Dr. Amy Nett: Remember you’re increasing stomach acid when you’re using HCl, so I would not use it with gastritis because gastritis is active inflammation, generally. I don’t want to be throwing more acid into the stomach when you already have gastritis, so don’t use it when you have gastritis.
If someone has Barrett’s esophagus, this depends a little bit on the context because if it’s gastroesophageal reflux with Barrett’s esophagus … With Barrett’s esophagus, you’re seeing changes in the epithelium that reflect reflux, so if someone knows that they have a diagnosis of Barrett’s esophagus, that means that they’ve had an endoscopy. Look at the rest of the endoscopy report. See if there was any evidence of ulcerations or active gastritis. Barrett’s esophagus could be that they had had reflux prior, but if there’s no evidence of active disease, then it should be OK to use, but you have to look a little bit deeper. Just knowing that they have Barrett’s esophagus I don’t think is enough information to safely make that decision.
Then the third one is a hiatal hernia. Yeah, with a hiatal hernia, it’s completely safe. Hiatal hernia is just where you get … these can shift a little bit, but the stomach will just slip a little bit up into the thoracic region, through the hiatus there. On imaging studies, when people have repeat imaging studies, you’ll see the size of a hiatal hernia changes. It’s literally just the location of where the stomach is. It doesn’t tell you anything about what the mucosa actually looks like or whether there’s gastritis or anything like that, so having a hiatal hernia alone wouldn’t necessarily deter me from using HCl.
Then you said, “How would you recommend handling long-term use of PPIs in these conditions?” I’m not entirely sure what you mean, using PPIs as they relate to these conditions, because we don’t recommend long-term use of PPIs, period. I’m not entirely sure what you mean there because we want to wean people off of proton-pump inhibitors, and really there’s no research supporting long-term use. That was never the intention of proton-pump inhibitors. As with anyone else who’s been on proton-pump inhibitors, we would slowly, gradually wean them off of the proton-pump inhibitors, supporting whatever underlying GI issue might be contributing to these symptoms.