Patient's Query
Hi doctor,
A few years back, I started experiencing pain in the upper abdomen, just underneath the chest. I consulted with a gastroenterologist and hepatologist. He recommended an ultrasound of the whole abdomen, which came back normal. He also conducted some stool tests and blood tests, all of which were normal.
Then, they prescribed some medication and advised me to avoid certain foods and to exercise. However, the pain intensified, so I returned for another appointment. He suggested a GI endoscopy, which showed normal results except for a hiatus hernia.
He diagnosed me with GERD and provided guidelines to follow, such as avoiding tea, coffee, and carbonated drinks, not smoking or drinking alcohol, waiting half an hour after eating before drinking water, and not lying down after meals.
He prescribed medications including Instaraft syrup, Vono 20, and Neopride. After following the rules and taking the drug, I experienced significant relief; the constant pain I had been feeling disappeared completely.
However, about 20 days ago, I began to feel the pain again, though it is now at a medium level, not extreme. I need to understand why this pain is recurring, particularly why it seems to worsen in the winter.
I suspect it may be related to my dietary choices, as I have broken some rules and consumed rich and fried foods. I would appreciate a thorough explanation of my case and an understanding of the complete solution.
Please guide.
Hi,
Welcome to icliniq.com.
I read your query and understand your concerns.
From what you have shared, you have been experiencing upper abdominal pain, and despite normal USG (ultrasound) and blood-stool tests, your GI (gastrointestinal) endoscopy revealed a hiatus hernia with GERD (gastroesophageal reflux disease).
This means the valve between your food pipe and stomach is slightly weakened, and a small portion of the stomach is sliding upward into the chest region. Because of this, acid easily flows back into the esophagus, causing pain, burning, and discomfort just below the chest.
It is very common for symptoms to improve with medicines and lifestyle discipline and then return whenever diet and routine slip, especially with fried, heavy, or spicy foods.
The relief you felt earlier confirms that your body responded well to treatment and lifestyle changes. However, recurrence of pain after 20 days and worsening during winter suggest two things:
1. Trigger foods and habits were reintroduced (fried, rich, and heavy meals).
2. Winter aggravates reflux because we move less, eat heavier foods, drink less water, and digestive motility slows down.
GERD with hiatal hernia is a chronic condition that does not fully cure, but it can be controlled very well with consistency. Pain recurring does not necessarily mean worsening disease but indicates irritation from lifestyle triggers.
I suggest the following for you:
Avoid tea, coffee, carbonated drinks, and foods that are fried or oily.
No large meals; small, frequent meals work best.
Do not lie down for two to three hours after meals.
Avoid drinking water immediately after meals; wait 30 to 45 minutes.
Elevate the head end while sleeping (two to three inches or use a wedge pillow).
Prefer soft, non-spicy, low-oil meals.
Include curd, banana, oats, and and boiled vegetables.
Avoid late-night dinners and heavy meals at night.
You responded earlier to Vono 20 (Vonoprazan). You may discuss with your doctor about restarting them temporarily.
Continuous long-term PPI (proton pump inhibitor) use should be medically supervised.
Walk after meals, even for 10 to 15 minutes.
Drink lukewarm water instead of cold water.
Avoid lying curled in bed immediately after food due to slow digestion in cold weather.
I hope this explanation clarifies the situation.
If you have any questions or require further assistance at any time, please do not hesitate to contact us. We are here to help.
Thank you.
Patient's Query
Hi doctor,
Thank you for your response.
I have been following the routine and about 70% of the recommended diet, and I have also made the suggested changes. The pain has not completely disappeared yet, although most of the time it remains mild. Occasionally, I still experience moderate pain in the chest and upper abdomen, along with a slight burning sensation near the stomach.
I have also noticed a pattern, the same issue has worsened during the winter and seems to increase again in colder weather. This makes me wonder whether there could be a seasonal or cold-weather association.
How long does it usually take for this condition to resolve completely? I have been taking Vonoprazan 20 and Instra-F for almost two weeks. Whenever the pain becomes moderate, I take one Drotin Plus tablet in a day, as previously advised. Over the last month, I have taken around seven to eight doses in total. I wanted to check whether taking Drotin Plus occasionally in this manner is safe and if there are any possible side effects.
Additionally, I have noticed a slight increase in flatulence recently.
Is there any surgical option for this condition, or is surgery not usually recommended at this age?
Also, in my previous ultrasound report, there was a note mentioning mild hepatomegaly with fatty changes. Could you please explain what this indicates and whether it has any relation to my current symptoms?
Please help.
Hi,
Welcome back to icliniq.com.
I read your query and understand your concerns.
You are recovering well, and with consistent diet and medication, it usually takes four to six weeks for the symptoms to fully settle. Mild flare-ups during winter are common, so the pattern you noticed is normal.
Winter worsening is common because:
Cold weather slows digestion.
People tend to drink less water.
Increased intake of tea and coffee.
Higher stress levels and irregular meals during winter.
Wearing tight winter clothing around the abdomen can increase reflux.
Taking Drotin Plus (Drotaverine hydrochloride and Mefenamic acid) occasionally, a few times a month, is generally safe. The increased gas is part of the healing phase and should improve soon.
Surgery (fundoplication) is considered only in cases of severe reflux that does not respond to six to 12 months of medical treatment. Surgery is not needed for this condition at your age.
