Suggest treatment for GERD and sore throat
GERD - I started having discomfort about three months ago not severe or really uncomfortable, more a sensation. A warm (not really burning) in my chest and I was burping more than usual. Over the counter anti-acids didn't really work so I went to my Dr. She suggested that I go on 40mg of Prilosec for two months to calm the inflammation down and see how it goes. Whilst I was on the Prilosec I had no symptoms at all. She has now advised to come off the 40mg and do 20mg a day or every other day to ease me off it. I'm pretty active but a few pounds over weight.
So over the past couple of days I've noticed myself burping a bit more and also a warm sensation and sore throat (although I thing the sore throat could be a bit of a cold/run done). My Dr doesn't seem overly concerned and said if the symptoms come back after I stop taking the medication she would send me for an endoscopy. I asked why and she said to check for an infection or something.
My questions are:
1. Could I not just stay on 40mg a day ongoing?
2. After only experiencing this for a few months and not severe could I have damage to my esophagus like Barretts Esophagus?
3. There seems to be info that an endoscopy is not need unless there are severe symptoms or if the mediation didn't work (mine did work whilst I was on it).
4. They say if they symptoms prevail after taking the medication for 2 months then you should have an endoscopy. Do they mean if the medication didn't work at all or the symptoms came back when you stopped?
5. What course of action do you think I should take?
P.S I had an abdominal CT scan and MRI six months ago (for something else) so I assume if there was anything nasty going on (tumor) in my esophagus/stomach that something would have shown up on those, correct?
Thanks in advance!
Omeprazole to continue if no response endoscopy
I have gone through the details you have provided.
To answer your questions.
You can continue to take 40 mg of omeprazole.
The aim of endoscopy would be to check for Barretts Esophagus as even though you have been symptomatic since a few months , you could have had asymptomatic GERD for a long time. Another reason is that you require a high dose of omeprazole to controls symptoms.
You are right about the two month guideline. It is failure of response or incomplete response for which an endoscopy is done. You have to remwmber that these are general guidelines and decisions have to be individualised.
In your case endoscopy is not mandatory at present. I usually suggest endoscopy to my patients if they have recurrent symptoms on medication or if they are unable to discontinue medications or if symptoms do not improve on medications.
A CT or MRI are not able to detect Barrets or early mucosal cancers( though this seems less likely in your case.
In my patients who have a recurrence I advise them omeprazole for two months and then reduce the dose for another 2 to 4 months and in case the symptoms recur the advise an upper GI endoscopy.
Hope I have been able to answer all your queries
Do get back in case you have further questions
Dr Samir Patil
So even though I have taken Omeperazole for a couple of months you would advise to do so for a couple more months?
And would I be best to do the endoscopy whist on the medication so any normal inflammation wasn't there?
I'm worried about Barrett's, but understand even with Barrett's that cancer is still quite rare. Is that correct?
low risknof cancer in Barrett's
That's right I would advise two more months.
I would prefer an endoscopy on medications and finally the incidence of cancer in Barretts is low and the chances are 1 in 200 .
Dr Samir Patil
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