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Suffer GERD. Prescribed ilaprazole and Riflux forte. Difficulty in swallowing, bloating feeling and uneasiness. Remedy?

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Hi , I am suffering with GERD symptoms since last two years. Did endoscopy twice (2011 and 2 weeks back) and result are more or less similar. Doctor also did H-Pylory IGG blood test and it came positive but Doctor could not find any H-pylori during recent endoscopy. Doctor suggested ilaprazole 10mg (1 daily empty stomach) and Riflux forte (3 daily) after food. Earlier (2011) doctor suggested me to take Rabicip. I was actually better with Rabcip (than ilaprazole ) but slowly it was becoming a part of daily routine. My usual symptoms are difficulty in swallowing and at a time I get kick middle of my heart or upper part of my stomach, bloating feeling and overall uneasiness with stomach. With current prescribed medicines I dont have all these symptoms but swallowing difficulty has increased and at time its very painful. I also tried taking Rantac after food and it gives some comfort. Somehow I felt that my body is not accepting Riflux Forte. Please suggest what would be the best remedy? Also do you suggest any home made remedy during that state when I am not able to swallow any solid food like bread . Even drinking water is painful sometime. I take daily homemade curd, is this causing any food allergy? BTW I have allergy symptoms since childhood with often skin rash from specific kind of foods.
Posted Wed, 17 Jul 2013 in Liver and Gall Bladder
 
 
Answered by Dr. Charles S Narasi 2 hours later
Hello, XXXXXXX
Thank you for contacting XXXXXXX with your questions.
You tell us that you have had GERD symptoms for
over two years now and have had three endoscopic
examinations. I understand that the findings were
negative for ulcers or erosions or narrowing of the
lower esophagus called the stricture. Because the
stricture can make your swallowing difficult due to
blockage, especially for solid foods. You have been
placed on different medications. Ilaprazole is a Korean
and Chinese pharmaceutical PPI similar to Omeprazole.
We do not have much experience with that drug. Riflux
Forte is an antacid with aluminum base. The other one,
Raicip is Rabeprazole which is a good PPI with longer
action. Some of the difficulty in swallowing could be from
spasm at the lower end of the esophagus due to irritation
from the acid. Rantac is a H-2 Blocker and the effect does
only last for about 6-8 hours compared to a PPI where the
acid control can last up to 18 hours or better.
In addition to staying on the medications , it is very important
that you pay attention to the diet as well. Avoid excess caffeine.
Tomato based products, citrus, tobacco, alcohol are all bad.
Same goes for dairy products including whole milk, curd (Yogurt)
cheeses etc.
I would use Rabcip twice a day 60-90 minutes before morning and
evening meals. Do not go to bed for at least two hours after your
last meal. No snacking at nights.
Once in a while you can take the antacid preparation in between but
again the effect will last for about 2-4 hours.
As for H.Pylori , if treated , the GERD symptoms can get worse.
So long as you do not have duodenal ulcer , I will not treat H.Pylori.
Hope this helps you.
I wish you the very best.
Above answer was peer-reviewed by
 
