Q. Persistent problems related to GERD and gastritis with sleep disturbances. Please help.

Answered by
Dr. Anshul Varshney
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Sep 02, 2020 and last reviewed on: Sep 07, 2020

Symptoms:

THE FOLLOWING ARE OBSERVED SINCE LAST 4-5 months Age:54 years,Weight:62.3 Kg,Height:158 CM

1. Anorexia- loss of appetite 2. Dyspepsia-difficulty in swelling during taking food/water 3. Eruptation at any time mainly after taking food. 4. Acid Burn-Presence of Mucin outcome 5. Presence of GERD 6. Sleep Disturbance-in a interval around 2-3 hours after sleeping without any reasionable significance. 7. Weight Loose from 72 Kg to 62.3 Kg within 3-4 Months 8. Helicobacter pylori infection positive. 9.U.G.I Endoscopy Pan Gastritis

HISTORY

1.She has past history of piles (Bowel: Constipation). 2.She has past history of feeling of Lump in throat occasionally during taking food. 3.She had suffered a head injury in the last month and she is now complaining of weakness & dizziness.

Current Treatment Current Medication:(Please refer to the attached files for details) 1. Aristozyne (Digestive Enzyme)-for 60 days-3 times daily 2.WelLiv Syrup(Liver)-for 30 days-2 times 3.Acid El Dervit -ZC(Folic )-for 30 days-1 tab per day

Above: Above are already taken for 15 Days

1.Vegazod for 60 days- 1 tab daily 2.HAPPI TM-IT(Rabeprazole-20mg & Itopride-150 mg capsul)-for 60 days-1 tab daily Above are already taken for 30 days

#

I have studied all the reports you have sent to me.

Important things are :

1. Pangastritis 2. Solitary Rectal Ulcer. 3. Anemia.

Since she has persistent problems related to the GERD and Gastritis , this can aonly be resolved with drugs she is taking like pantoprazole. I recommend a combinatipn of Pantoprazole with Domperidom which will help in GERD. At this age , she has significant weight loss , that can not be neglected. I would like to know that she has anorexia , or she has fear of eating due to gastritis symptoms post meal?

You have not mentioned about her Blood Pressure , ECG , Chest Xray.

My most of the concern is about her weight loss , as at this age at could be malignancy.

Please do tell me her menstrual history , i also advice you for her breast examination (self or by a gynecologist/surgeon) to see for any lump. I also advice you to discuss add to her a drug called as Escitalopram (SSRI). Please review with the above. Thanks

OUR REPLY:

1. A combination of anti gastric (Omido) and antiemetic drug was taken for a month but no significance relief observed.
2. B.P-130/83, Pulse: 74
3. I would like to know that she has anorexia, or she has fear of eating due to gastritis symptoms post meal: Only due to anorexia. No fear observed.
4. ECG-Not Done
5. Chest Xray: Refer to the attached report (AP & LAT view).Rest sides are not taken.
6. Malignancy: There is no any breast lump. Please advice for necessary test for weight loss.
7. BIOPSY Report attached.
8. Menstrual History: Her menopause has been started before ten years.
9. Please tell the necessity of SSRI. We don’t observe any dispersion on her.

Current Observation:

1. Mucin out coming through nose is increasing (Mainly During taking food),
2. Eruptation: Increasing day by day mainly after taking food but it comes at any time.
3. Mucin out coming through mouth: Decreasing after medication and GERD also decreasing
4. Sleep Disturbance Continue.
Kindly suggest the other requisite department to consult if required.
#

Everything seems to be realted to "Acid peptic disease"

Solitary Rectal Ulcer has to be kept into consideration , at present , the report doesn't suggest any sign of malignant ulcer , but we should mark it , and follow it up after 6 months.

I don't find any reason to get her into more investigations , and consulting another specialist for this problem , since she has already been evaluated by specialists.

You should know that sleep disturbances and stress , increases acid peptic diseases and GERD.

So, i want her to sleep peacefully , i don't mind adding a drug to her for her sleep problems. If she takes good sleep , you will notice a lot of improvement in her symptoms.

Now your other question about SSRI. SSRI are used for treatment of depression , but they have other roles in other diseases too. i find SSRI or drugs like amitryptilline very effective in Acid peptic diseases. Infact i have seen , in one of your prescriptions , that she was prescribed Tab Tryptomer 10 mg , i don't know , she took it or not , or she got some benefit or not.

So, consider giving her SSRI , and some people get a good sleep with SSRI , so if she gets , it's a good thing , if she doesn't i suggest an addition of drug like etizolam.

I hope i am able to solve your query , still if you have any query , please ask me. Wish her a healthy life. Dr Anshul Varshney


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