Brief Answer:
I would like you to answer a few questions.

Detailed Answer:
Hi,

Wellcome to Health Care Magic.

I am Dr.Muhammad Ahmad.
I have read you question in detail and will help you in this matter

I would like you to answer a few questions,

1- Can you swallow liquids with ease?

2- Did you discuss this issue with specialist after the diagnosis of barretss esophagus ?

3- Have you discussed surgical options with your doctor?

4- When was your last barium swallow done if any?

5- Any CT scan done?

6- Are you following diet and life style modifications?

7- Do you smoke or drink?

Answers to these questions will help me guide you in a better way.
I am waiting for your input.

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Brief Answer:
This thing can be dealt with don't panic.

Detailed Answer:
Hi,

Thanks for writing back,

You wrote back after quite some time I hope you are doing fine,we try to respond within 12-24 working hours ,you can always check for a response, soon after you post a question.

I have read your medical history again and information you have provided on the website in this and your other question,

well If your barium scan is normal then it means that symptoms can be treated without any surgical intervention,

because if barium scan had shown some sort of stomach hernia or narrowing of lower end of your esophagus then it was nothing but a surgical case, you said you haven't underwent a CT scan yet , i just means that your esophagus have metaplastic change but it IS NOT severe enough to be suspected as cancer , this is a good news again.

Now we come to your symptoms, well to deal with this you will both life style changes and meds.

As i can see, you are quite well aware and educated about your condition, so i have little doubt that you must have been following life style modifications strictly and you must be knowing what food and activity you should follow and what you should stay away from.

So i will come to meds,


We use three groups of drugs in the situation you are in,

Combining them or giving a single one of them or what to chose , depends upon choice of the doctor and reponse of patient to the drugs.

1) Antacids:

You must be aware of them , they are used for immediate relief , they aren't beneficial for long term relief.

2) Drugs that reduce acid formation:

A) PPI's:

they are drugs like omeprazole,pentoprazole,lansoprazole etc.

B) H2 inhibitors:

Like ranitidine (zantac)

3) Pro-Kinetic drugs:

They are specially used as adjunct therapy in typical GERD cases because they cause quick emptying of stomach so reflux of food antacid is reduced.


WHAT OPTIONS DO YOU HAVE:

1) Increase the dose of PPI:

You are using a sustained release tablet , but still it's been proved that if you can use two tablets at 12 hours distance it get more effective you can try it.

2) Adding Zantac at night with PPI:

Other trials show that there is remarkable improvement in symptoms if zantac 50mg is used at night and PPI in morning before breakfast.

3) Adding a Pro kinetic med with PPI:

You can add pro-kintic drug with the PPI , the best in the regard is metoclopramide because it not only increases gut motility but it also causes better pressure in cardiac end of esophagus , which causes reduction in GERD, this you can take two times a day or probably three times if required... comes with many names Plasil is one well known name among them.


What seems more appropriate in your case:

If i were your doctor i would have asked you to Keep PPI dose same and add zantac at night, eat 2 hours before sleeping and have a walk after dinner plus add a prokinetic drug in morning and evening. Thus you get a good protection from acid, and metoclopramide also gives strength to your sphincter reducing reflux of acid.

avoiding alcohol, spicy, sour foods, fizzy drinks, caffeine ,,coffee, tea is also very important,, switch to small soft meals for 2-3 months with time improvement is expected.

Get manometric studies from somewhere else if you can get, this is the only abnormal finding you have told me so far which can be a concern , barratt's is a concernt but if you relux is controlled there should be a problem in long term.


Hope this answers your question. If you have additional questions or follow
up questions then please do not hesitate in writing to us.
Wishing you good health!!


Dr.Muhammad Ahmad

Resident M.D.

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Brief Answer:
Your issues are treatable just be patient n calm.

Detailed Answer:
hi,

Thanks for writing back,

I hope you are having a great weekend.

You don't have to worry even if this option fails we have many others too, though it rarely fails.

You can discuss the option of a medical combo as i suggested with your G.P.

Let's plan a strategy for some weeks about solid food.... you said you can swallow liquids easily and have problem in swallowing solids.. lets make every solid almost a liquid by chewing it more than you usually do. Can also mix water in food during chewing.

It will help you big time, like if you had chewed the eggs for a minute more may be this wouldn't have happened.

I also will like to share my thoughts about people not believing your symptoms, well..!!

i do believe your symptoms but i also want to mention one thing here that some times , when a patient is having a particular problem for a long time , and is anxious about it, sometimes in such patients, psychology also comes into play,

it can manifest itself by giving increasing intensity of symptoms, a normal burning may feel like severe one..

I would suggest you to give a visit to psychiatrist as well , this doesn't mean that you have psychiatric issues of something it is just to get evaluated and just to know some tips and tricks to keep your anxiety away and nerves calm.

Your issues can be resolved,by chainging life style eating habits and adjusting meds there is no big deal as far as my opinion is concerned .


Wish you the very best of health :)

when ever you need to ask any health related question you can also directly ask me through my profile .Stay blessed...!!