Follow-up: Suffer GERD. Prescribed ilaprazole and Riflux forte. Difficulty in swallowing, bloating feeling and uneasiness. Remedy? 9 hours later
Thx doctor, i have enclosed my recent endoscopy report for your review. As i told you i was taking rabicip for 2 years (not everyday but whenever i had symptoms or whenever i knew that i had to eat outside food, approx 3 to 4 tablets per week and always only 1 tablet per day) , my recent endoscopy was part of routine check up since h-pylori igg came positive , even my platelet count came only 0000 but then rest of the blood reports were normal. Doctor asked me not worry about lower platelet count since there were no symtoms on the skin. Coming back to original topic, i did not want to live on medicine (rabicip) and was looking for parmanent cure and hence went for second endoscopy. With new medicine i dont have any other symptoms by swallowing issue bothers me a lot. A week back even i was feeling terrible pain in my tooth and mouth, went to gp and she suggested antibiotic (t-mox) and rantac for three days. She felt pain may not for acid reflux since there is local infection. I was ok for those three days but once again swallowing difficulties started yesterday after lunch. During those three days i was avoiding riflux forte and was taking only Rantac and hence i thought my body may be rejecting riflux forte. I have nomal bowel, good appetite and no pain in lower or upper abdomen as i write this. I dont take meat but take fish regularly, i also take aloe vera juice and karela jamun juice empty stomach every day, i take rice, curd , dal and low spicy curry for lunch. Cucumber puffed rice , groundnut and chana ( no oil) as evening snacks, for dinner i take boiled vegetables, corn, carrot , ginger, lots of cavaage , two rotis and 1 cup rice and 1 piece of fish. I usually take 4 cups of tea with milk and 1 cigarette before sleep. Used to take 10 cigarette even 4 years back and gradually reducing this. I take one amway neutralite per day after breakfast. As i told you, for allergic symptom i take one half citrizine every alternate day, taking anti allergic drug for last 20 years. Because of stress ful work i sometime get constipation, acid reflux symtom becomes worst during that, to avoid constipation i sometime take ayurvedic laxative like isabgol. My body weight is under 73kg and height is 5ft 10inch, i do regular exercise and yoga.
My question is, can i live normal life with normal food? Can i not get rid of medicines parmanently? Also You have suggested me not to take milk food and curd but my other doctor saw me 2 yrs back suggested me take curd, i am confused here. What are the side effect of these acid suppressing drugs on long term? Thx in advance again,
Follow-up: Suffer GERD. Prescribed ilaprazole and Riflux forte. Difficulty in swallowing, bloating feeling and uneasiness. Remedy? 0 minute later
Thx doctor, i have enclosed my recent endoscopy report for your review. As i told you i was taking rabicip for 2 years (not everyday but whenever i had symptoms or whenever i knew that i had to eat outside food, approx 3 to 4 tablets per week and always only 1 tablet per day) , my recent endoscopy was part of routine check up since h-pylori igg came positive , even my platelet count came only 0000 but then rest of the blood reports were normal. Doctor asked me not worry about lower platelet count since there were no symtoms on the skin. Coming back to original topic, i did not want to live on medicine (rabicip) and was looking for parmanent cure and hence went for second endoscopy. With new medicine i dont have any other symptoms by swallowing issue bothers me a lot. A week back even i was feeling terrible pain in my tooth and mouth, went to gp and she suggested antibiotic (t-mox) and rantac for three days. She felt pain may not for acid reflux since there is local infection. I was ok for those three days but once again swallowing difficulties started yesterday after lunch. During those three days i was avoiding riflux forte and was taking only Rantac and hence i thought my body may be rejecting riflux forte. I have nomal bowel, good appetite and no pain in lower or upper abdomen as i write this. I dont take meat but take fish regularly, i also take aloe vera juice and karela jamun juice empty stomach every day, i take rice, curd , dal and low spicy curry for lunch. Cucumber puffed rice , groundnut and chana ( no oil) as evening snacks, for dinner i take boiled vegetables, corn, carrot , ginger, lots of cavaage , two rotis and 1 cup rice and 1 piece of fish. I usually take 4 cups of tea with milk and 1 cigarette before sleep. Used to take 10 cigarette even 4 years back and gradually reducing this. I take one amway neutralite per day after breakfast. As i told you, for allergic symptom i take one half citrizine every alternate day, taking anti allergic drug for last 20 years. Because of stress ful work i sometime get constipation, acid reflux symtom becomes worst during that, to avoid constipation i sometime take ayurvedic laxative like isabgol. My body weight is under 73kg and height is 5ft 10inch, i do regular exercise and yoga.
My question is, can i live normal life with normal food? Can i not get rid of medicines parmanently? Also You have suggested me not to take milk food and curd but my other doctor saw me 2 yrs back suggested me take curd, i am confused here. What are the side effect of these acid suppressing drugs on long term? Thx in advance again,
 
 
Answered by Dr. Charles S Narasi 9 hours later
Hello, XXXXXXX
Thank you for sending the endoscopy pictures. As they mention,
you do have hiatus hernia and a weak sphincter muscle at the
junction of the esophagus and stomach. In addition they also
mention that the opening between the stomach and duodenum
(Intestine) is also weak and that might make bile back up into
the stomach and combined with acid could cause more damage
to the lining of the stomach and esophagus. You mention a lot
of things in your diet. Tea that you drink contains caffeine and
it can aggravate the symptoms. Cigarette smoking weakens the
sphincter muscle at the junction of esophagus and stomach
making reflux worse.
For the most part PPI class of drugs are safe long term.
Omeprazole has been in use for a long time.
There are some concerns about infections such as pneumonia in
people with weak immune system when they take PPIs for a long
time. One time there was concern about stomach polyps or tumors.
That is no longer true.
If medications can't control your symptoms or if you are very very
concerned about long term medications , you can consider other
options such as surgery . There are newer endoscopic measures to
tighten the junction. You can discuss these with your gastroenterologist.
Try not to combine too many medications , even natural ones.
Whole milk contains fat and also calcium. Fat slows down the emptying
of the stomach and the calcium increases the acid and that is the
reason for restricting if you have acid issues.
I wish you the very best.
Above answer was peer-reviewed by
 
Follow-up: Suffer GERD. Prescribed ilaprazole and Riflux forte. Difficulty in swallowing, bloating feeling and uneasiness. Remedy? 14 hours later
Doctor,

Thx once again, while I understand that there is no permanent cure through medicines and if I want to avoid surgery (as most of us would) then I need to continue with PPI tablets and there is no known side-effect. I still have few questions as part of my follow up

1. Scopy shows weak junctions , hole etc - will these aggravate as part of the my aging process? Even if I consider quitting Cigarette completely and cut down tea intake? I don’t drink but I can not avoid stress full work environment. I get tensed quickly under pressure.
2. What are the chances for such disease like Lax XXXXXXX or Hital Hernia etc to become cancerous as I grow older? Will surgery reduce the chances?
3. Sometime I get urine infection along with Riflux symptoms, are these related? Do you think it would help if I upload my complete blood and pathology report as well?
4. Can you please suggest a balanced diet for me? I usually don’t take milk or milk sweet but I take curd regularly and so far that did not trouble and in fact improved my bowel system.

Thx again
 
 
Answered by Dr. Charles S Narasi 6 hours later
Hello, XXXXXXX
I can understand your concerns but you do need to relax.
Hiatus hernia does not turn into cancer. I think by cutting back
on tea intake and quitting smoking , it will help improve the
symptoms. For the most part it is safe to take the PPI drugs
for extended periods of time. When you get complete relief
of symptoms , you can take the drug on an as needed basis.
I don't think there is any relation between PPI and urinary
tract infection.
Try not to think too much about a lot of things.
I am sure that you will be O.K. in the long run.
Wish you good luck.
Above answer was peer-reviewed by
 
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