Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Difficulty In Swallowing And Heart Burns When Treating Barrett's Esophagus?
Question: I have been diagnosed with Barretts and GERD and am currently trying a second type of PPI. I feel that the treatment plan I was given (medicate indefinitely and scope every 5 years) is not adequate for my symptoms. I have great difficulty swallowing solid food without lots of water, increasing heartburn and pain despite being on PPis. Do you think it's reasonable to get a second opinion? Is it possible for a PPI to work some of the time or even stop working? I had such terrible heartburn pain about an hour after taking my pill last night...all night and even until this morning. In Canada it takes forever to see a specialist so I don't know what to do.
Brief Answer:
detailed below.
Detailed Answer:
Hello!
Welcome to Healthcare Magic.
I read carefully your query and I understand your concern.
Considering all your symptoms and the fact that symptoms are progressive despite the fact that your are on PPI , I would suggest to consult your treating physician .
When the symptoms don't respond to the treatment ,it is called refractory GERD and it requires a detailed evaluation of your situation to understand the cause.
To control GERD symptoms you need to do some lifestyle modifications like:
-Avoid all foods that can trigger acid reflux (fatty ,processed foods,spicy foods,coffee ,juices,chocolate,tomato etc)
-Eat small frequent meals instead of three major meals.
-Don't lay down at least three hours after eating
-Raise the head of your bad about 6-8 inches.Drink plenty of water.
You should take the PPI drug 30 min before breakfast .
If despite doing all these your symptoms don't improve ,your doctor can double the dose of PPI so you should take it twice a day ,30 min before meals.
If this doesn't improve your symptoms , an H2 rec antagonist like Ranitidine can be added in therapy.
If despite all the possible treatment your symptoms don't improve ,it is called refractory GERD.
In this case your doctor can order some additional tests to understand the cause including :
-H.pylori infection
-Barium swallow test
Surgical options can be discussed if all other treatment options are ineffective.
Hope it helps.
Let me know if you need further help.
Kind regards,
Dr.Rovena Murati
detailed below.
Detailed Answer:
Hello!
Welcome to Healthcare Magic.
I read carefully your query and I understand your concern.
Considering all your symptoms and the fact that symptoms are progressive despite the fact that your are on PPI , I would suggest to consult your treating physician .
When the symptoms don't respond to the treatment ,it is called refractory GERD and it requires a detailed evaluation of your situation to understand the cause.
To control GERD symptoms you need to do some lifestyle modifications like:
-Avoid all foods that can trigger acid reflux (fatty ,processed foods,spicy foods,coffee ,juices,chocolate,tomato etc)
-Eat small frequent meals instead of three major meals.
-Don't lay down at least three hours after eating
-Raise the head of your bad about 6-8 inches.Drink plenty of water.
You should take the PPI drug 30 min before breakfast .
If despite doing all these your symptoms don't improve ,your doctor can double the dose of PPI so you should take it twice a day ,30 min before meals.
If this doesn't improve your symptoms , an H2 rec antagonist like Ranitidine can be added in therapy.
If despite all the possible treatment your symptoms don't improve ,it is called refractory GERD.
In this case your doctor can order some additional tests to understand the cause including :
-H.pylori infection
-Barium swallow test
Surgical options can be discussed if all other treatment options are ineffective.
Hope it helps.
Let me know if you need further help.
Kind regards,
Dr.Rovena Murati
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your quick reply,
I will look up information on refractory GERD. Right now I feel like nothing helps and I actually have acid reflux as I type this. It's there almost 24hours/day.
I barely eat 3 small meals a day and things like bread and meats feel like they get stuck half way. Then I drink tons of water and it feels like a large ball of food being pushed down. I don't understand why that is one of the symptoms?
Thanks again
XXXX
I will look up information on refractory GERD. Right now I feel like nothing helps and I actually have acid reflux as I type this. It's there almost 24hours/day.
I barely eat 3 small meals a day and things like bread and meats feel like they get stuck half way. Then I drink tons of water and it feels like a large ball of food being pushed down. I don't understand why that is one of the symptoms?
Thanks again
XXXX
Brief Answer:
detailed below.
Detailed Answer:
Hello again.
Dysphagia or difficulty swallowing can be a symptoms of severe uncontrolled GERD .In this case the cause is inflammation of esophagus due to acid reflux ,which makes swallowing solid foods painful.
Motility disorders of esophagus also can cause dysphagia ,but in this case Manometry can exclude motility disorders.
I would suggest the following :
-If you are taking PPI once a day ,double the dose to twice a day ,30 min before breakfast and dinner.
-If you are taking PPI twice a day ,add Ranitidine at bedtime for 1-2 weeks and see if this helps.
If not ,consult your physician for evaluation.
In a patient that doesn't respond to PPI drugs ,an option to be taken in consideration is non-acid reflux,in which the material of reflux is not acidic and PPI (that suppress acid production ) won't help.
The diagnosis is established by doing a test called multichannel intraluminal impedance and pH (MII-pH).
This is a test that evaluate the presence of reflux from stomach to esophagus and determine the pH of this material to see if it is acidic or non -acid reflux.
-You also may need to run an barium swallow test to exclude other causes for dysphagia.
If the symptoms persist I suggest to consult a specialist and discuss with him these options.
Take care,
Dr.Rovena
detailed below.
Detailed Answer:
Hello again.
