Hi XXXXXXX
Thanks for writing in.
I am a medical specialist with an additional degree in Cardiology. I read your mail with diligence. I must compliment you for getting rid of 76 lbs and blood pressure went with it? If that is so nothing could be better.

Coming to your symptoms due to GERD. You are taking salt Esomeprazole which is a proton pump inhibitor (brand name Nexium) ; if you tick from the check list below what else you are doing:
Life Style Changes for treatment of GERD
•If you smoke, stop. (There is no mention that you are a smoker so pass)
•Avoid foods and beverages that worsen symptoms. (Make a value judgement)
•Lose weight if needed. (YOU DID IT!)
•Eat small, frequent meals. (Eat like a sparrow or better as a toddler)
•Wear loose-fitting clothes.
•Avoid lying down for 3 hours after a meal. (Imp.: you do not want more GERD)
•Raise the head of your bed 6 to 8 inches by securing wood blocks under the bedposts. Just using extra pillows will not help. (EASY !)

Medications

You have a specific complaints which is part of whole gamut of symptoms some have more. May be not lying for 3 hours after meals help you or may be addition of one or more of following medicines help. For gaseous distension avoid high fiber diet. Tab charcoal (OTC used for preparation of patient for abdominal ultrasound) two to three tablets day do wonders as they literally soak gas.

We recommend over-the-counter antacids or medications that stop acid production or help the muscles that empty your stomach. You can buy many of these medications without a prescription. However, see your health care provider before starting or adding a medication.

Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts— magnesium, calcium, and aluminum—with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt may cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well. AS YOU HAVE IBS IF it is not preferred choice avoid it.

Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux.

H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), decrease acid production. They are available in prescription strength and over-thecounter strength. These drugs provide short-term relief and are effective for about half of those who have GERD symptoms.

Proton pump inhibitors include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are available by prescription. Prilosec is also available in over-thecounter strength. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms and heal the esophageal lining in almost everyone who has GERD. YOU ARE TAKING ONE. Unless you have problems with it. Stick to it.

Prokinetics help strengthen the Lower Esophageal Sphintor and make the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness— fatigue, sleepiness, depression, anxiety, and problems with physical movement.

We discussed a lot of general treatment if you have any specific question regarding this, please ask.It shall be replied as soon as possible. Regards and good luck.
With Best Wishes
Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

---