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DEAR DR. ROACH: You recently wrote that you do not recommend probiotics in healthy people. I am a 78-year-old male who, three years ago, underwent an esophagectomy to remove my esophagus and part of my stomach because of cancer. I was put on 30 mg of pantoprazole, which was later increased to 40 mg. I've read that prolonged use of this medicine isn't recommended.

My understanding is that this medicine is used to reduce the chance of acid reflux. I have read that it also kills bacteria (both bad and good) in the stomach. I asked my primary care physician about this and if she was OK with me starting probiotics to help restore the good bacteria. -- E.M.

ANSWER: Proton-pump inhibitors like pantoprazole are often used in people after surgical treatment for esophageal cancer. They reduce acid reflux and consequently prevent a stricture where the remainder of the esophagus was connected with the remainder of your stomach.

While it is true that proton-pump inhibitors do have the potential for side effects with long-term use, there are times when the benefits outweigh the risks. Many esophageal cancer experts feel that the benefits outweigh the risks in esophageal survivors like you.

Long-term acid suppression does lead to changes in the gut bacteria, called the microbiome. Using probiotics to improve the quality of the microbiome has been studied, and preliminary studies showed that taking probiotics daily can get more healthy bacteria in the gut. What isn't clear is whether this translates to better outcomes for the patient or whether any of the long-term adverse effects of proton-pump-inhibitor therapy will be reduced. It makes sense that it might help, but it is unproven as yet.

There is the potential for harm in probiotic treatment, but it's not common. A very few cases of infection have been shown to be transmitted by probiotics. The main harm is mostly financial, since some probiotics are expensive.

DEAR DR ROACH: I am 81 years old and in pretty good health. I often have a hard time getting to sleep and staying asleep. A couple of months ago, I was dealing with a sore lower back from overdoing yard work, so I took two ibuprofen tablets before going to bed for several nights in a row. What I noticed is that I was able to get to sleep quicker.

I have continued to take ibuprofen as a sleep aid, and it continues to help me get to sleep. But I am wondering if there might be any medical issue that could arise from the continued daily use of ibuprofen. -- J.T.N.

ANSWER: Most people don't find that ibuprofen helps or hurts their sleep, so I don't recommend it as a sleep aid in general. In fact, some people find that ibuprofen can be disruptive to their sleep. Others, however, find that it makes them sleepy.

In any case, the risk of two ibuprofen tablets at night, or even every day, is small. A person with a history of ulcer disease or abnormal bleeding shouldn't take ibuprofen daily without discussing it with their doctor.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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