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Q. Am I under correct medication for my symptoms? Is it GERD?

Answered by
Dr. Kannane Tirou
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Aug 09, 2017 and last reviewed on: Oct 09, 2018

Hi doctor,

I am a 50 year old male. My weight is 72 kg and height is 168 cm. I am a vegetarian. I do not drink alcohol and I do not smoke too. I have recently stopped taking tea and coffee. I do exercise regularly. I am suffering from the following symptoms for the last five years but not on a daily basis. There is sudden awakening from sleep due to feeling of suffocation, sometime feeling of breathlessness even if I am awake. Sometimes, flu like experience passing throughout the body. This is quite evident immediately after a sexual ejaculation. My ECG, 2D echo, treadmill test, pulmonary function test, chest x-ray, MRI brain scan were normal. I do not feel any heartburn or acid entering the throat. For the last three months I am under medication for suspected gerd. My current medications are Topcid 40 mg, Nexpro 40 mg and Perinorm CD. Especially with the last medicine I am a little bit apprehensive as I feel uncomfortable after having it. I would like to have a second opinion on my symptoms, the probable causes and about the medicines prescribed. Thank you.

#

Hi.

Welcome to icliniq.com.

From going through the information you have provided, it is clear that currently you are on treatment for suspected GERD - gastroesophageal reflux disease (acid reflux disease). You have been having intermittent problems over five years.

Acid reflux can cause breathlessness and waking up from sleep at night. Some might feel and describe heartburns, but others may not actually feel the burning sensation. The symptoms can be worsened by stress, anxiety and panic attacks.

My recommendations are an endoscopy procedure called gastroscopy will help to check for any weakness in the valve at the lower end of the food pipe (gullet or esophagus) and to directly visualize any evidence of inflammation there that is reflux esophagitis.

Following the above test, you may require a 24 hour pH monitoring study and a manometry test to confirm that acid is refluxing back whenever you have symptoms and that there is no problem with motility of the gullet.

I agree with you that I would not continue on Perinorm CD (Metoclopramide). I tend to give it only for nausea or vomiting.

  • Nexpro (Esomeprazole) 40 mg is best taken once daily in empty stomach in the morning. If despite this symptoms persist, it can be taken twice daily before food that is before breakfast and the other before dinner at night.
  • You can take Topcid (Famotidine) 40 mg at bedtime to prevent symptoms at night.

Some people with GERD may find that eliminating certain food helps to improve their symptoms. For example avoiding spicy foods, raw onion, garlic, black pepper, citrus products and juices of orange, grapefruit or cranberry, tomato products, chocolate or brownies, caffeine, sodas, coffee, tea, etc., peppermint, fatty or greasy foods.

  • Eat smaller and frequent meals. Try to eat more slowly, try to spend at least 30 minutes per meal and avoid eating on the run.
  • Avoid large, high fat meals. Avoid late evening snacks or eating before bed. Avoid lying flat after eating; try sitting up for at least two hours after finishing a meal and sleep on your left side.
  • Try light walking for 15 to 30 minutes following a meal. Try chewing non-mint type chewing gum for 30 minutes following a meal.
  • Raise the head of the bed 6 to 8 inches to prevent reflux when sleeping. Extra pillows may only elevate your head. Try putting pillows under the mattress near the head of the bed or use a special wedge.
  • Avoid tight fitting clothes around the abdomen. I wish you a speedy recovery.

Investigations to be done:

1. Gastroscopy.
2. 24 hour esophageal pH monitoring and esophageal manometry.

Probable diagnosis:

1. GERD.
2. Functional dyspepsia.

Regarding follow up:

For further information consult a medical gastroenterologist online.---> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist

Thank you doctor,

I would like to know more about proton pump inhibitors. Kindly explain, please.

#

Hi,

Welcome back to icliniq.com.

  • Medicines used to control acid called proton pump inhibitors are quite useful for this purpose.
  • They are also relatively safe, but as like any other medications, should be used under the guidance of the doctor as needed for the prescribed time.
  • Long-term use of any medication may have undesirable side effects and should only be done if there is a need for the drug.

For further information consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist


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