Can proton-pump inhibitors, a prokinetic medication, along with a diet change help overcome burning sensation in the chest area?

Hello,

Welcome to icliniq.com.

I have thoroughly reviewed your query and understand your concerns. There are two primary possibilities that could explain your symptoms:

1. Gastroesophageal Reflux Disease (GERD): A thin area of narrowing in the lower esophagus can intermittently cause difficulty swallowing foods, which may be the case in your situation. Your history of heartburn also suggests GERD. In GERD, stomach acid refluxes back into the esophagus, constantly irritating the mucosa lining and causing scarring in a particular area. This scarring leads to the narrowing of the esophageal cavity, making it feel like food is stuck in the throat. The inflammation caused by constant acid irritation also leads to heartburn.

2. Achalasia: This 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. The impaired relaxation of this sphincter can also lead to the feeling of food being stuck in the stomach. Nerve degeneration due to uncontrolled GERD in the esophagus can contribute to advanced symptoms of this condition.

Suggested tests for evaluation:

1. High-resolution esophageal manometry: This test measures muscle contractions in your esophagus when you swallow water using a catheter inserted down your esophagus.

2. Endoscopy: To visualize the esophagus and stomach.

Regarding the burping problem, excessive burping suggests improper digestion of food. The gut consists of thousands of bacteria and yeast, collectively termed as the microbiota of the gut, which plays a vital role in proper digestion and fermentation of food. However, in patients with GERD, this beneficial flora is depleted, leading to improper fermentation and the production of excessive gases. These gases can be expelled as burps or flatulence.

Considering the interconnectedness of your symptoms, I recommend you request your gastroenterologist to start you on PPI (Proton-pump inhibitors) antacids like tablet Rabeprazole or Esomeprazole. Tablet Ranitidine may not be as effective. Tablet Esomeprazole, in particular, has shown superiority in controlling reflux symptoms. Additionally, ask them to add a prokinetic medication such as tablet Domperidone 30mg or Levosulpiride (both are prokinetic) slow release once daily to slow down acid reflux.

An antacid containing local anesthetic (Mucaine gel) can be taken two teaspoonful thrice daily. Tablet Acotiamide is another effective drug for GERD and esophagitis symptoms. It has been shown to significantly affect esophageal motor functions or gastroesophageal reflux in healthy adults when used at a standard dose of 100mg thrice daily in trials. Your gastroenterologist can consider all these medications to provide symptomatic relief.

To prevent esophageal damage from developing into Barrett's esophagus or achalasia, I suggest following an aggressive treatment pattern initially. As your symptoms improve, drugs can be gradually tapered off.

Avoid the following:

1. Dairy products containing lactose, which causes gas.

2. Vegetables such as onions, radishes, cabbage, celery, carrots, Brussels sprouts, broccoli, cauliflower, and legumes.

3. Fruits high in sugar, especially prunes, raisins, bananas, apples, apricots, and fruit juices from prunes, grapes, and apples.

4. Fiber-rich foods.

5. Fatty foods and carbonated drinks.

Try incorporating more fermented foods into your diet, such as raw natto, kefir, or cultured veggies, as they are rich in beneficial bacteria and enzymes. Additionally, consider taking a high-quality probiotic and external enzyme supplements. Regular exercise can also help in keeping food moving through your system. Using spices like turmeric, coriander, peppermint, fennel, sage, chamomile, and ginger may help prevent flatulence. Finally, when reintroducing a food that previously caused gas, do so gradually to allow your body to adapt to the adjustment.

I hope I have addressed your query thoroughly. If you have more doubts, feel free to ask.

Thanks and regards.