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Suggest Treatment For Chronic GERD While On Nexium

Posted on Tue, 19 Sep 2017

Question: Hello Doctor ,
33 years old Male , software engg , chronic GERD and IBS patient.
I am unable to stop Nexium , on and off i am on it.
And whenever I eat outside I take Country Life - Maxi-Zyme Caps with food .(is it bad?)
No other medication. I take PHGG guargum powder for motion.
I am worried about the usage of the multi enzyme tablets . Please share your views on that.
I had taken atazanavir and ritonavir tablets as (Post exposure prevention of HIV) for 6 days and then stopped . This i had started taking as I was not sure of HIV status of one of my sexual partner , but later i stopped as the person concerned is negative. During taking the drugs , my eyes were already yellow as a side effects. I stopped the drugs 10 days back after taking it for 6 days.
Today My blood tests are little alarming.
Alkaline Phosphatase (SAP) (Serum/PNPP / Kinetic) 185 U/L 53 - 128
Cholesterol Total (Serum/Cholesterol
oxidase/Peroxidase)
224 mg/dL
Triglycerides (Serum/Glycerol phosphate oxidase /
peroxidase) 193 mg/dL
I am worried about Alkaline Phosphatase high level.
Do you think it could be because of my continuos intake of Nexium (more than 4 years now ) and the multi enzymes (whcih I have been taking for last 6 months , whenever i eat out) or it could be due to brief intake of atazanavir and ritonavir which i stopped 10 days back.
I was taking B12 shots last year and was on calcirol also last year.
Please comment on my enzym intake and Alkaline Phosphatase.
I will control my choleterol , my food habit has been bad for last few months.
Thanks & Regards

Answered by Dr. T Chandrakant (29 minutes later)

Brief Answer:
As described below

Detailed Answer:
Hi.
Thanks for your query.
Read and understood your concerns.
To answer your specific queries:
Country Life - Maxi-Zyme Caps with food is a great combination of enzymes which as per the research are: Papain 189‚450 PU, Lipase 5‚400 LU, Protease 216 ,
Lactase 125.1 LacU, alpha-Galactosidase (from aspergillus niger) 48 AGSU, Phytase 47 PHU, Bromelain 18 BTU, alpha- Amylase 13.5 SKBU. These should help in proper digestion and should be taken during meals.
You may please continue if this is helping you and not causing any any adverse efects.
About the raised Alk Phos:
This can be raised due to many reasons and needs proper clinical evaluation and further investigations to know the exact cause.
Also needs serial follow up to see if this is raising, reducing or remains same and other values of liver function.
Since your liver function are normal, including GGT first thing to do is to repeat the Alk Phos levels to see the status.
Also needed are:
Ultrasonography and MRCP/ ERCP of the abdomen for any stone in the bile duct or any other obstruction to bile flow one the most important reasons for raised Alk Phos.
Plain X-ray of flat bones like pelvis and skull.
Please discuss this with your Doctors to get a proper evaluation and further investigations as well as management.
Antivirals may disrupt the liver functions as a whole and not just the Alk Phos.
Nexium may not cause such raised Alk Phos.

IBS can best be controlled by control of your stress, anxiety and change of lifestyle.

I hope this answers your concerns and helps you get further evaluation, investigations and management.
Please feel free to ask for further relevant queries if you feel that there is a gap of communication.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (26 minutes later)

Hello Doctor ,

Thanks for the reply.

After using life country enzyme my condition has improved a lot , so i would like to continue that.

Should I wait for few days before repeating the LFT?

During using of Antivirals my eyes had turned full yellow 10 days back , and that became better as soon as I stopped the medicine. Just hoping the ALP could be due to that.

But before I go for any invasive process of endoscopy i just wanted to make sure its needed. Will get tested for GGT and LFT first.
Btw for bone issues , or blockage of bile duct, how alarming are the values of ALP?
is 185 too high?

As of now i dont have any other symptoms as such.

Thanks & Regards XXXXXXX

Answered by Dr. T Chandrakant (8 minutes later)

Brief Answer:
As explained below.

Detailed Answer:
Thanks for your appreciation.
Please continue the Enzyme preparations.
Yes, you may please wait for a few days but as the last report is on 25 th, get these as soon as possible.
At least go for Ultrasonography of abdomen as a preliminary examination and X-ray of Pelvis.
Eyes getting yellow 10 days back and having normal values of LFT except alk phos is difficult to believe but possible.
It is not about alarming values, it is about raised value and persistence should be investigated.

I hope this helps you further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (18 hours later)

Hello Doctor,

After 4 days when i got tested today the report seems little better.
ALP is reduced by 20.

GGT(Gamma Glutamyl Transpeptidase) (Serum/
IFCC / Kinetic)
20 U/L < 55
Alkaline Phosphatase (SAP) (Serum/PNPP / Kinetic) 165 U/L 53 - 128

Can you please check the report uploaded and comment?

Thanks & Regards XXXXXXX

Answered by Dr. T Chandrakant (3 hours later)

Brief Answer:
Flat bone -rays

Detailed Answer:
Thanks.
Since alk phos is still elevated but GGT is normal, it is better to rule out any bone disease.
Get the X-rays of Pelvis and skull bone, consult your Doctor.

Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar