Brief Answer:
improper management of acid peptic disorder.

Detailed Answer:
Hello,
Thanks for query.

Please request your gastroenterologist to start you on PPI- Esomeprazole.. Esomeprazole is to be used in the dosage 80 mg twice daily.Trials have shown that esomeprazole is superior to other PPI's in controlling reflux symptoms. Also, request him/her to add Domperidone 30mg or Levosulpiride(both are prokinetic)slow release once daily. This will slow down the reflux of acid back.Prokineic should be added in your regimen.
While ppi will stop formation of acid prokinetic would help to control reflux.
An antacid containing local anesthetic (Mucaine gel ) should be taken 2tsf thrice daily.
Acotiamide is another wonderful new drug and is very effective in controlling symptoms of GERD and esophagitis. In trials- Acotiamide, a gastrointestinal motility modulator, at a standard dose of 100mg thrice daily has significantly affected esophageal motor functions or gastroesophageal reflux in healthy adults.

All these drugs can be considered by your gastroenterologist to provide you with symptomatic relief in your problem.All these medicine can be used at a time also by your primary.

Along with it-

Avoid-
Dairy products, which contain sugar lactose that causes gas.
Vegetables, including onions, radishes, cabbage, celery, carrots, brussel sprouts, broccoli, cauliflower and legumes.
Fruit sugar, which is especially high in prunes, raisins, bananas, apples, apricots and fruit juices from prunes, grapes and apples
Fiber.
Fatty foods and carbonated drinks.

Try Eating more fermented foods. These are rich in both good bacteria and enzymes you can try raw natto kefir or cultured veggies. This is probably one of the most important first steps.
Take a high-quality probiotic.
Take external enzyme supplements.
Exercising, to help keep food moving through your system.
Using spices that may help to prevent flatulence. These include turmeric, coriander, peppermint, fennel, sage, chamomile and ginger.
Finally, when you reintroduce a food that was previously a gas-causing food, be sure you do so slowly. This will give your body a chance to adapt to the adjustment.

Hope i answered your query in details.
In case you have more doubts feel free to ask

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Brief Answer:
Follow up answer.

Detailed Answer:
Thank you for follow up my dear patient,
Esomeprazole –80 mg twice daily 7 am 7 pm for 21 days initially
Domperidone or Levosulpride (Can I take Itopride) –Yes you can take itopride with morning dose of esomeprazole.
Antacid containing local anesthetic (mucaine gel) –2tsf with half cup of water before lunch and dinner(10 min) for 21 days.
Yes you can take them they have no significant practical interaction.

2)Acotiamide 100mg thrice daily 9 am -4 pm -9 pm for 21 days if relieved to be continued for 3 months minimum.

3)Digezyme/unizyme/aristrozyme-2tsf with half cup of water before lunch and dinner(10 min) for 21 days.

4)Yes acid irritates the mucosa layer hence causing increase secretion of mucous causing cough.

5)Yes you can contact a dietician at the same site.All these drugs are easily available in middle east countries.

Don't stop them on your own.
Take them as suggested by me and tell me how you are feeling after 10 days.
You can use this link-
http://doctor.healthcaremagic.com/doctors/dr-ramesh-kumar/72660

Regards.

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Brief Answer:
Follow up answer.

Detailed Answer:
1. I have checked in the pharmacy in Qatar and understand that esomeprazole is only available in 20 mg and 40 mg doses. So, how should I take the dose? -2 tablets 40mg twice daily
2. If I buy levosulpride, what would be the dosage and how many mg? 35 mg once
3. Can I take the antacid (with water) and digezyme (with water) together before lunch and dinner? Can I take tablet for digezyme/unizyme/artistrozyme? Which among the three is the best supplement?aristrozyme is best.Yes you can combine them together.
4. Acotiamide (100 mg) doesn’t seem to be available when I checked in 2 pharmacies. Will check another also tomorrow. Is there any brand name for this tablet which would be available in Qatar?Acogut 100mg
5. Can I take Acotiamide together with Esomeprazole?yes
6. In which category of doctors can I approach for a nutritionist or dietician?just write your query and post it as for a dietician.

Thanks

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Brief Answer:
Follow up answer.

