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    Are burps and flatulence indicative of GERD?

Posted on Mon, 24 Jul 2017 in Digestion and Bowels
Question: Please find attached 2 prescriptions. I have been diagones with GERD. I am very worried as the symptoms are quite disturbing. Few symptoms are when my stomach bloats
1. Heartburn
2. Sour taste in throat
3. little coughing
4. little pain in left arm
5. Feeling like somethinf is stuck in throat
6. Dryness of mouth
7. Little dizziness when i stand still
8. I feel a bit unstable too
9. Mild Headache
10. Rapid Movement inside the stomach

When i get burps or gas passes away by medicines then i feel better. After taking the medication I am feeling a little better but the symptoms reoccur if I stop medication.
My questions
1. Are these symptoms associated with gerd?
2. How long does it taked to cure it?
3. Do I necessarily need to go through endoscopy?
4. How can I deal with these symptoms?
5. Can I eat something which can reduce these symptoms
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Classical case of reflux disorder.

Detailed Answer:
Thanks for asking query on HealthcareMagic.
Have gone through your query and i appreciate your concerns.
Before answering your questions i would like to give you a briefing about your problem this will help you to understand things in a better way.

Gastroesophageal reflux disease, or GERD, is a digestive disorder that affects the lower esophageal sphincter (LES), the ring of muscle between the esophagus (food pipe) and stomach. Reflux means to flow back or return. Therefore, gastroesophageal reflux is the return of the stomach's contents(specially acid) back up into the esophagus.The backwash irritates the lining of your esophagus and causes GERD.In normal digestion, the lower esophageal sphincter (LES) opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the esophagus. Gastroesophageal reflux occurs when the XXXXXXX is weak or relaxes inappropriately, allowing the stomach's contents to flow up into the esophagus. If not treated, chronic acid reflux can injure the esophagus and, in some people, progress to a precancerous condition known as Barrett’s esophagus.When the acid refluxes into stomach it irritates the mucosal lining it causes local inflammation this inflammation causes severe pain,burning sensation ,nausea sore throat change in taste etc.

Usually we manage GERD with a combination of medication and lifestyle changes. If symptoms persist or are severe, innovative endoscopic and surgical procedures can be done that provide long-term symptom relief.

Use antacids like omeperazole or pantoprazole before meals.
Using motility agents like domperidone will help with rapid stomach emptying and decreased refurge or heart burn or vomiting.

Don't lye flat right after meals but take brisk walk or stay upright for almost half an hour after meals.

Avoid spicy, greasy, oily foods as well as fizzy drinks. Avoid too much quantity if hot beverages.

Now lets move to your questions-

1)They are classical symptoms of GERD infact each and every symptom is present in you.You are a text book case of GERD.

2)There is no cure of GERD however by following proper diet and medications you can live perfectly normal life.

3)GERD can be caused by a bacterium called H.Pylori usually endoscopy is done to rule out possible infection by this bacterium and Gastric ulcers.However in your case all symptoms of GERD are there.You can go for breath test.It's a quick test to rule out infection of H.Pylori.

4)with proper medications and life style changes-

Please request your gastroenterologist to start you on PPI-antacids like Rabeprazole or Esomeprazole. Esomeprazole can be used in the dosage as high as 80 mg twice daily.Trials have shown that esomeprazole is superior to other PPI's in controlling reflux symptoms. Also, request him/her to add Domperidone 30mg or Levosulpiride(both are prokinetic)slow release once daily. This will slow down the reflux of acid back.Prokineic should be added in your regimen.

An antacid containing local anesthetic (Mucaine gel ) should be taken 2tsf thrice daily.

Acotiamide is another wonderful new drug and is very effective in controlling symptoms of GERD and esophagitis. In trials- Acotiamide, a gastrointestinal motility modulator, at a standard dose of 100mg thrice daily has significantly affected esophageal motor functions or gastroesophageal reflux in healthy adults.

All these drugs can be considered by your gastroenterologist to provide you with symptomatic relief in your problem.All these medicine can be used at a time also by your primary.

To prevent the esophageal damage from developing into Barett or acalasia cardai i would suggest you to ask your gastroenterologist to follow aggressive treatment pattern initially. As your symptoms will improve drugs can be tappered off gradually.
Dairy products, which contain sugar lactose that causes gas.
Vegetables, including onions, radishes, cabbage, celery, carrots, brussel sprouts, broccoli, cauliflower and legumes.
Fruit sugar, which is especially high in prunes, raisins, bananas, apples, apricots and fruit juices from prunes, grapes and apples
Fatty foods and carbonated drinks.

