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What is the cause and treatment for frequent vomiting and belching?

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Gastroenterologist
Practicing since : 2000
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My 17 years old daughter is suffering from Vomiting and gas since last 3 months. Vomiting 2-3 times a day and frequent belching/burping. She is also frequently having flatulance. She is on medicines like Ondem/Zofer without much relief. Please help, what medicines she should take.
Posted Thu, 6 Feb 2014 in Digestion and Bowels
 
 
Answered by Dr. Poorna Chandra K.S 26 hours later
Brief Answer: Answered Detailed Answer: Hi and thanks for the query Frequent vomiting and belching is usually a sign of gastroesophageal reflux disease (GERD). GERD is the reflux of acidic stomach contents into the esophagus. As the esophagus is not designed to handle acids it produces various symptoms like heartburn, nausea, burping and vomiting. Presence of a hiatus hernia, where in part of the stomach is in the thorax compromises the sphinter present at the junction of the stomach and the esophagus and predisposes to GERD. In some it may occur with menestruations In a healthy young girl like your daughter other causes of vomiting and belching like renal dysfunction are unlikely. Hence consult your physician and get an endoscopy done to identify the problem and the predisposing factors. Meanwhile after sleep delay lying down by atleast 2 hours, have the head end of the bed raised by 10cms and start doing some breathing - Diaphragmatic exercises. Adding a proton pump inhibitor to the already consuming drugs will help. Regards Dr XXXXXXX
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Follow-up: What is the cause and treatment for frequent vomiting and belching? 26 hours later
The following part of the reply needs further details: Presence of a hiatus hernia, where in part of the stomach is in the thorax compromises the sphinter present at the junction of the stomach and the esophagus and predisposes to GERD. Can Endoscopy rule this out? Is hiatus hernia a surgical condition? In a healthy young girl like your daughter other causes of vomiting and belching like renal dysfunction are unlikely. While undergoing MRI scan, she has had Blood Urea and Creatinine tests,which are OK. Meanwhile after sleep delay lying down by atleast 2 hours, have the head end of the bed raised by 10cms and start doing some breathing - Diaphragmatic exercises. How to delay lying down AFTER sleep... is not quite clear. Pls. elaborate. Adding a proton pump inhibitor to the already consuming drugs will help. Which drug will be more helpful? She is already taking Pantocid and DOM-DT. Will famotidine help?
 
 
Answered by Dr. Poorna Chandra K.S 41 hours later
Brief Answer: Hello Detailed Answer: Thanks for the details. Sorry for my delayed response, was out for a conference. -Yes, endoscopy can rule out the condition of hiatus hernia. Hiatus hernia requires surgical correction if medical treatment does not suffice, and the symptoms remain. Usually nissen's fundoplication surgery is done for this. - Since the blood urea and creatinine are normal, renal cause is ruled out in your daughter. - I am sorry; please make the correction. It is after meal and not after Sleep. Delay lying down by atleast 2 hours after meal. - Pantocid is a proton pump inhibitor. If she is taking this drug, she can continue with it. No need to add other drugs. Pantocid is superior to Famotidine in actions. There is no need to add famotidine either. Hope this clarifies. Thanks,
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Follow-up: What is the cause and treatment for frequent vomiting and belching? 47 minutes later
Is there any other (non-invasive but effective) alternative to endoscopy (like CT scan, manometry, Barium meal X-Ray etc.?). In her case, Ondem with Mirtaz was working well, as compared to Ondem alone. But, Mirtaz was discontinued due to (potential) side effects. She is now taking Escitalopram, 5 mg. She is obviously under stress due to loss of valuable 3 months, especaially as her 12th exams are also approaching. But, should she be given these antidepressant at this age?
 
 
Answered by Dr. Poorna Chandra K.S 1 hour later
Brief Answer: Answered Detailed Answer: Hi Endoscopy is the best way to look at the gastroesophageal junction as it can tell about the grade of esophagitis as well as detec a hernia. Other alternatives will be like barium meal which is inferior and outdated. Manometry looks at the motility aspect of it but cannot determine the grade of reflux or the size of hernia Mirtaz is rerelu used now a days and in the treatment of GERD a combination of a proton pump inhibitor like pantoprazole and a prokinetic like domperidone or levosulphiride is better than any one of them Escitalopam is also known to help in people with non ulcer dypepsia. However whether your child needs one depends on various issues which can only be assesed on a personal interview and examination Hope this clarifies. Thanks, Dr XXXXXXX
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Follow-up: What is the cause and treatment for frequent vomiting and belching? 2 days later
Is there anything like Video-endoscopy, in which we can get the findings on a CD? What to ask/expect the doctor doing endoscopy? (like, we want to rule out haitus hernia, or we want to know the degree of reflex... etc.) She has also tried Stemetil for two days which gave some relief in vomiting, but led to stiff muscles/muscle pains, and thus discontinued. Does this medicine has serious side effects? Can OTC medicines like Perinorm help, when prescription medicines have failed? Will she be all right after diagnosis in Endoscopy and proper medication? Kindly help.
 
 
Answered by Dr. Poorna Chandra K.S 2 hours later
Brief Answer: Answered Detailed Answer: Hi again You have got your questions right Stemetil is primarily for giddiness associated vomiting and can cause dystonias or muscle stiffness Perinorm is good for nausea and vomiting but also carries a risk of dystonias. Hence it is better to take domperidone which doesnot have these side effects Rest will depend on the results of the investigations and a good physical examination Regards Dr XXXXXXX
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