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I Have Gerd , Being Treated Had Upper Gi.part Of

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Posted on Wed, 8 Apr 2020
Question: I have gerd, being treated Had upper gi.part of diagnosis tortous esophagus with dysphagia. I have severe pain in the center of my chest as though food stuck there. pain is constant resulting in my not eating or drinking because of pain. In 5 weeks have lost 25 lbs
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Follow up: Dr. Ramesh Kumar (0 minute later)
I have gerd, being treated Had upper gi.part of diagnosis tortous esophagus with dysphagia. I have severe pain in the center of my chest as though food stuck there. pain is constant resulting in my not eating or drinking because of pain. In 5 weeks have lost 25 lbs
doctor
Answered by Dr. Ramesh Kumar (2 hours later)
Brief Answer:
Need more details.

Detailed Answer:
Hello,
Thanks choosing "Ask a Doctor" service for your query.
Have gone through your details and i appreciate your concerns.
You have not mentioned whether endoscopy has been done or not?
Had upper GI part of tortous esophagus with dyphagia? Is this your symptom or diagnosis given by your doctor?What test had been done?
please elaborate your question.
Initially i would like to say that their are some lacunas in treatment part.
Why?
Please go through every line and try to understand that basic cause of your problem is reflux of acid from stomach to esophagus.Stomach is lined by a natural layer of mucosa membrane which is resistant to acid however mucosa in esophagus is easily destroyed by acid which regurgitates back from stomach.This cause severe irritation of esophagus leading to inflammation. Esophagus reacts to the repeated injury from the acidic fluid by changing the type of cells lining it from squamous (normal cells) to columnar (intestinal-type cells). This transformation, called metaplasia, is believed to be a protective response because the specialized columnar epithelium (epithelium means lining) in Barrett's esophagus is more resistant to injury from acid than the squamous epithelium.However in long term it increases risk of adenocarcinoma by 5%. Dysphagia associated with GERD is usually caused by acid reflux.
In simple language lower esophageal sphincter (LES) is a valve that is located at the junction of the stomach with the esophagus. Its function is to prevent acid and other contents of the stomach from coming back into the esophagus. GERD is a condition in which excessive acid-containing fluid refluxes (flows) back into the esophagus, in part because the lower esophageal sphincter is weak.
In some patients with GERD, the esophagus reacts to the repeated injury from the acidic fluid by changing the type of cells lining it from squamous (normal cells) to columnar (intestinal-type cells). This transformation, called metaplasia, is believed to be a protective response because the specialized columnar epithelium (epithelium means lining) in Barrett's esophagus is more resistant to injury from acid than the squamous epithelium.

There is a small but definite increased risk of cancer of the esophagus (adenocarcinoma) in patients with Barrett's esophagus.

Now managemebt consists of two step-
1)Control acid production-Just taking pantoprazole 40 mg won't help.Its just a basic PPI and dose too is just optimal.It can be used safely in doses ranging from 80 to 160 mg daily initially.Secondly there are much better PPI's available in market like Lansoprazole Rabeprazole etc.

2)Prevent reflux of acid formed back to esophagus-This part is completely overlooked by your Gastro.

Please request your gastroenterologist to start you on PPI-antacids like Rabeprazole or Esomeprazole.Pantoprazole is a basic PPI and better options are there for treating specific conditions like Barett.
Esomeprazole can be used in the dosage as high as 80 mg twice daily.Trials have shown that esomeprazole is superior to other PPI's in controlling reflux symptoms. Also, request him/her to add Domperidone 30mg or Levosulpiride(both are prokinetic)slow release once daily. This will slow down the reflux of acid back.Prokineic should be added in your regimen.

An antacid containing local anesthetic (Mucaine gel ) should be taken 2tsf thrice daily.

Acotiamide is another wonderful new drug and is very effective in controlling symptoms of GERD and esophagitis. In trials- Acotiamide, a gastrointestinal motility modulator, at a standard dose of 100mg thrice daily has significantly affected esophageal motor functions or gastroesophageal reflux in healthy adults.

All these drugs should be given by your gastroenterologist to provide you with relief in your problem.
To prevent the esophageal damage from developing into late stage Barett ask your gastroenterologist to follow aggressive treatment pattern initially. As your symptoms will improve drugs can be tappered off gradually.
Avoid-
Dairy products, which contain sugar lactose that causes gas.
Vegetables, including onions, radishes, cabbage, celery, carrots, brussel sprouts, broccoli, cauliflower and legumes.
Fruit sugar, which is especially high in prunes, raisins, bananas, apples, apricots and fruit juices from prunes, grapes and apples
Fiber.
Fatty foods and carbonated drinks.

Try Eating more fermented foods. These are rich in both good bacteria and enzymes you can try raw natto kefir or cultured veggies. This is probably one of the most important first steps.
Take a high-quality probiotic.
Take external enzyme supplements.
Exercising, to help keep food moving through your system.
Using spices that may help to prevent flatulence. These include turmeric, coriander, peppermint, fennel, sage, chamomile and ginger.
With above mentioned medication and restrictions you cn take meat and corn.

I don't think you are managed properly by your gastro.
Kindly mail this answer to your gastro and ask him/her for an explaination.
Please do answer my question and if possible please elaborate your question(what actually do you want to ask along with it kindly provide all investigations done and duration from which you are following the medicines and how doctor diagnosed that esophagus is tortous?)
Waiting!
Hope i answered your query in details and hope you understood my explaination.
Thank you!

