suggest asking his GP for another prescription for Aquipta, and to take it daily or every other day.
In my view…
It’s vital to breathe through your nose
Did you know that the air flow through your nose alternates between the two nostrils?
Known as the nasal cycle, it means one passage remains open while the other is partly congested as the blood vessels swell up – the sides then change over roughly every two hours.
The purpose of this isn’t fully understood, but it may be that it allows the two sides to take turns at the different jobs – while one side handles more of the airflow, the other clears mucus and trapped particles.
This matters as air flow through the nose influences much of what goes on elsewhere in our body – for example, synchronising activity in brain areas such as the olfactory cortex (which processes smells), the amygdala (involved in processing emotions) and the hippocampus (important for memory) – which does not occur when mouth breathing. The nose and sinuses also filter the air before it is inhaled into the lungs.
The message here is that breathing through the nose is important. Yet many people breathe through their mouths, even if they have no nasal congestion. So do your utmost to change this, even if you have to consciously retrain yourself.