Detailed Answer:
Hi,

1) was asking if 160 mg per day too much a dose? Please clarify-Strategy is to start you on maximum doses of nexium for initial 21 days to see how you respond to it.
On the other hand acotiamide is not available.
As per your history you have already tried ppi's in optimal doses so there is no sense in prescribing a ppi to you in low or optimal dose.
First lets treat the symptom then after 20 days we would start tapering the medicines off.
Itopride 50 mg once daily with morning dose of nexium is ok.
Ok start taking antacid 2tsf 10 min before heavy meals.
Take 1 tablet twice daily 10 min before heavy meals.
Tell me how you feel after 10 days.
Dont take any citrus fruit like orange.
Do intimate me about the diet chart given to you by dietician.
Regards.

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Brief Answer:
Follow up answer.

Detailed Answer:
1.Yes sir but except oranges and other fruits and berries which are citrus in nature as they contain citric acid.
Drink one glass of fat free chilled(iced) milk once in morning and once in evening before going to bed.Iced milk is alkaline and would neutralize acid in gut.
2.Do not lie down for 2-3 hrs after eating.
3. Decrease caffeine (colas, coffee) and sodas in general.
4. Decrease alcohol or completely stop it.
5. If you smoke cigarettes, now is the time to stop. They increase acid production and delay healing.

6. If you are overweight through the middle, that increases the risk of reflux. Try to decrease your weight (though not over weight yet you are towards the higher side) slowly over time by 3-4 kg.

7. Eat smaller amounts at a time so there is less pressure in the stomach which can reflux acid into the stomach.

8. Avoid eating/drinking mint (it relaxes the lower esophageal sphincter which can allow more acid up).

Basically you should try a mild fat restrictive diet for next 8 weeks.
As you are XXXXXXX i think you must be eating XXXXXXX food.

Food plan is
maintainence calorie is around 2300 cal/day
for losing 3-4 kg you should keep a calorie deficit of 400-500cal
so you should take 1800 cal diet a day

6 a.m 4 egg white
i glass water

8 a.m
200ml chilled fat free milk
40 gram oat
1 scoob of saltless and sugarless peanut butter(myprotein )
1 apple/pear.

11 a.m 1 scoob of protein supplement(sugar free)

2pm
60 gram mixed atta(2 rotis)
100 gram grillled chicken breast/curry
150 gram mixed veggies

5 pm
1 fruit of choice
1 cup sugar free yoghurt

10 pm
100-150 gram grilled paneer low fat
50 gram brown rice
20 minutes of mild to moderate exercise 5 days a week.
Any thing you want to add revert back to me.
Can send a direct query to me at this link
http://doctor.healthcaremagic.com/doctors/dr-ramesh-kumar/72660
Regards.

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Brief Answer:
Please see the reply

Detailed Answer:
Rewiewed
7:30 am
1 glass water + 1 green tea
I will add egg to this. Cant I take 1 or 2 full eggs instead of 4 egg whites, or can I limit to 2 egg whites.
Yes its ok infact best diet is what suits you and you can follow easily for long terms.
8:45 a.m.
Dosas (3 nos.) / Idlis 5 nos. / Roti - 3 nos. / Rice Roti (prepared with rice flour) - 4 nos./Poori - 5 nos. with either Sambhar, Chutney, Potato bhaji, Chicken curry-Stop poori and sambhar should not contain anything citric.

10:30 a.m. 1 glass water + 1 green tea

11:45 a.m. 1 glass water

1 p.m.
White Rice (very small portion compared to regular rice eaters)-change it to brown rice, fish curry(very less extra virgin olive oil cooked), 2 types of vegetables cooked in XXXXXXX style, curd/butter milk, fish fry (in case of no fish curry)-No fish fry it contains lots of oil rather switch to grilled fish.

3:30 p.m.
1 glass water + 1 green tea

5:30 p.m.
1 coffee / tea / green tea (switched to green tea these days), snacks like samosas (1 no.) or pakodas or cutlet (1 no.).-Tsnack is not acceptable(once or twice a week is ok) add fruits or grilled paneer

8:45 p.m.
Vegetable salad with olives,
Roti - (3 nos.) or dosa (3 nos.), vegetable curry or fish curry(less oil)

In addition I take fruits like green/red apple (half), banana(no you are diabetic), papaya, guava, plums(no you are diabetic) after lunch and dinner.
Thanks

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