Brief Answer:
Hiatal hernia.

Detailed Answer:
Hi XXXXXXX
Firstly thanks for choosing this forum to ask query.
I would just like to give you a small briefing about ypour problem.This will help you understand why symptoms are more in your case.

The esophagus connects to the stomach at an opening in the diaphragm called the hiatus. The lower esophageal sphincter (LES), which is normally at the same level as the diaphragm, keeps stomach contents (food, acid, and other digestive juices) from backing up (or refluxing) into the esophagus.
But when a sliding hiatal hernia is present, part of the stomach moves up through the hiatus and into the chest cavity. This pushes the lower esophageal sphincter (LES) up into the chest cavity away from the hiatus. Away from the hiatus, the XXXXXXX loses the support that it needs from the diaphragm to stay closed. This raises the risk for symptoms of heartburn and gastroesophageal reflux disease(as in your case dear).

If you are not reileved by prilosec only.
Ask your gastroenterologist to consider the following conciderations-

- Firstly I would suggest you to switch to Nexium(Esomeprazole). Initially take it 40mg twice daily, However if not relieved doses can be increased to 80mg twice a day.On the day of appointment ask your gastroenterologist to add Prokinetic drug like

Option 1. -Levosulpiride- It is a sulpiride isomer and exerts its prokinetic effect by blocking D2 receptors. Recent trials have shown that combining it with PPI's have excellent effect in patients suffering from acid reflux.

Option 2. Domperidone- Very effective in treating reflux not controlled by PPI's especially when combined with Rabeprazole/Esomeprazole.

However just medicines will not do strict adherence to life style modification is required.


-Take a low fat easily digestible food.
-Eat a lot of raw salads esp. vegetables.
-No alcohol or smoking.
-No aerated beverages or soda.
-Avoid meat or processed food.-Avoid cheese, Dairy, Milk etc.
.-Take a lot's of yogurt in food
.-Avoid spicy or fast food(No pizza or Burger).-If possible try vegans diet in dinner and normal diet in lunch.-Drink at least 8 cups of water everyday.-avoid all fruits which are citrus.Avoid orange or pineapple juice.-Eat 1 cups of fruit like banana daily.

In case you have to ask any particular question.I would be happy to help.
Feel free ask anytime.

Regards.

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Brief Answer:
Follow up answer.

Detailed Answer:
Hi again,
Yes you should take a quality Probiotic atleast twice a day.Our gut consists of its own environment of micro organism called gut flora.They are responsible for proper digestion of food.
I would suggest you to take a good probiotic for 4 weeks. This will again replenish the depleted flora. Once the flora is replenished intestinal motility and secretions will be improved and overall digestion and health will improve.
This is not just for your Hiatal hernia but will improve your overall digestion.


For sleep apnea you should consult a respiratory and chest specialist.

I hope i answered your query well.
Thanks and Get well soon.

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Brief Answer:
Follow up answer.

Detailed Answer:
Hi again,
Yes cold milk acts as an alkali and neutralize the acid.Hence a glass of cold skimmed milk can be taken every day.
In eggs if possible try to avoid yolk for few days however white can be taken.Egg yolk is fat rich and difficult to digest easily.
Nexium can be taken initially in doses 40mg twice daily and can be increased to upto 80mg twice.

Regards.

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Brief Answer:
Follow up answer.

Detailed Answer:
Hi again,
The area 2-3 inches above belly button medically termed as epigastrium.As per your history the problem started when you were on golf ground(exertional activity).

A male patient aged 70 years presenting with pain in epigastric area on exertion with dyspnea and lightheadeness can be Angina also.Angina occurs when an area of the heart muscle is receiving decreased blood oxygen supply. It is not a disease itself, but rather a symptom of coronary artery disease, the most common type of heart disease in old males.

I would suggest you to go for few cardiac investigations namely-

Resonance imaging of heart (2d echo)- Motion of heart can be seen and ischemia could be ruled out.
Stress test- You are required to run on a tread mill and recording will be taken.Any gross ischemia to heart would be reflected.

Please answer the following questions?

Are you a smoker or alcoholic? If yes then from how many years?
How long did the pain lasted?
Was it relieved on taking rest?
Did it respond to Nexium?
Do you ever feel a bit breathless on climbing upstairs or walking fast?
How are your anxiety levels and sleep cycle?
How long does dizziness lasted?

Waiting.

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Brief Answer:
Follow up answer.

Detailed Answer:
Hello again,
Have gone through your details.
One of the main cause of atrial fibrillation in adults is coronary artery disease.
So though the pain responded to Nexium yet i would suggest you to go atleast for a stress test to rule out any possibility of coronary artery disease.
Mild dizziness can be due to meroprolol you are on.Metoprolol decrease the blood pressure and keep the pulse low. In case if your baseline pulse is always around 52-56 /min you can ask your cardiologist to decrease the dose of meroprolol.
As of now start taking Nexium in optimal doses 40 mg twice daily along with a good probiotic daily for few days till tests are done.Follow the advice's as suggested by me.
You should feel better in a day or two.

Follow up with reports!

Regards

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Brief Answer:
Follow up advice.

Detailed Answer:
Hi again,
Since Metoprolol is causing mild bradycardia and hypotension its better to shift either on diltiazem or verapamil.Though they slows down the heart yet effect on blood pressure(most likely cause of your dizziness) is minimal.
As per your query regarding Flecianide i would say that it is a proarrhythmogenic drug and can precipitate a number of arrhytmias hence my suggestion would be to go for either diltiazem or verapamil in doses suggested by your cardiologist.

Good luck!
Thanks.

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Brief Answer:
Esophagus show metaplasia.

Detailed Answer:
Hi There,
Sorry for a bit delayed reply.

Have gone through your reports stress echo is normal with excellent exercise tolerance.I don't think you need to worry about you heart however endoscopic findings are suggestive of metaplasia. Metaplasia is the reversible replacement of one type of cell with another mature cell type. The change from one type of cell to another may be part of a normal maturation process, or caused by some sort of abnormal stimulus.A biopsy should be done to rule out metaplasia as GERD is one of the most common cause of metaplasia.
Yes Nexium can be taken safely upto a dose of 160 mg in a day.In severe cases it is given i.v at a rate of 8-10mg/hr.

Suggestion
Biopsy of esophageal tissue.
Increase doses of nexium to 40 mg twice daily.

Follow up with reports.

Regards.

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Brief Answer:
Follow up answer.

Detailed Answer:
Hello again,
Have gone throughyour biopsy report its normal.You are having chronic gastritis.
Most likely your discomfort is due to chronic gastritis. However in case you think its related to muscle sprain take tab Etorcoxib 90 mg for 3 days.If the pain responds to it;Its muscular otherwise not.
Rest follow all advice and i think you will feel better soon.

Regards.

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