Hi XXXX,
Thanks for writing in.

I suppose you are already having fibromyalgia, hiatus hernia, osteoporosis, osteoarthritis and gastro oesophageal refulx. You presently are experiencing a sore throat and are on medications.

For the sore throat you have been given the following antibiotics:
Metrogyl 200mg
Amoxycillin 500mg Caps (sz)

This combination of medications is known to work well in sore throat. I would like to make you aware that Metrogyl (metronidazole) tablets cause tastelessness (metallic taste) and nausea in many patients and this might be making you feel more sick at the moment. Amoxycillin is usually does not cause any common side effects.

A 5 day course of both antibiotics cures sore throat and gum infection in most patients. If your sore throat worsens or is still persistent, you might need to see your doctor again.

These infections happen during sudden climatic changes due to weather exposure. On most occasions it can start as a viral flu and secondary bacterial infection might occur. Sore throat can occur form one to three/ four times a year and is seen more in children and the elderly.

You may get a dental consultation if the gum infection does not heal.

Hope your queries are answered.
Should there be any further queries, please feel free to write back.

Wishing you good health and quick recovery.

Regards
Dr Vivek

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Hi XXXX,
Thanks for writing back again.

I understand we must shift our discussion towards Gastro-oesophageal reflux disorder (GERD) and hiatus hernia for better understanding of your situation.

GERD has been known to be associated with sore throat, chronic coughing, difficulty swallowing, wheezing, choking and hoarseness.

Coming to your primary question, we shall discuss the cause for sore throat in GERD.
Due to acid reflux disease, ingested food particles and stomach acid are pushed up from the stomach lumen and into the upper esophagus sometimes reaching the throat and mouth. The low pH (acidic) of stomach acid is irritating to the tissue in the esophagus and throat. This occurs for many reasons including a hiatal hernia (which is there in you) or failure of the esophageal sphincter to close.
A sore throat caused by acid reflux is usually worse in the morning because laying down makes it easier for acid to make its way up the esophagus.

Inflammation and swelling of the esophagus is an alarming symptom when medical attention needs to be considered. If ignored, stricture formation can take place and symptoms may become difficult to treat.

You have been given antibiotics to safeguard against infections. I assume you are already under treatment for hiatus hernia and GERD and taking medications like proton pump inhibitors (omeprazole, pantoprazole) to decrease acid formation in the stomach.

Completing the course of antibiotics is essential. Getting an endoscopy of your esophagus and stomach may be necessary to see any particular areas affected by your GERD. You should avoid bending down forwards unnecessarily. Take your GERD medications regularly and have small meals every 3-4 hours and avoid fasting for longer periods of time. You might consult a dietitian for dietary suggestions.

Hope your queries are answered.
Should there be any further queries, please feel free to write back.

Wishing you good health and quick recovery.

Regards
Dr Vivek

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Hi XXXX,
Thanks for your feedback.

Nexium 40 mg is esomeprazole (proton pump inhibitor) which decreases acid formation in the stomach in GERD patients.

Glad to know that now you are taking Nexium 40 mg once in morning and again at night. You should be taking this medicine as you wake up early in the morning 30 mins before brushing your teeth. At night you may take it 30 mins before dinner. I am sure your doctor would have given you that information.

Regards
Dr Vivek

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Hi XXXX,
Thanks for writing back to us.

I would like to clarify about taking Nexium.

Nexium must always be taken before food and if possible, on empty stomach in the morning. This is to decrease the acid in your stomach and hence the GERD symptoms. You may take it Nexium after brushing teeth in the morning and 30 minutes before dinner.

All medicines given to you have started to work.
- Nexium is already reducing the acid in your stomach with the first dose
- Similarly first dose of metrogyl and amoxycillin have started fighting the bacteria in your throat and gums.

I understand what you mean by sore throat has not changed. The throat mucosal lining is very sensitive and sometimes may take a while to heal. Also if there is a viral flu at the same time, your recovery will take a little more time (over a week). You can do warm water gargling twice a day, without wretching your throat to for a while till it eases out.

Hope your query is answered.
Wishing you quick recovery.

Regards
Dr Vivek

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