Your ultrasound showing mild fatty liver indicates a small amount of fat buildup in the liver. This condition is reversible and is not the main cause of your burning symptoms, although it can contribute to bloating.
Overall, your progress is good. Continue following the routine, and your symptoms should keep improving.
I hope this has helped you.
Please feel free to reach out to me again for further queries.
Thank you.
Patient's Query
Hi doctor,
Thank you for your response.
The last time we spoke was around three weeks ago. Since then, the abdominal pain has reduced significantly overall. On most days, the pain has been very mild, around one to two out of 10. On two to three occasions, it increased to about four to five out of 10, but it remained tolerable and not severe.
As the pain improved, the prescribed medications have been completed, and at present I am not taking any medicines, including Vono or Drotin Plus.
I would like to mention that I have not had any episodes of vomiting, no difficulty in swallowing, and no sensation of food getting stuck. My weight has remained stable; in fact, it has slightly increased.
Currently, the main symptoms I experience are intermittent pain and burning in the middle chest and upper abdomen. Additionally, sometimes when I consume home-cooked spicy food, I feel a burning sensation on the right side of my abdomen, which I also perceive near the skin surface. I would like to understand why this happens and whether it is a cause for concern.
I am also feeling anxious regarding my upper GI endoscopy, which was completely normal at that time. As a significant amount of time has passed, I am worried about whether an ulcer or something serious, such as cancer, could have developed. I would like to know how long an endoscopy report is considered clinically valid and whether a repeat endoscopy is required in my case.
In addition, I have been experiencing symptoms suggestive of IBS for some time. There are occasional days when I need to pass stools five to six times a day. The stool consistency is usually smooth but not well-formed like a sausage; it is neither completely liquid nor properly solid, often soft or mushy. I would like to understand the reason for this and whether it is related to IBS.
I also had a previous finding of mild hepatomegaly and would appreciate your advice on what should be done for both my IBS symptoms and the mild hepatomegaly.
Lastly, after reviewing my entire case and symptom pattern, I kindly request you to let me know whether these findings are not serious in nature and what the most likely diagnosis is in my case. This would greatly help reduce my health-related anxiety and palpitations.
I am attaching my endoscopy report and my complete blood test report, which includes an 89-parameter panel done approximately five months ago. I kindly request you to review both reports in detail.
Thank you for your time and guidance.
Hi,
Welcome back to icliniq.com.
I read your query and understand your concerns.
I have reviewed your reports. They are overall normal, and the only area that needs attention is the lipid profile, which is slightly out of range. I would recommend strict dietary control and lifestyle modifications.
A healthy lipid profile can be effectively managed through consistent lifestyle changes. Adopting a balanced diet rich in fruits, vegetables, whole grains, legumes, nuts, and seeds, while reducing the intake of saturated fats, trans fats, fried foods, and refined sugars, helps lower cholesterol and triglycerides. Including healthy fats such as those from fish, olive oil, and flaxseeds can help improve HDL (high-density lipoprotein) cholesterol.
Regular physical activity at least 30 minutes of moderate exercise, such as brisk walking, on most days plays a key role in improving lipid levels. Maintaining a healthy weight, managing stress, getting adequate sleep, and avoiding smoking and excessive alcohol intake are equally important.
A repeat lipid profile is advised after three months.
I hope this has helped you.
Please feel free to reach out to me again for further queries.
Thank you.
Patient's Query
Hi doctor,
Thank you for your response.
Since last night I have been experiencing a burning sensation on the inner side of my right thigh. The sensation is not constant at one spot and seems to move or radiate toward my lower back and occasionally to the right side of my abdomen. The discomfort feels more like burning or heat rather than sharp pain.
There is no associated weakness, numbness, fever, vomiting, or difficulty in walking only a burning sensation. I would like to understand what this could be, the possible reason for it, and how it can be treated.
Please explain what I can do to manage this. I would also like to mention that I had some mildly spicy food for dinner yesterday.
Please guide me.
Hi,
Welcome back to icliniq.com.
I read your query and understand your concerns.
The burning or heat-like sensation you are experiencing on the inner side of your right thigh, which seems to move toward the lower back and occasionally to the right side of the abdomen, is most commonly due to irritation of sensory nerves in the lower back or pelvic region. Such nerve-related discomfort often presents as burning, warmth, or a migrating sensation rather than sharp pain and can occur without weakness, numbness, fever, or difficulty in walking, as in your case.
Sometimes, factors such as posture, prolonged sitting, mild back strain, dehydration, or increased acidity can sensitize these nerves. Having spicy food the previous night may have increased gastric acidity, which can occasionally trigger or worsen such nerve sensations, causing referred burning discomfort.
This condition is usually benign and temporary. At present, avoiding spicy and oily foods, maintaining good hydration, taking adequate rest, and using simple measures such as warm compresses can help. A mild pain reliever like paracetamol, an antacid for a few days, and vitamin B-complex supplementation may be used if needed.
You should seek medical attention from a neurologist if the sensation persists, worsens, or if new symptoms such as numbness, weakness, rash, or fever develop.
I hope this has helped you.
Please feel free to reach out to me again for further queries.
Thank you.
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Answered byDr. Vandana Andrews
Medically reviewed byiCliniq medical review team
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