Suggest treatment for burping and stomach bloating

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Posted on Mon, 2 Jun 2014 in GERD
Question: I am a 46 year old woman, in very good health. However, last november I went to see a doctor because I was always burping and feeling bloated. I did an ultrasound to make sure my galbladder was not filled with stones. The ultrasound was fine. He gave me a prescription of Pantoloc for one month. I took it for two weeks and was feeling fine. I went back on it a couple of weeks later because the symptoms came back. Fast forward to January, I had a scope exam down my throat to make sure everything was fine and it was perfect. They put me on Nexium for a year. I took it for 5 weeks but then started having the same blating feeling so I stopped it all together. After 3 days, I had the worst reflux ever. I startd the pantoloc again but saw a naturopath and started a 21-day clense. Cut our basically everything. Lost 13 pounds but still felt symptoms. Went back on pantoloc for another 5 weeks and now recently changed back to pantoloc. I still have symptoms. I went to see my pharmasict and he suggested to double the dose. It's been 3 days that I now take 40mg of pantoloc in the morning and another 40mg before dinner. It was better on sunday and yesterday, but today I am experiencing again mild irritation. Please help!!!!Also, when I did the scope in January I also did a blood test for h.pilory and it was negative.
doctor
Answered by Dr. T Chandrakant 1 hour later
Brief Answer:
Add on some more treatment.

Detailed Answer:
Hi,

Thanks for your query and faith in us.

To recapitulate::: burping and feeling bloated -ultrasound was fine-Pantoloc for one month- feeling fine- symptoms came back- scope exam- Nexium - same bloating feeling- worst reflux- pantoloc again-naturopath- still have symptoms- double the dose-again mild irritation

I would Suggest:
*Add Ranitidine 150 twice daily. Take Pantoloc once only (both work differently).
*Antacid gel 3 TSF 3 hourly.
* Soft bland diet, avoid every food and beverages you have experienced that increases your problems. Small frequent meals.
*Stress-free lifestyle changes the outcome positively with the medicines.
*Sound sleep is very important.
* Early dinner and not to go to bed immediately.

I hope this should give you an immediate relief.
please continue this for 3 weeks.
Review Upper GI endoscopy.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. T Chandrakant 28 minutes later
I'm not sure I understand. I never had reflux until I started taking nexium and then stopped, ignoringly not knowing to wean myself off. My scope was perfect. Now I constantly feel a mild esophageal irritation / or reflux ( not really sure what i feel). I am also taking domperidon twice a day before lunch and supper. What is ratinidine and why? What is the antacid gel and why and why hourly? Why do another scope?
doctor
Answered by Dr. T Chandrakant 40 minutes later
Brief Answer:
This will help to clarify

Detailed Answer:
Hi.
Let us talk the basics then. The reflux is the return of the stomach contents into the esophagus. In a normal person this never occurs. The lower esophageal ''sphincter'' (non-return valve) is tight enough not to allow the stomach content to come back once they enter the stomach.

Laxity of this sphincter allows the stomach contents to come back into esophagus along with the acid which is produced into the stomach (normally). The mucosa of the esophagus does not tolerate this, so one gets the burning sensations.

Any sensation including burning is esophagus is to be taken as reflux.

The dose of the Domperidone is 10 mg to be taken thrice daily so one tablet to be taken at the interval of 8 hours to be really effective and is independent of the food. So at 6 am in the morning the moment you get up. Suppose you are getting late the doses to be adjusted accordingly. This medicine is given to tighten the lower esophageal sphincter and increase gastric emptying into the small intestine so that the contents do not come back into the esophagus.

Ranidine is a name of the medicine It reduces the gastric acid secretion by a different way than what is achieved bu Pantoprazole or esomeprazole (Nexium).
Our aim is to give you a symptoms -free life.

Antacid gels are the liquids which neutralize the acid in stomach, coats the stomach mucosa and esophageal mucosa to protect it from the acid and the bile.
This is given at the interval of 3 hours , as this is supposed to be the gastric emptying time. SO you have to take another dose by the time it passes out of stomach into the intestine.

Another scope to see the status of the mucosa of the esophagus, stomach, to see the status of the lower esophageal sphincter, and the first part of the duodenum ( intestine), whether there is reflux of the bile from duodenum into the stomach and esophagus, any secondary changes.

I hope this clarifies your queries.
Please free to ask more if you have further queries.



Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. T Chandrakant 41 minutes later
I understand how the sphincter is the cause of acid going up. What I don't understand is that if I never had reflux, why do I have it now? All I went in for was bloating and burping.

Also, the domperidon should be taken every eight hours? The doctor I saw said take it three times a day 20 minutes before eating.

I'm still not sure about the antacid gel when to take them. Is it every three hours after I eat?

What is the cause of this? The symptoms we know, but the cause? Is it age, is it stress, food allergy, what is it?

My biggest concern is that my esophagus has been damaged beyond repair. If I follow this therapy for a while, will I heal? I'm scared of Barrett's. Am I over worried? My scope on January 14 was negative. No sign of anything.

doctor
Answered by Dr. T Chandrakant 46 minutes later
Brief Answer:
Worries, anxiety, stress all cause this

Detailed Answer:
Hi.
Thanks.
This is exactly one of the causes you just mentioned. '' WORRIES'' .
Yes, anxiety, worries, over-thinking, going into minute details of everything related to life, non-belief all these lead to a symptoms complex including ''burping and bloating which in turn leads to GERD- reflux''.

So a part of the therapy is change of lifestyle, calm life, being stress-free ( difficult in the days of mobile phones and internet),
Be your own ''naturopath''.

Since Endoscopy In January 2014 was normal, meaning the esophagus was normal , there is no Barrett's ( and this was the reason I asked for a review Endoscopy after 3 weeks of proper treatment).

Domperidone works well if taken at the interval of 8 hours. This is the pharmacology of this particular drug.

Antacid gel to be started the moment you get up in the morning, as the acid secretion increases the moment one awakens from the sleep. So the rule is to take one tablet of Domperidone, 3 teaspoonful of Antacid gel ( for immediate neutralization of acid) and a tablet of Ranitidine. So that you start the day fresh.
The gel is repeated 3 hourly and particularly when you are on empty stomach. Not to be taken for 2 hours after food ( as the food is going to do the dilution and neutralization of acid).SO taking 3 hourly is not a strict rule, the time can be adjusted a bit as per your food timings.

Causes I have already mentioned.

Please do not take this otherwise , but I gave you the solution as your history is suggestive of you need a proper care as you are still having recurrent symptoms.
Please feel free if you further clarification about anything...
We are here to serve you for your betterment.






Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 13346 Questions

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