Dr. Ajeet Kumar
Medical Gastroenterology
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Patient's Query
Hello doctor,
I am a 47-year-old female with a history of hiatus hernia diagnosed through endoscopy before six years. Since the past one month, I have an increased acid reflux problem and a feeling of heaviness in the throat. I have a burning sensation in the stomach sometimes with mild pain and burning in the food pipe. I have been taking Aciloc 150 mg twice for the past ten days for temporary relief from the burning sensation in the stomach, but there is no relief from the heaviness and mild pain in the throat. I do not want to visit the hospital due to the Coronavirus scare. Please advise.
Hello,
Welcome to icliniq.com.
You should switch to capsule Esomeprazole 40 mg (proton pump inhibitor) once daily, half an hour before breakfast. If that does not settle your problem increase the dose to 40 mg twice daily before meals.
Let me know about your symptoms in a week's time, because that is the time required before a further reasonable decision can be taken. The throat pain may or may not be acid-related. But if it is acid related then it should resolve with the above medication.
If these medications do not improve your symptoms (unresponsive, refractory acid reflux symptoms), then a thorough evaluation with extensive history and some investigations can be considered.
Patient's Query
Thank you doctor,
I have been taking the prescribed dose of Esomeprazole 40 mg once daily before breakfast. I have a lot of relief from the same. The burning sensation in the stomach has subsided considerably. I have about 70% relief in my symptoms. I still have a mild heartburn in the morning and some times after the meals in the stomach. The burning sensation in the throat has subsided considerably (a relief of 90%).
I realized that throat pain is due to a couple of mouth ulcers on the tongue and under the tongue on the (left side). Please prescribe something for the mouth ulcers as well. Do I need to continue with Esomeprazole?
Hello,
Welcome back to icliniq.com.
Feeling relief to hear that your symptoms improve a lot. The mouth ulcers can be due to the same mechanism of acid reflux, but they usually take time to show healing. But to speed up their healing you can use
1. Nilstate drops (Nystatin drops) twice daily for a period of one week.
Method of use: Take a full filled dropper and keep in the mouth for some time (15 to 20 seconds) and then swallow it.
2. Any multivitamin containing two things, one is folic acid and other is zinc. The few such commercially available are tablet Revital, tablet B-tage, tablet Surbex-Z. You just choose one and take that once in a day preferrbly just before meals. You can take this for 15 days.
3. If above both fail then you can use Kenalog (Triamcinolone) oral cream. It is like a paste and take a small cream one-inch length on pulp of your finger and apply all over the oral ulcers. Thrice daily for a period of five days.
Lastly, yes, you should continue with capsule Esoz for now. At least for a total of four weeks. Your symptoms seem to be secondary to GERD (gastroesophageal reflux disease). And once your symptoms completely settle, I would think of stopping it. After completion of four weeks, I may suggest you to take these medications as on basis.
Beside all this take some precautions.
1. Your weight seems normal, but if you could decrease it by another 26 lbs then it would be perfect. The two things you can do is to do brisk walk daily and keep your caloric intake not more than 1500 to 2000 kilocalories. The rough idea how would you measure this kilocalories is you can type every food you eat on google and see how much calories it contain. For example, a cold drink contains approximately 200 kcal. Similarly a banana contains 150 to 200 kcal. Commercially available foods often have a label with their kilo caloric value mentioned over that label.
Why I am emphasizing this, because this is going to solve your GERD and acid reflux problem for future.
2. Avoid spices.
3. Avoid talking a large volume of water while having meals.
4. Do not exercise or brisk walk on the fed stomach. Excercise should be done preferably on an empty stomach.
5. Do not bend after having meals.
6. Avoid wearing tight-fitting clothes.
7. Give at least three to four hours difference between night meals and bedtime.
Just update me about your symptoms in a three weeks time, then we would decide about capsule Esoz. You can follow earlier if your oral ulcers do not improve.
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Medical Gastroenterology
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