This topic is about the challenges faced by someone with an ileostomy who needs to take a proton-pump inhibitor (PPI) like omeprazole. The concern is that the enteric-coated beads in standard omeprazole capsules may not dissolve properly, leading to poor absorption. The person is looking for advice on which PPIs or formulations might work better for someone with an ileostomy.

Here are some helpful insights and advice:

1. The PPI is needed not for acid reflux but to manage excessive stomach acid that is affecting the Brunner’s glands in the duodenum. Medication is necessary as diet changes alone are not enough.

2. PPIs that other people with ileostomies have found effective include:
- Lansoprazole capsules.
- Dexilant (dexlansoprazole) delayed-release capsules.
- Omeprazole gastro-resistant "hard" capsules at 20 mg doses, which some users find effective despite having an ileostomy.
- Omeprazole, Esomeprazole, and Pantoprazole are available in forms like immediate-release oral suspension or powder packets to mix with water. These forms avoid the issue with enteric coatings. Check with a pharmacist if these are available over-the-counter or by prescription in your area.

3. For those also dealing with reflux, consider non-drug strategies:
- Elevate the head of your bed by a few inches to prevent nighttime reflux.
- Adjust meal timing and avoid eating right before lying down.

4. Some alternatives and supplements mentioned include Actazin tablets (kiwifruit extract), which helped one person after stopping omeprazole.

5. Be aware of potential long-term risks of PPI use, such as links to renal disease, cardiovascular events, liver disease, fractures, infections, nutrient deficiencies, dementia, and gastric cancer. It's important to discuss these risks with your doctor and monitor your health as advised.

6. A practical tip if you need to use a capsule formulation: you might open the capsule and sprinkle the granules into applesauce or yogurt, swallowing without chewing. However, only do this if a pharmacist confirms it's safe and effective for the specific medication.

7. Many people with ileostomies can still absorb capsule PPIs, but switching to a liquid or packet form can eliminate any doubts. It's best to consult with your doctor or pharmacist to find the most suitable version and dose for you.