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Nausea, burping, abdominal pain, diarrhea, acid reflux, heartburn. May be hiatal hernia

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Practicing since : 2004
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I am a 20 year old male with multiple G.I issues. The most worrying one for me is chronic burping. Nausea and chronic burping occur whenever I lean forward even slightly. I also experience abdominal pain , and diarrhea usually soon after I lean over ,constipation occurs sometimes. I also experience acid reflux fairly regularly. I never had any of these symptoms until i started cycling on a mountain bike. Since then these symptoms have been permanent. I believe I may have given myself a hiatal hernia. Improper weightlifting also gave me a small lump on the lower right side of my abdomen. I felt a strong and sharp pain in my perineum . However it was the leaning over on the bike which caused all the above symptoms. I have stopped riding the bike but the symptoms have persisted after 6 months. It is interfering with my life as I can not study properly ( leaning forward causes symptoms) . The chronic burping is also embarrassing . I went to my g.p twice for this condition, the first time he prescribed me something for heartburn. Now he has prescribed me nexaprole. What is your opinion on my condition? Do you think I should get and endoscopy?

Thank you,
Posted Tue, 11 Sep 2012 in Digestion and Bowels
Answered by Dr. Om Lakhani 43 minutes later

Your symptoms are classical of gastroesophageal reflux disease (GERD). Yes constant leaning over can cause the problem. Hiatal hernia is also a possibility. Burping and reflux symptoms especially on leaning are characteristic. The best treatment of this is proton pump inhibitors (which probably is what your GP gave you). We sometimes add a prokinetic agent if the symptoms do not resolve with above. (You can ask you GP to prescribe you a proton pump inhibitor with a prokinetic agent)

1/3rd of the patients with GERD do not respond to Proton pump inhibitors, there are some other drugs which are tried first, for patients who do not respond to anything... a final option is an anti-reflux surgery. But my advise is to have patience. Proton pump inhibitors take about 2-3 weeks sometimes for action to catch up.

Apart from I would also advise you the following :

•     Elevate your head end on bed while lying supine by 6-8 inches with pillow while sleeping
•     avoid tight fitting clothes
•     avoid bed time meals or snacks
•     avoid lying supine after meals

The lump you mentioned is a concern. Did your GP find anything on his physical examination ? If not you must go for an ultrasound of abdomen for evaluation of the same.

Should you go for an endoscopy ? My answer is you can wait. If Proton pump inhibitors donot work for 2-3 weeks we can go for further evaluation including an endoscopy. If you have already tried the drug for this period, an endoscopy is recommended.

Hope I have answered your query. If you have any further questions I will be happy to help

Dr. Om Lakhani
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