heartburn/GERD from Tamoxifen
Hi everyone. After 18 months on Tamoxifen I have developed heartburn and perhaps GERD. It started with a feeling of being full after even small meals, then a sore throat and now full-on frequent heartburn. Turns out it's yet another side effect of the anti-hormone drugs. Yuk. Has anyone else developed this and did it go away? My other SEs were temporary so maybe this will be as well? I did not have chemo so it's not related to that. Any info. welcome.
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I get it periodically, not sure if it’s the Tamoxifen as I also had it pretty bad when I was pregnant. When it flares up, I take Prevacid for a few days and it usually resolves
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I had this for about the first month I was on Tamoxifen. Took a course of Omeprazole to relieve it. I really hope it doesn't come back at 18 months.
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I had off and on stomach issues before taking Tamoxifen however now need prescription medication daily. Still having some burning and upset stomach. I've been on Tamoxifen for 4 months and then this year for 6 months. I'm worried that the Tamoxifen is burning out my stomach even with PPI medication. Will be going to a GI consult soon.
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Thank you everyone. Veeder, I'll be curious to know what you find out. Right now I'm trying all the non-prescription stuff: looser clothes, smaller meals, no carbonated beverages. Hoping it will help.
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I am definitely experiencing acid reflux. I am not sure if it is the medication itself, or if it is the reduction in hormones but yeah its there. I cannot take most of the over the counter acid reducers - I am an intermediate Tamoxifen processor and a lot of the inhibitors utilize the same CYP2D6 pathway so no go. Those guys need to focus only on metabolizing Tamoxifen for me.
I chew a Cal/mg supplement twice a day since I need the calcium anyway and supplement during the day if needed with some peppermint tums. So far keeping things manageable although if I drink too much coffee, or do too many situps I can feel things stirring around.
If anyone has any tips beyond using the PPI type meds would love to hear them!
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Hi Rah4264:
If you are experiencing GERD here are some interventiosn you can try: low fat diet, avoid alcohol, caffeine and carbonated beverages; avoid tobacco; and eliminate peppermint and spearmint since they stimulate gastric acid production. The peppermint tums may be adding to your discomfort. Sit-ups increase intra-abdominal pressure so try to find something where you are not bending at the waist especially if you are wearing restrictive clothing or have eaten within the last few hours. Sleep with your head elevated on several pillows or a wedge pillow. Trying these may mean a PPI can be avoided. You may want to see a GI specialist since reflux can damage the esophageal mucosa if it is not checked. Hope you get some relief.
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I do all the above in addition to a low fat diet I eat bland, non spicy foods.And it’s better to avoid laying down on a full stomach of food or after taking any med that irritates the stomach. unfortunately I still need PPI meds.
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Betrayal - thanks for the tips!
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I think you can take pepcid? I take it occasionally and am pretty sure there's no interaction.
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Oops, forgot to mention chocolate as an irritant as well. It is not only the fat content but it contains a chemical similar to caffeine. So if you must indulge, look for dark chocolate with a low fat content which means it can be very bitter and eat it sparingly. If you are taking OTC pain meds such as ibuprofen (non-steroidal anti-inflammatory drugs) and aspirin, make sure to take them on a full stomach or with milk or a chunk of bread.
PPI's can be a necessary evil for some of us but the alternative of developing Barrett's esophagitis makes them a must for me. If OTC antacids are not working, please see a GI specialist. Hoarse speech can be a sign of reflux for some. I never experienced heartburn, just a gravelly voice that persisted and sent me to an ENT who then sent me to a GI specialist. Eternally grateful to him.
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To Betrayal’s good list of foods to avoid, I add citrus or any highly acidic food. Regarding sleep position, elevate not just your head but your upper torso. You can buy a wedge for your bed this at the usual online place.
I have no proof of this, but I think whole breast radiation may have set off my reflux. The rad onc says no, but hmmm, the timing.
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Georgia1, my GERD and SIBO (small intestine bacteria overgrowth; closely connected to the GERD) came back with a vengeance when I went on Tamoxifen. I have abandoned Tamoxifen now because having these other issues was not tolerable to me.
I recommend the "Fast Tract Diet" by Dr. Norm Robillard. This doctor did so much research on GERD and the related ailments and put together a research-based program that really helps. It's really not a diet or even a strict program, just tons of information on what foods can cause flares and what can help. There's a book (called Fast Tract Diet) as well as a facebook group that contains tons of useful info. The main website is https://digestivehealthinstitute.org/fast-tract-diet/
Hoping you find relief!
