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Suggest Remedy For Persistent Diarrhoea, Heartburn And Sore Throat
Question: I have been feeling unwell which started about 2-3 months ago after consuming a lot of alcohol (having a history of alcohol abuse) This gradually passed after a few weeks until I got a pain under my right ribs about 4 weeks ago. This was a familiar pain as I had this before, self diagnosing it as gastritis. This passed quite quickly but after eating a big bag of chips it was back. Then I started a healthy diet to relieve stomach but ate something spicy and it gave me the pain again and caused diarrhea. I then switched to totally non acidic diet.
My current issue is that since over a week I started waking up at night with sort of bitter taste in mouth and it happened every night since then. a few days ago I felt something on the back of my tongue and then in my throat. At the moment I have a sore throat and a lump and swallowing is difficult, also hoarse voice. After doing some research this must be caused by stomach fluids moving up to the mouth and causing damage to throat and vocal chords. Other symptoms I am having recently is rumbling stomach quite often, stools have been floating and at times green. There is also still a numbing feeling under my right ribs which sometimes radiates to the back.
The common treatment for the LPR (as I have no heartburn) seems to be twice daily PPI and an added H2. However I have just seen a presentation https://www.youtube.com/watch?v=SysD2B1aXJA
Which suggests this method seems to work but patients recover without the drug as well after half a year anyway. So now I am kinda hesitant to start taking this drug
I have been taking zantac since a couple of days but despite that I had an uneasy night again and it felt like the stomach fluids were in my mouth again (despite not eating for hours/elevated bed/left side sleep)
What is your assessment of my issues? my primary concern is the LPR
My current issue is that since over a week I started waking up at night with sort of bitter taste in mouth and it happened every night since then. a few days ago I felt something on the back of my tongue and then in my throat. At the moment I have a sore throat and a lump and swallowing is difficult, also hoarse voice. After doing some research this must be caused by stomach fluids moving up to the mouth and causing damage to throat and vocal chords. Other symptoms I am having recently is rumbling stomach quite often, stools have been floating and at times green. There is also still a numbing feeling under my right ribs which sometimes radiates to the back.
The common treatment for the LPR (as I have no heartburn) seems to be twice daily PPI and an added H2. However I have just seen a presentation https://www.youtube.com/watch?v=SysD2B1aXJA
Which suggests this method seems to work but patients recover without the drug as well after half a year anyway. So now I am kinda hesitant to start taking this drug
I have been taking zantac since a couple of days but despite that I had an uneasy night again and it felt like the stomach fluids were in my mouth again (despite not eating for hours/elevated bed/left side sleep)
What is your assessment of my issues? my primary concern is the LPR
Brief Answer:
It is reflux disease only
Detailed Answer:
Hello! Thanks for putting your query in HCM. I am a Gastroenterologist (DM). I can understand your concerns. You are right that it is nothing else but LPR. To confirm you may undergo endoscopy examination. For which I will suggest you following which I found very useful in my patients with reflux disease:
1.Avoid fatty and spicy meals, citrus fruits, tea and coffee
2. Don’t lie down soon after meals for at least two hour
3.Take small and frequent meals, instead of full meals at a time
4. wear loose clothes
5. If you are overweight or obese do weight reduction with dieting and exercise
6. Dont drink water after meals at least for 2 hrs
7. Take dinner early
8. Take a walk after dinner
9. make your head end of bed raised by 9 inches by putting blocks
10. Avoid alcoholand smoke if you do
Among the medicines I will suggest you to:
1. take domperidone it don't simply act as a prokinetic agent but it also increase the tone of lower esophageal sphincter which will prevent reflux
2. Baclofen also helps in increasing tone of lower esophageal sphincter
3. A proton pump inhibitor like rabeprazole which is more effective than H2 blocker zantac
I hope I have answered your query and this will help you. If you have any further query I will be happy to answer that too. Remain in touch and get-well soon.