Dr.Muhammad Ahmad

Resident M.D

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Brief Answer:
please answer a few questions in this regard

Detailed Answer:
hi,

thanks for writing back,

It's my pleasure that you are so well educated about your issues. I would like to admire your efforts for your girls, indeed raising young kids specially as a single mother is a real tough job one is always facing problems.

Yes stomach acid does increase in production during phase of stress, something we call stress dyspepsia or stress ulcers ( if an ulcer develops) .

Almost every one these days is under stress but all of them don't have stomach issues it just means that there are many other factors which contribute to this problem.


I would like you to answer a few questions to come up with a better and more beneficial answer.

1) Do you have severe reflux? or is it just pain or burning?

2) do you have food particles in your mouth or pillow as you wake up?

3) Have you talked to a psychologist about your issues?

4) Took any meds for stress? did it help?

5) Do you avoid caffein? smoking, tea, choclate alcohol, spicy food?

6) have you started chewing the food more? did it help?

7 ) Any complaints of constipation lately?

8) What does you latest endoscopy report says?

im waiting for your input.

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Brief Answer:
There are a few things to avoid,

Detailed Answer:
Hi XXXXXXX

Thanks for writing back,

Thanks for helpful answers, I understand your concerns and will try to come up with a helpful answer in this regard.

Acid reflux is actually a broad term , mostly it is all about the symptoms felt by the patient...like in some patients there is no extra acid but they have eaten spicy foods so that is causing burning, this is again called acid reflux, not technically right, but since there are no good methods to know why is some one having symptoms, we categorize anything causing burning and is felt refluxing in esophagus, as acid reflux.

Yes!! lower sphincter of esophagus has big part to play , and quantity of acid goes hand in hand with sphincter issues , in causing symptoms. Some times quantity of acid is high but sphincter is functioning fine so there are not many symptoms and in other cases quantity isnt abnormally high, but sphincter isn't working well to keep acids in stomach do they enter eophagus and cause sever symptoms.

Stomach has super strong acid in it which will make a Pound of beef dissapear within an hour, so you can well imagine that it doesn't need any extra acid production to cause severe symptoms , if one's sphincter isn't keeping acids within stomach, there is a problem.

Correcting sphincter hasen't been a success story for us, going for surgery usually carries more risk compared to the benefits , so we go for drugs like PPI and prokinetics , they cause improved symptoms. Plus we avoid foods which relax sphincter, stay in stomach for a longer period of time, or cause constipation.Weight reduction also helps big time.


How severe does your problem looks like after all this discussion:

Well its a good news that your symptoms have got better as far as burning is concerned i will suggest you some life style changes it will hopefuly reduce frequency of occasional dyspepsia you are having. According to endoscopy there is no stricture at the end of your esophagus plus metaplasia is also not severe so there you haven't yet reached a stage where one needs cancer screening or consider a surgical option that's a good news.

Will you have to take PPI for your whole life?

Well 1st you have to go for life style change then you can try reducing the doses after some time when frequency of occasional acidity get reduced significantly. Some times people do get to use these meds for decades but try to learn which foods irritate you more and what helps.. with life style and food modification you can at least reduce meds intake .


What can you further do about the issue:

1) Reduce weight is BMI is above 25

2) Please din't take coffee , caffeine in any form and dexalin, dexalin might have reduced your pain but it's very notorious in causing stomach ulcers use of selective cox-2 inhibiotrs instead can cause pain relief with stomach protection, this can be discussed.

3) Eat very less at night and have some walk after dinner, dont drink water after meals,,,, drink 2 glasses before meal.

4) Eat simple soft food for a month with proper use of meds and no coffee and caffeinated drinks, may be there is some irritated part of esophagus or stomach which causes your burn and pain symptoms and causes difficulties in swallowing , if it gets better there are chances that you problems will get better.

I want to assure you that you problem is very treatable and avoidable but you will learn with time how to deal with it plus you have to avoid few things there is XXXXXXX chance that you are drinking coffee and want occasional burn attacks not to happen , caffein also loosens up esophageal sphincter which further adds to the injury.

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Brief Answer:
We have so many options so stay calm.

Detailed Answer:
hi,

Thanks for such kind words,

I am pleased that discussing with me helped you.
I found you really educated about your issues but it amazed me that you are using coffee on daily basis, dexalin is also not good but its ok if you don't know the side effects of a med, but i expected you to know that coffee is highly contraindicated.

Fizzy drinks..
caffeine...
..cigarette...
teas..
spicy..

fried..
junk.. these things are super contraindicated.

Any ways thats how we learn i would suggest you to read about diet and life style changes in acid reflux and dyspepsia,

You got to be following diet modification fully before you start thinking about effects of a drug.

I am quite hopeful that changing your diet habits will reduce he frequency of occasional aggravations you get.

Here I would also like to mention that we have so many options and drug combinations in your case if one doesn't work please don't panic we can have plan B,C,D,E till we get good results.

Just stay steady and determined to fight this issue , with time you will learn how your stomach behaves with stress , food and life style.

Take good care, you can follow up for feedback and suggestion any time through my profile if you want answer directly from me.

Stay blessed. wish you health...!!

Dr.Muhammad Ahmad

Resident M.D.

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