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Thanks so much everyone. And Betrayal, that is such an interesting story. Mine started with a sore throat when swallowing, which I didn't take seriously til I made the connection to GERD and Tamoxifen. It has been a bit better since a flare-up last week, so I have to add carbonated beverages to the "don't" list you all are helpfully compiling. I was at a wedding and thought a sparkling water would help but nope, it made the heartburn worse! Lesson learned.
EDITED TO ADD: I did some research today and heartburn is a more frequent side effect of osteoporosis medications like Fosomax (which I am also on) than Tamoxifen and AIs! I will ask my doctor about it when I see her next and will update you all again. Sigh.
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The main concern I have is avoiding permanent damage. Also the concern about long term PPI use. If Tamoxifen wasn't such a long term treatment then I could manage this stuff, but years with a daily irritant is scary. I've also seen those on Al medication posting about GERD/stomach irritation so it's not just from SERM meds. Pain meds also contribute to problems for some people like me.
I've had 2 endoscopies and both times by the time I could get scheduled and had the procedure, the PPI medication healed my throat/stomach and everything looked normal. It's not a procedure you want to do often. I did get worried when I had my last PET/ct scan in November for melanoma and the throat/stomach irritation showed up on the scan.
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I had GERD before the tamoxifen and chemotherapy that I managed with diet. Things took a while to settle back down after chemotherapy. PPIs can cause a rebound effect and I had to wean myself off the omeprazole with Zantac.
I'm not sure if the tamoxifen contributes at all to my baseline acid reflux but I take it in the morning and avoid foods that I know make my reflux worse.
When my reflux was bad during chemotherapy because I did not start the omeprazole soon enough, I found carrots and lettuce soothing.
Here's a list of things that tend to trigger my acid reflux.
1. Processed foods like Stove Top Stuffing, instant ramen, shelf stable baked goods like pop tarts.
2. High amounts of butter/oils. Probably fatty food in general but I don't eat much of it.
3. Egg plant.
4. Rao's Marinara sauce.
Things that make my acid reflux worse when I already have it.
1. Tea.
2. Chocolate.
3. Anything acidic.
4. Milk.
5. Bread.
6. Anything on the trigger list.
7. Laying at certain angles.
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Hi everyone, The subject line caught my attention. I recently posted this in the Ibrance thread:
I HAD issues with indigestion too, even before ibrance. Then I had to have my gallbladder out. After surgery I developed pancreatitis. I was released from hospital with terrible indigestion and was told I will probably need to be on a prilosec type drug for life. My research told me that's not good. My pharmacist said I could probably benefit from digestive enzymes. Smart guy. I haven't had an antacid except an occasional tums since I started enzymes. I dont even take those now unless I have pizza late. I would encourage trying those to anyone that isn't digesting cause it just makes sense. I would describe indigestion as a failure to digest food. Food just sits in your tummy. And a digestive enzymes by definition helps body digest food. Its a no brainer. Plus They wont hurt you like prilosec. I guess I didnt understand the antacid angle cause I never felt I had excess acid. I had no heartburn type pain. But then I'm not presently taking ibrance, so maybe. . . Good luck to all
edited to add: When I took letrezole for 3 1/2 years before I also had a good case of heartburn but gee I remember it starting before that with coffee! I'd be curious if anyone has luck trying a digestive enzyme. Note that this is not the same as probiotics. I used Nexium beforeand went cold turkey off that stuff when I used the digestive enzymes. 1 pill a day of 21st Century Brand. Never even finished the bottle. Sure hopes this helps alllll of you.
Gailmary
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I had started with indigestion and heartburn in my late forties and was put omeprazole. I noticed it was more stress related (even good stress!) than food related. When I was diagnosed with breast cancer at 53 I had started to decrease my dosage of the PPI and seemed to be feeling better. I actually felt the healthiest I've ever felt during the cancer! I had an easy cancer; they just whipped off the offending breast and since no lymph nodes were affected - no chemo or radiotherapy were needed. Then I went onto Tamoxifen (and probably was into menopause too!) - what a nightmare. My tummy, my bowels. Oh my! It doesn't help I can't get the same brand of Tamox. all the time. Some brands seem to affect me more negatively. Oh well...God is good and considering what some ladies (& men) go through...but I might look into the enzyme thingy as I am doubling up on the PPI which isn't ideal!
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