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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Hello doctor My inquiry is related to my husband He

Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2352 Questions

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Posted on Fri, 8 Feb 2019 in General Health
Question: Hello doctor
My inquiry is related to my husband
He is 42 years old
He has a severe gastritis problem and has also developed acid reflux problem since last 2 years.
Previously (abt 7/8 years ago)we have visited XXXXXXX for a check up and they just prescribed probiotics and colosspa
Last year he had severe throat pain .. on consulting the doctor she told us that it was because of the reflux he is having the pain
we did a thorough check up again and during endoscopy they found a polyp for which polypectomy was done
Right now he is just under pan40 and gaviscon
Please advice how to make his life better as he is suffering a great deal from the reflux
He sit for about 3/4 hrs every night after his dinner
Waiting for your advice
Thank you XXXXXXX Malpani
doctor
Answered by Dr. Ramesh Kumar 10 hours later
Brief Answer:
Incomplete medical management.

Detailed Answer:
Hello,
Thanks for choosing HealthcareMagic for your query.
Have gone through your details and i appreciate your concerns.
Initially i would like to say that your doctor is not treatinghim properly.
Why?
Please go through every line and try to understand that basic cause of his problem is reflux of acid from stomach to esophagus.Stomach is lined by a natural layer of mucosa membrane which is resistant to acid however mucosa in esophagus is easily destroyed by acid which regurgitates back from stomach.This cause severe irritation of esophagus leading to inflammation causing pain burining sensation etc.
So after reading this you can see that food allergy as such has no big role in this problem all we need to do is to control acid production and its reflux back into esophagus.
Have a more detailed look,
The esophagus is a muscular tube that is located in the chest and serves to transfer food from the mouth to the stomach. The lower esophageal sphincter (LES) is a valve that is located at the junction of the stomach with the esophagus. Its function is to prevent acid and other contents of the stomach from coming back into the esophagus. GERD is a condition in which excessive acid-containing fluid refluxes (flows) back into the esophagus, in part because the lower esophageal sphincter is weak.



Now managemebt consists of two step-
1)Control acid production-Just taking pantoprazole in low doses wont help.There are much better PPI's available in market.

2)Prevent reflux of acid formed back to esophagus-This part is completely overlooked by your Gastro.

Please request your gastroenterologist to start him on PPI-antacids like Rabeprazole or Esomeprazole.Pantoprazole is a basic PPI and better options are there for treating specific conditions.
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 should be given by your gastroenterologist to provide you with relief in your problem.
Ask your gastroenterologist to follow aggressive treatment pattern initially. As your symptoms will improve drugs can be tappered off gradually.
Avoid-
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
Fiber.
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.

In short
Tab Nexium 80 mg twice daily 9 a.m -9 p.m for 21 days
Tab Domstal dt 30 mg once daily 9 a.m
Tab Acotiamide 100 mg thrice daily 9 am-2p.m-9pm
Syrup Mucaine gel 2 tsf thrice daily
Take them for 21 days initially he would feel much better.
Hope I was helpful,
Regards!
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ramesh Kumar 29 hours later
Hello doctor
Thank you for your advice
I have a few queries
1.why do we give him domstal
2.can he have chena made from milk in the morning
3.what are cultured vegetables and raw natto kefir?
4. I may have missed the detail that he has frequent diarrhoea.. almost every day
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Follow up.

Detailed Answer:
Hi there,
1)Prokinetics help strengthen the lower esophageal sphincter (LES) and cause the contents of the stomach to empty faster. This allows less time for acid reflux to occur and control GERD very well.
2)Chena is very heavy instead give him a chilled glass of milk which acts as an alkaline agent and neutralise acid.
3)Kefir natto etc are fermented foods if not available at your place give him lots of curd and yoghurt.
4)First let's deal with current problem have these medicines and tell me how he feels after 10 days.
Regards.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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