Dysphagia or difficulty swallowing can be a symptoms of severe uncontrolled GERD .In this case the cause is inflammation of esophagus due to acid reflux ,which makes swallowing solid foods painful.
Motility disorders of esophagus also can cause dysphagia ,but in this case Manometry can exclude motility disorders.
I would suggest the following :
-If you are taking PPI once a day ,double the dose to twice a day ,30 min before breakfast and dinner.
-If you are taking PPI twice a day ,add Ranitidine at bedtime for 1-2 weeks and see if this helps.
If not ,consult your physician for evaluation.
In a patient that doesn't respond to PPI drugs ,an option to be taken in consideration is non-acid reflux,in which the material of reflux is not acidic and PPI (that suppress acid production ) won't help.
The diagnosis is established by doing a test called multichannel intraluminal impedance and pH (MII-pH).
This is a test that evaluate the presence of reflux from stomach to esophagus and determine the pH of this material to see if it is acidic or non -acid reflux.
-You also may need to run an barium swallow test to exclude other causes for dysphagia.
If the symptoms persist I suggest to consult a specialist and discuss with him these options.
Take care,
Dr.Rovena
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you again for your reply,
I am currently taking dexalin which is apparently a 24 hr time released PPI so I dont think I can double that but I will add Zantac at night. Also I've had the 24hr PH test that indicated 49 episodes of acid reflux despite the other PPI I was taking called pantoprazole. I also had a barium test- first thing they checked. It was normal.
I am currently taking dexalin which is apparently a 24 hr time released PPI so I dont think I can double that but I will add Zantac at night. Also I've had the 24hr PH test that indicated 49 episodes of acid reflux despite the other PPI I was taking called pantoprazole. I also had a barium test- first thing they checked. It was normal.
Brief Answer:
detailed below.
Detailed Answer:
Hello again!
The fact that Barium swallow test was normal ,excludes other possible conditions like hiatal hernia,motility disorders that would explain the fact that the treatment isn't working.
It is true that recommended dose of Dexilant for GERD is 30 mg once a day for 4 weeks.
I would like to know how long have you been taking this drug and if changing to this drug improved the symptoms or it never worked because it may take some time before the medication start to work if you have started it recently.
Take care,
Dr.Rovena
detailed below.
Detailed Answer:
Hello again!
The fact that Barium swallow test was normal ,excludes other possible conditions like hiatal hernia,motility disorders that would explain the fact that the treatment isn't working.
It is true that recommended dose of Dexilant for GERD is 30 mg once a day for 4 weeks.
I would like to know how long have you been taking this drug and if changing to this drug improved the symptoms or it never worked because it may take some time before the medication start to work if you have started it recently.
Take care,
Dr.Rovena
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr Rovena
I just started Dexilan about a week ago. So far I get relief for a couple of hours but as soon as I eat I get heartburn during and after. The pain while resting and not eating is less than before but the breakthrough acid reflux is greater pain during meals then it was prior to medication. I'm just always worried about the acid hitting the barrets because that section in at the GIJ...even though it's only 3 cm long. I feel like this is going to progress to cancer.
I just started Dexilan about a week ago. So far I get relief for a couple of hours but as soon as I eat I get heartburn during and after. The pain while resting and not eating is less than before but the breakthrough acid reflux is greater pain during meals then it was prior to medication. I'm just always worried about the acid hitting the barrets because that section in at the GIJ...even though it's only 3 cm long. I feel like this is going to progress to cancer.
Brief Answer:
detailed below.
Detailed Answer:
Hello!
You have been taking Dexilan for a week.It may need some more time to show the complete effect.
Give it some time and add Ranitidine once a day for additional relief.
If the symptoms don't resolve ,your doctor may increase the dose of Dexilan to 60 mg a day.
I can understand that such symptoms are really disturbing and having Barrets esophagus concerns you, but if acid reflux is totally controlled by medication ,the changes in your esophagus won't progress further.
So the issue in your case is to find the right medication or combination of drugs that will keep under control the reflux.
So for now continue Dexilan with Ranitidine and see what happens.If the symptoms don't resolve consult your physician to modify the treatment.
Hope it helps.
Wish you all the best.
Take care,
Dr.Rovena
detailed below.
Detailed Answer:
Hello!
You have been taking Dexilan for a week.It may need some more time to show the complete effect.
Give it some time and add Ranitidine once a day for additional relief.
If the symptoms don't resolve ,your doctor may increase the dose of Dexilan to 60 mg a day.
I can understand that such symptoms are really disturbing and having Barrets esophagus concerns you, but if acid reflux is totally controlled by medication ,the changes in your esophagus won't progress further.
So the issue in your case is to find the right medication or combination of drugs that will keep under control the reflux.
So for now continue Dexilan with Ranitidine and see what happens.If the symptoms don't resolve consult your physician to modify the treatment.
Hope it helps.
Wish you all the best.
Take care,
Dr.Rovena
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank u for the advice, I will add Zantac and give the Dexalin more time. I appreciate the help and understanding.
Brief Answer:
You are welcome.
Detailed Answer:
Hello.
You are totally welcome.
I wish you all the best and hope soon your symptoms will resolve.
Let me know if you need further help.I will be happy to help you.
Take care,
Dr.Rovena
You are welcome.
Detailed Answer:
Hello.
You are totally welcome.
I wish you all the best and hope soon your symptoms will resolve.
Let me know if you need further help.I will be happy to help you.
Take care,
Dr.Rovena
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