Try Eating more fermented foods. These are rich in both good bacteria and enzymes you can try raw natto kefir or cultured veggies. This is probably one of the most important first steps.
Take a high-quality probiotic.
Take external enzyme supplements.
Exercising, to help keep food moving through your system.
Using spices that may help to prevent flatulence. These include turmeric, coriander, peppermint, fennel, sage, chamomile and ginger.
Finally, when you reintroduce a food that was previously a gas-causing food, be sure you do so slowly. This will give your body a chance to adapt to the adjustment.

Hope i answered your query in full details.
Feel free to follow up.

Above answer was peer-reviewed by : Dr. Raju A.T
Follow up: Dr. Ramesh Kumar 1 hour later
Would request you to please go thru the attached prescriptions. I believe my doctor has given me rabeprazole and levosulpiride... should I consult some other gastroenterologist who can give some aggressive treatment?

can I eat non vegetarian food?
Answered by Dr. Ramesh Kumar 54 minutes later
Brief Answer:
Follow up.

Detailed Answer:
Hi agin dear,
No need to consult any gastroenterologist
Add Syrup Mucaine gel 2 tsf thrice a day with half cup of water 5 minutes before lunch breakfast and dinner.
Take Tab Acotiamide 30 mg thrice a day 5 minutes before all three meals.
Continue taking Rabialfa once daily(Please note you have to take it empty stomach and should not eat any thing for al least half an hour).
Capsule econorm theice daily(probiotic)

Follow them for 7 day.All are common brands in XXXXXXX you can get them easily.
Try to eat simple food in initial phase for atleast 21 days.
Eat lots of curd.
Drink cold milk twice daily(Neutralize acid).
Avoid any citrus food it increases acidity.
Don't add spice to food.
Drink 8 glasses of fresh water daily.

Follow up after 1 week.
Above answer was peer-reviewed by : Dr. Raju A.T
Follow up: Dr. Ramesh Kumar 6 hours later
so should I stop taking rablet twice daily and lesuride which i take after meal thrice?
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Follow up answer.

Detailed Answer:
Hello again,
Take combination(Rablet L 75mg Rabeprazole and 40mg levosupiride once daily) with two other medicines i prescribed and fell me how good you feel on a scale of 1 to 10 in 10 days.

Why so?
Rabeprazole stops acid formation.
Levosupiride would prevent its reflux.
Mucaine gel would for a smooth coating over esophagus and gut mucosa(hence shielding it from acid torture).
Acotiamide motility inhibitor.

Complete coverage to every thing responsible for GERD.(Acid production,reflux,irritation of mucosa)
-Instead of giving you small doses every 8 or 12 hour i am loading you with a large dose(Agressive protocol).
Don't worry Nissan's surgery is also there with cure rate as high as 90% but surgery should always be the last option.

Above answer was peer-reviewed by : Dr. Nagamani Ng
Follow up: Dr. Ramesh Kumar 54 minutes later
So I am just consolidating the prescription. kindly vet the same
1.Rablet 75mg once daily in morning empty stomach
2. Lesuride 40mg once daily after breakfast
3. Acotiamide 30mg thrice daily before meal
4. Econorm thrice daily
5. Mucaine gel thrice daily before meal

also let me know if there are any side effects which i need to take care of
Answered by Dr. Ramesh Kumar 20 minutes later
Brief Answer:
Follow up answer.

Detailed Answer:
Hey there ,

1.Rablet 75mg once daily in morning empty stomach
2. Lesuride 40mg once daily after breakfast

Its Rablet -l( 75mg Rabeprazole and 40mg levosupiride in combination once daily 7 a.m empty stomach with just one sip of water).Don't take any thing for next 30 minutes.
Please tell me the duration from how long are you having these symptoms?
From how many days were you on Rabiprazole and levosulpiride?
Level of relief on a scale of 1 to 10?
Your food pattern?
Diet habits?
Nature color and consistency of stools?
Number of bowel moment every day?
Alcoholic or smoker?
Drink carbonated beverages fast food etc?
Sleep cycle?
Gym or any work out?
Levels of anxiety?
Before starting my prescription i would like to get detailed answer of these questions.
Rablet-A numberof side effect on google. Practically on of the safest drug can be used for years in high doses with almost no side effect.

Levosulpiride-Again a very well tolerated salt.Practically in doses of 40 mg no side effects.
Mucaine gel-An antacid can increase risk of stone formation in kidney but again when abused for years without any guidance.
Econorm-Natural bacteria's.
Acotiamide-headache, diarrhea, and increased prolactin were reported in few cases.

Frankly speaking they are very safe medicines.
I would suggest you not to google any salt.Please don't read mechanism of action etc etc on google. In case you can't control your temptation to read then search and read only from NCBI official site.

Always choose your doctor carefully do as much background research you want to do but once you enter his/her cabin.Follow him/her with thy heart.
Waiting for answers.
Wish you great luck.

