Q: I’ve a hiatus hernia and my physician has put me on lansoprazole. I have learn that proton pump inhibitors (PPIs) like this will purpose Alzheimer’s if taken for greater than 4 years. Is there any choice?Simone Steele, Pembrokeshire.Dr Martin Scurr replies: A hiatus hernia is when a part of the tummy squeezes up into your chest throughout the diaphragm (the muscle that separates your chest hollow space out of your stomach).In some instances, abdomen acid spills up into the oesophagus (referred to as acid reflux disorder), inflicting signs comparable to heartburn, chest or stomach ache, issues swallowing, recurrent sore throat or an unexplained cough.Sufferers with persistent signs are ceaselessly given long-term prescriptions for a proton pump inhibitor drug, comparable to lansoprazole, which reduces the quantity of acid the tummy produces.That is vital for the reason that acid can harm the cells lining the oesophagus, inflicting a pre-cancerous situation referred to as Barrett’s oesophagus. 
Remedy for reflux will have to be in response to the severity of the indications. Analysis presentations as much as 40 in line with cent of signs may also be diminished with nutrition and way of life changesBut all drugs have doable side-effects, and taking PPIs long-term can carry headaches: the medicine cross into the mind and feature been connected with migraine, and issues of listening to, imaginative and prescient and reminiscence.And, as you are saying, a find out about within the magazine Alzheimer’s & Dementia confirmed that taking PPIs for greater than 4 years is related to a better chance of dementia.Remedy for reflux will have to be in response to the severity of the indications. Analysis presentations as much as 40 in line with cent of signs may also be diminished with nutrition and way of life adjustments — those, in conjunction with an over the counter antacid comparable to Gaviscon, at the moment are regarded as the first-line remedy.Way of life adjustments come with weight reduction for sufferers whose BMI is close to 30 or above (this does not practice to you, as your longer letter unearths you weigh 8 stone). Commonplace meals triggers come with caffeine, chocolate, highly spiced meals, fizzy beverages and peppermint; smoking and alcohol also are to be have shyed away from. Those all worsen the valve that prevents abdomen acid travelling up into the oesophagus. And keep away from consuming for 3 hours sooner than bedtime; by means of then the tummy contents may have moved on, decreasing the potential of reflux.Sufferers that suffer night-time signs — e.g. coughing — additionally have the benefit of elevating the top in their mattress (by means of about 6 in).Your next step is to check out an H2 receptor antagonist (e.g. ranitidine), which reduces abdomen acid however is much less tough than a PPI. If that fails then a once-daily PPI may also be prescribed till signs transparent. If that does not paintings, you’ll be referred for surgical procedure to prevent the reflux completely.Q: I used to be instructed that the ache in my neck and each shoulders used to be polymyalgia and used to be placed on steroid pills, however I did not really feel nice taking those. After I instructed my GP, I used to be instructed it wasn’t polymyalgia so that you can ease myself off the pills. I nonetheless have neck and shoulder ache.Rosemary Rose, Middlesex.Dr Martin Scurr replies: Polymyalgia rheumatica (PMR) is a commonplace situation that reasons ache, aching and stiffness across the shoulder, neck and hips, which is typically worse within the morning.Analysis is in response to a blood check, and the usual remedy is low-dose steroids, typically prednisolone. This will have to begin to unravel the indications inside days — the truth that you have not progressed is more than likely why the GP has dominated out PMR.I wonder whether the issue may well be put on and tear of the discs within the neck. Those must enhance the burden of the top and through the years this will purpose arthritis, ache and stiffness, as bone rubs on bone. The nerves too can develop into pinched, inflicting neck ache. Your shoulder ache could also be the ache radiating down from the neck.I would recommend asking your GP about having a scan: X-rays could also be enough, despite the fact that an MRI would offer even better element. If that is the issue, physiotherapy would lend a hand, however sadly there is not any everlasting treatment.Write to Dr Scurr at Just right Well being, Day-to-day Mail, 9 Derry Side road, London, W8 5HY or e mail: drmartin@dailymail.co.united kingdom. Dr Scurr can’t input into non-public correspondence. Replies will have to be taken in a basic context. Seek the advice of your individual GP with any well being considerations. Personally… Any other nail within the coffin for GPsAt A time when inflation is round 4 in line with cent, investment for GPs in 2024/25 will upward thrust by means of simply 1.9 in line with cent. What many of us do not realise is that the GP provider is carried by means of about 7,000 small companies. In contrast to health center consultants, GPs are particular person subcontractors who draw maximum in their source of revenue from a monopoly employer: the NHS.The paltry upward thrust for overheads when power costs on my own have doubled — will increase shouldered by means of your native follow — will additional squeeze those small companies. Medical doctors are transferring out of the country, others are transferring to the personal sector or taking early retirement. Regardless of the case, it is affected person care that suffers.I do wonder whether the present slide is welcomed by means of Executive, in order that GP care may also be deserted, leaving doctor mates (who’ve little coaching) and nurses in rate, aided by means of AI.Medical doctors could be confined to health center paintings. Am I being paranoid? I do not believe so.