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Ramesh Kumar (0 minute later)
Brief Answer:
Need more details.

Detailed Answer:
Hello,
Thanks choosing "Ask a Doctor" service for your query.
Have gone through your details and i appreciate your concerns.
You have not mentioned whether endoscopy has been done or not?
Had upper GI part of tortous esophagus with dyphagia? Is this your symptom or diagnosis given by your doctor?What test had been done?
please elaborate your question.
Initially i would like to say that their are some lacunas in treatment part.
Why?
Please go through every line and try to understand that basic cause of your problem is reflux of acid from stomach to esophagus.Stomach is lined by a natural layer of mucosa membrane which is resistant to acid however mucosa in esophagus is easily destroyed by acid which regurgitates back from stomach.This cause severe irritation of esophagus leading to inflammation. Esophagus reacts to the repeated injury from the acidic fluid by changing the type of cells lining it from squamous (normal cells) to columnar (intestinal-type cells). This transformation, called metaplasia, is believed to be a protective response because the specialized columnar epithelium (epithelium means lining) in Barrett's esophagus is more resistant to injury from acid than the squamous epithelium.However in long term it increases risk of adenocarcinoma by 5%. Dysphagia associated with GERD is usually caused by acid reflux.
In simple language lower esophageal sphincter (LES) is a valve that is located at the junction of the stomach with the esophagus. Its function is to prevent acid and other contents of the stomach from coming back into the esophagus. GERD is a condition in which excessive acid-containing fluid refluxes (flows) back into the esophagus, in part because the lower esophageal sphincter is weak.
In some patients with GERD, the esophagus reacts to the repeated injury from the acidic fluid by changing the type of cells lining it from squamous (normal cells) to columnar (intestinal-type cells). This transformation, called metaplasia, is believed to be a protective response because the specialized columnar epithelium (epithelium means lining) in Barrett's esophagus is more resistant to injury from acid than the squamous epithelium.

There is a small but definite increased risk of cancer of the esophagus (adenocarcinoma) in patients with Barrett's esophagus.

Now managemebt consists of two step-
1)Control acid production-Just taking pantoprazole 40 mg won't help.Its just a basic PPI and dose too is just optimal.It can be used safely in doses ranging from 80 to 160 mg daily initially.Secondly there are much better PPI's available in market like Lansoprazole Rabeprazole etc.

2)Prevent reflux of acid formed back to esophagus-This part is completely overlooked by your Gastro.

Please request your gastroenterologist to start you on PPI-antacids like Rabeprazole or Esomeprazole.Pantoprazole is a basic PPI and better options are there for treating specific conditions like Barett.
Esomeprazole can be used in the dosage as high as 80 mg twice daily.Trials have shown that esomeprazole is superior to other PPI's in controlling reflux symptoms. Also, request him/her to add Domperidone 30mg or Levosulpiride(both are prokinetic)slow release once daily. This will slow down the reflux of acid back.Prokineic should be added in your regimen.

An antacid containing local anesthetic (Mucaine gel ) should be taken 2tsf thrice daily.

Acotiamide is another wonderful new drug and is very effective in controlling symptoms of GERD and esophagitis. In trials- Acotiamide, a gastrointestinal motility modulator, at a standard dose of 100mg thrice daily has significantly affected esophageal motor functions or gastroesophageal reflux in healthy adults.

All these drugs should be given by your gastroenterologist to provide you with relief in your problem.
To prevent the esophageal damage from developing into late stage Barett ask your gastroenterologist to follow aggressive treatment pattern initially. As your symptoms will improve drugs can be tappered off gradually.
Avoid-
Dairy products, which contain sugar lactose that causes gas.
Vegetables, including onions, radishes, cabbage, celery, carrots, brussel sprouts, broccoli, cauliflower and legumes.
Fruit sugar, which is especially high in prunes, raisins, bananas, apples, apricots and fruit juices from prunes, grapes and apples
Fiber.
Fatty foods and carbonated drinks.

Try Eating more fermented foods. These are rich in both good bacteria and enzymes you can try raw natto kefir or cultured veggies. This is probably one of the most important first steps.
Take a high-quality probiotic.
Take external enzyme supplements.
Exercising, to help keep food moving through your system.
Using spices that may help to prevent flatulence. These include turmeric, coriander, peppermint, fennel, sage, chamomile and ginger.
With above mentioned medication and restrictions you cn take meat and corn.

I don't think you are managed properly by your gastro.
Kindly mail this answer to your gastro and ask him/her for an explaination.
Please do answer my question and if possible please elaborate your question(what actually do you want to ask along with it kindly provide all investigations done and duration from which you are following the medicines and how doctor diagnosed that esophagus is tortous?)
Waiting!
Hope i answered your query in details and hope you understood my explaination.
Thank you!
Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2913 Questions

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I Have Gerd , Being Treated Had Upper Gi.part Of

I have gerd, being treated Had upper gi.part of diagnosis tortous esophagus with dysphagia. I have severe pain in the center of my chest as though food stuck there. pain is constant resulting in my not eating or drinking because of pain. In 5 weeks have lost 25 lbs