Above answer was peer-reviewed by : Dr. Nagamani Ng
Follow up: Dr. Ramesh Kumar 55 minutes later
Dear Sir

Please be rest assured that based on your answers I am very confident of starting the medications prescribed by you. I have received such detailed explanations for the first time since last 4 months. Have full faith in you hence please give me a full medication schedule which I need to follow

Here are my answers

1.     I am observing many of these symptoms since last 4 months .
2.     I am taking Rabiprazole and levosulpiride since last 2 months
3.     Level of relief – 5 out of 10
4.     Food Pattern – Breakfast at 8 am (Oatmeal or Chappati with vegetable) / Lunch at 12.45 pm (3 chappatis dal and veg) / Snacks at 5.30 pm (Poha/Upma etc) / Dinner at 9.30 pm (Chapati with Veg or Non veg gravy)
5.     I have also started taking yoghurt / fermented milk and butter milk in between
6.     Stool – Sticky and dark brown
7.     Bowel movement – Once a day
8.     I am non alcoholic and a non smoker
9.     Don’t drink carbonated drinks
10.     Twice a week I eat food from outside
11.     Sleep is from 11.15 pm to 6.15 am
12.     No gym or workout – I have a job which requires sitting and working on laptop
13.     Try to walk a bit but normally don’t get time
14.     I got panic attack once during heartburn as I took it as heart attack. I got all my cardiac tests done including CT scan of heart and cardiologist have told me that I don’t have any heart issues. I got CT angiogram because I failed to clear stress test . But my cardio told that its because I am out of practice and as per CT angiogram theres no blockage or plaque or any other heart issue
15.     My BP remains at 115/80 and pulse rate at 75
16.     I remain very anxious because of these bloating episodes and many times I feel heart burn and the symptoms described in my first message. Its really worrying and stressful

I have a stressfull job though.
Answered by Dr. Ramesh Kumar 5 hours later
Brief Answer:
Follow up.

Detailed Answer:
Hi again,
Sucralfate is the primary agent for prophylaxis of stress gastritis.
However right now i want you to follow medications which i suggested.
Your foos habits are good.
Anxiety stimlates autonomous nerves in body and increase secretion of acid in stomach.However as of now i won't suggest you to take sucralfate or anxiolytic medicine.

Just follow my prescription for 10 days and revert me back.

Wish you great luck and fast recovery.

Above answer was peer-reviewed by : Dr. Remy Koshy
Follow up: Dr. Ramesh Kumar 25 minutes later
Dear Sir . again collating the medication schedule. pls let me know if this is ok now
1. Rablet-1 75mg and levosupiride 40 mg once at 7am daily empty stomach .
2. Acotiamide 30mg 3 times before meal
3. Econorm - 3 times before meal
4. Mucaine gel - 3 times before meal
Answered by Dr. Ramesh Kumar 10 minutes later
Brief Answer:
Follow up.

Detailed Answer:
Hello again,
Yes absolutely right!
Plus One glass 200 ml chilled skimmed milk before breakfast in morning and before dinner at night.
Remain motivated follow up after 10 days!
Wish you fast recovery.
Above answer was peer-reviewed by : Dr. Remy Koshy
Follow up: Dr. Ramesh Kumar 3 hours later
can u pls provide some common trade names and substitutes for these medicines which can b available in XXXXXXX
Rablet l 75mg
Acotiamide 30mg
Levosulpiride 40mg
Answered by Dr. Ramesh Kumar 8 hours later
Brief Answer:
Follow up.

Detailed Answer:
Hello again XXXXXXX
Tab Acogut 100 mg thrice daily.
Cap Econorm/Proenetera/thrice daily.
Cap Rablet L/Rabitic L/Rabialfa l once daily.

However the names i have mentioned earlier are very famous in XXXXXXX and you would get them easily.

Above answer was peer-reviewed by : Dr. Arnab Banerjee
Follow up: Dr. Ramesh Kumar 2 days later

I have started taking the medication prescribed. This question is a separate one wherein i want to discuss few symptoms which I observe mostly when my stomach bloats
1. Dizziness
2. Lightheadedness
3. Slight weakness
4. Sight breathlessness

Pls confirm is this related to GERD? why it happens? and what should I eat or do to get rid of it when its occurring?


Answered by Dr. Ramesh Kumar 5 hours later
Brief Answer:
Follow up answer.

Detailed Answer:
Hi again,
All these are not side effect of antacids.
They are usually very well tolerated by patients.
They can be due to GERD.

Have already explained the mechanism in primary response.Dizziness nausea fatigue etc are general parameters of body.if a particular part of body is not functioning well they can appear.
Just chill down calm your nerves other wise anti anxiety medications would also be required.

Symptoms will take time to settle down.

Above answer was peer-reviewed by : Dr. Kampana
Answered by
Dr. Ramesh Kumar


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