How Can GERD With Excessive Burping Be Treated?

Posted on Fri, 19 May 2017

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Fri, 19 May 2017 Answered on

Thu, 8 Jun 2017 Last reviewed on

Question : My father's medical record:

1978: Removal of stones form the gall bladder

2000: Total prostate gland removal because of appearance of cancer

2008: Invasive surgery to fixed asymptomatic abdominal aorta aneyrism

2011: MRI BRAIN scan revealed 2-3 deteriorate cells due to age. He took aricept 5mil for some months.Due to vivid dreams and other symptoms the neurologist diagnosed Lewy body dementia. However my father was fully functional and independent. He walked every day. he was able to drive, and he was 100% sane in conversation, and fully functional.

2013:July 2013 my father had a big shock after losing most of his money in bank bankruptcy.He fell down and broke his left hip. He was operated with total sedation (not epidural).

When he came out of the surgery room he was in complete confusion for many months and since then he has mobility problems like parkisonian shuffle and stiff joints. He was sen by a neurologist who said that the post surgery cognitive decline was probably due to worsening of Lewy body dementia.Was it the sedation that cause this damage??????????

Since then my father is taking the following medications:

Seroquel 25

Cretanil 1mg

Aricept 10

Clonotril 0.5 twice a day

2016: In May 2016 my father fell and broke his other hip flexor. He was operated with epidural sedation this time. Since then he has not recovered. He cannot walk,he has very low understanding of his suroundings, does not eat and apparently he is very aggressive. Very often he punches/hits caregivers something that he did not do before 2016. He has also GERD AND RECENTLY HE HAS BeeN BURBING A LOT ACCOMPANIED WITH PHLEGMS.

I would appreciate if you could advise us on how to help my father improve!

Regards ,
XXXX

Answered by Dr. Panagiotis Zografakis (-3 hours later)

Brief Answer:
worsening dementia

Detailed Answer:
Hello,

this is very commonly seen in old patients with mild dementia. Such patients may get worse by any untoward event. Surgery is one of the most upsetting events for them. It's not only that they have to stay at hospital (which will look too unfamiliar to bear with) but their brain goes under stress when they receive anesthetic drugs. A broken leg is one of the commonest scenarios in this regard.

I've seen the MRI report which is old. Perhaps you can try a CT scan to see if anything new occurred. I doubt he could do a new MRI without sedation. The CT scan is faster to complete, so it may provide additional clues.

In patients with impaired brain functions there are some basic tests to do to exclude common disorders like the following: complete blood count, thyroid function tests, serum electrolytes, urea, creatinine, liver function tests, inflammatory markers, etc. The drugs have to be reviewed by the neurologist as well. I've seen the tests you've done and besides the CRP they're OK.

Even a mild infection (like a cystitis) may cause worsening. Since your father's condition has been consistently deteriorating for a long time, it's more likely that it's his dementia only.

So in conclusion, I don't have much to suggest than to review his drugs (with the help of his neurologist) and do the necessary tests (the rest of the tests, since you've done most of them). The neurologist can then decide for further action like a change in his regimen and perhaps also alternative ways to feed him like a nasogastric tube (temporary solution) or gastrostomy (permanent solution). His GERD has to be managed with either ranitidine or a proton pump inhibitor like omeprazole unless contraindicated for some reason.

Kind Regards from XXXX!

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