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    What causes persistent indigestion and acid reflux?

Posted on Mon, 7 Aug 2017 in Digestion and Bowels
Question: For several weeks I have been experiencing symptoms like indigestion and acid reflux. It feels like my food isn't being swallowed and is remaining in my throat and chest. I don't want to go to my doctor. She just replaced my previous doctor and apparently just out of school, very immature, more concerned of my sleep habits versus anything else. Help!!
Answered by Dr. Ramesh Kumar 20 minutes later
Brief Answer:
reflux problem just over the counter drugs won't help.

Detailed Answer:
Thank you for choosing HealthcareMagic for your query.
I am a Gastroenteriologist and would be answering your query.
Have gone through your query in detail and i appreciate your concerns.

See there can basically be two possibilities-
1)A thin area of narrowing in the lower esophagus can intermittently cause difficulty swallowing foods. So my primary differencial in your case is Gastroesophageal reflux disease.History of heartburn and acid reflux is also suggestive of GERD. As per standard text books one of the classical complaint of patient of GERD is -"feel like i have food stuck in throat or like food is choking or throat is tight."(Exactly the same feeling you are having).In case of GERD the acid produced in stomach is refluxed back into esophagus.The mucosa lining of esophagus is constantly irritated by acid leading to scarring of a particular area.
This scarring leads to narrowing of the esophageal cavity hence food when swallowed feels like stuck in throat.As the acid constantly irritates esophagus it causes severe inflammation leading to heartburn.

2)Achalasia is a primary esophageal motility disorder characterized by the absence of esophageal peristalsis and impaired relaxation of the lower esophageal sphincter (LES) in response to swallowing.Esophagus is seperated from stomach by a muscular sphincter called lower esophageal sphincter.Impaired relaxation of this sphincter can also be responsible for feeling of food struck in stomach.The degeneration of nerves due to uncontrolled GERD in esophagus often contributes to the advanced symptoms of the condition.

Tests suggested are-
High-resolution esophageal manometry. Using a catheter inserted down your esophagus, muscle contractions in your esophagus are measured when you swallow water.
Endoscopy- To visualise esophagus and stomach.
Now lets move on toindigestion part-

Our gurt consists of thousands of bacteria and yeast termed as microbiota of gut.This microflora plays a very important role in proper digestion of food.These bacterias and yeast are responsible for proper digestion and fermentation of food. However in patients having GERD this good flora is depleted hence food is not properly fermented leading to incomplete digestion.

So as per the above explaination all the problems and symptoms are linked to each other.
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.

I am sorry but you need a prescription for them.

Till you get prescription-
Take omeprazole 40 mg twice daily.
Peptobismol 2tsf thrice daily both are OTC.

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 details.
In case you have more doubts feel free to ask
Above answer was peer-reviewed by : Dr. Prasad
Answered by
Dr. Ramesh Kumar


Practicing since :1986

Answered : 2436 Questions


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