It is reflux disease only
Detailed Answer:
Hello! Thanks for putting your query in HCM. I am a Gastroenterologist (DM). I can understand your concerns. You are right that it is nothing else but LPR. To confirm you may undergo endoscopy examination. For which I will suggest you following which I found very useful in my patients with reflux disease:
1.Avoid fatty and spicy meals, citrus fruits, tea and coffee
2. Don’t lie down soon after meals for at least two hour
3.Take small and frequent meals, instead of full meals at a time
4. wear loose clothes
5. If you are overweight or obese do weight reduction with dieting and exercise
6. Dont drink water after meals at least for 2 hrs
7. Take dinner early
8. Take a walk after dinner
9. make your head end of bed raised by 9 inches by putting blocks
10. Avoid alcoholand smoke if you do
Among the medicines I will suggest you to:
1. take domperidone it don't simply act as a prokinetic agent but it also increase the tone of lower esophageal sphincter which will prevent reflux
2. Baclofen also helps in increasing tone of lower esophageal sphincter
3. A proton pump inhibitor like rabeprazole which is more effective than H2 blocker zantac
I hope I have answered your query and this will help you. If you have any further query I will be happy to answer that too. Remain in touch and get-well soon.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
hello and thank you for your response!
After doing some more reading I have come to the conclusion this is the path I need to travel:
As it is (surely) LPR I need to find out if it is acid type or not acid type (or both). I will need to insist on a dual probe test to determine this, this seems the only way to determine. I do not see the sense in taking PPI medication for 3-6 months to be able to conclude which type I (don't) have.
If the outcome is acid after all I can start using (or continue if there is a good reason after all to take them) and hope for improvement. If it is non acid then I guess there is not much other choice then surgery. From the types I favor Trans-Oral Incisionless Fundoplication or LINX system. Surgery appeals as the complaints will surely get worse over time and it may improve my quality of life not having to be on a diet and the lifestyle changes, not sleeping the way I like is the most bothersome
Thank you as well for the tips.
As I guessing non acid LPR I am thinking of using Gaviscon Advance as this has shown good results in trials. I will discuss this all with my GP and ask to see a ENT and gastroenterologist asap.
Would you be so kind to comment on my findings and conclusion?
After doing some more reading I have come to the conclusion this is the path I need to travel:
As it is (surely) LPR I need to find out if it is acid type or not acid type (or both). I will need to insist on a dual probe test to determine this, this seems the only way to determine. I do not see the sense in taking PPI medication for 3-6 months to be able to conclude which type I (don't) have.
If the outcome is acid after all I can start using (or continue if there is a good reason after all to take them) and hope for improvement. If it is non acid then I guess there is not much other choice then surgery. From the types I favor Trans-Oral Incisionless Fundoplication or LINX system. Surgery appeals as the complaints will surely get worse over time and it may improve my quality of life not having to be on a diet and the lifestyle changes, not sleeping the way I like is the most bothersome
Thank you as well for the tips.
As I guessing non acid LPR I am thinking of using Gaviscon Advance as this has shown good results in trials. I will discuss this all with my GP and ask to see a ENT and gastroenterologist asap.
Would you be so kind to comment on my findings and conclusion?
Brief Answer:
You are absolutely right
Detailed Answer:
Welcome back. You are absolutely right. But I want to add one thing even if it is non acidic reflux, prokinetic agents like domperidone or levosulpiride do well and surgery is not required in most of the cases. Moreover surgery is an invasive procedure and one should give at least once trial of non invasive methods like medicines and lifestyle changes which I have mentioned earlier. Wish you good health
You are absolutely right
Detailed Answer:
Welcome back. You are absolutely right. But I want to add one thing even if it is non acidic reflux, prokinetic agents like domperidone or levosulpiride do well and surgery is not required in most of the cases. Moreover surgery is an invasive procedure and one should give at least once trial of non invasive methods like medicines and lifestyle changes which I have mentioned earlier. Wish you good health
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Above answer was peer-reviewed by :
Dr. Sonia Raina
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