Brief Answer:
where exactly is the gaping muscle

Detailed Answer:
Hi XXXXXXX

I have been through your query and I understand your concern.

But before i can help you, i want to know where exactly is the gaping muscle, as mentioned in your endoscopy report. Can you upload that report?

Next thing is that, the exercises done by us are only for the external muscles. Muscles of the intestine don't get effected by these exercises in any manner whatsoever.

Also, Dexilant, is not a medication for gastritis. Its an anti-anxiety drug. And as I can see its not helping you with your stress levels either. And stress increases gastric acid production and delays recovery of gastritis. So, i would suggest that you get its dose increased, in consultation with your physician.

Nexium, you can take twice a day for now, as single dose is only partially effective. Plus you can take an antacid syrup in combination with a local anesthetic like Gelusil MPS syrup, and its available in U.S.A. (or Syp Mucaine Gel, if its available there). This syrup you need to take 15 mins before taking food or in case of severe pain due to gastritis.

In addition to these, you need to follow certain lifestyle modifications like-
- avoid tea, coffee, soda drinks and spicy foods.
- reduce your stress levels.
As all these will worsen your gastritis and prevent its healing.

Also, i would suggest that you get yourself tested for H.pylori infection inside your stomach, as this could be a cause for for recurrent gastritis. You can discuss this with your treating physician.

Hope, i have been helpful.

If ant further queries, i will be glad to answer them.

Regards,
Dr. Ashish Verma

---

Brief Answer:
you are having GERD then

Detailed Answer:
Hi XXXXXXX

That gaping is not in any muscle. There is a sphincter at the lower end of esophagus where it joins the stomach. This sphincter prevents the reflux of gastric acid up into the esophagus and throat.

Its this sphincter that is lax (or gaping, as told in the report) in you. This leads to a condition called as GERD (Gastro Erophageal Reflux Disease). This is the reason that your nexium is giving only partial relief, as its only half of the treatment.

There are two aspects in treatment of GERD. First is to decrease gastric acid production. This is being managed by your nexium.

And other is to prevent reflux. This second part is done by enhancing the emptying of the stomach. The drugs that help to do this are called as prokinetic drugs, like levosulpride. And you need to take this also along with the nexium. There are tablets of the above combination also available, but for the prescription you need to see your local physician.

And in addition to the previous lifestyle modifications, you need to follow these too-
- eat small meals, as if you will take a heavy meal, the stomach will distend more and the 'gaping' will increase, leading to increased reflux.
- you can eat more frequently, so that you total intake remains the same.
- don't lie down immediately after a meal, walk or sit for an hour or so, before lying after a meal, as reflux will be more in lying down position with a full stomach.
- while lying down, put two pillows below your head, to decrease reflux. If two pillows are uncomfortable, put a block under the head end of your bed to elevate it.
- avoid fatty foods.

Regards
Dr. Ashish Verma

---

Brief Answer:
continue Dexilant

Detailed Answer:
Hi XXXXXXX

You can continue Dexilant. It will help reduce your stress and stress also causes increases gastric acid production and thus can help your condition in that way.

Levosulpride in USA you have to check with your nearest chemist. In case its not available, you can take domperidone tablets. It also increases the gi tract motility and increases the tone of the lower esophageal sphincter.

It is also available in combination with pantaprazole or omeprazole or esmoprazole (nexium).

Pain is due to gastritis. Once this gets controlled, you pain will also go. For pain relief you can take Gelusil MPS or Gelusil-O or Mucaine syrup. But I don't know for sure if they are available there. You need to check with your chemist. Ask him for an antacid with local anesthetic combination, or ask your local doctor for the prescription.

Regards
Dr. Ashish Verma

---

Brief Answer:
all are antidepressants, take any one only

Detailed Answer:
Hi XXXXXXX

Sorry for the delayed reply.

Dexilant, Pamelor and Xanax, all are antidepressant medications. So i would suggest that you take any one of them, and not all of them.

These drugs reduce the stress and so help to reduce the stress induced gastric acid secreation.

And Nexium you have to take life long, as you are having GERD with gastritis. All you can do is that you can reduce its dose and frequency after a few months when you are able to control the gastitis symptoms by the previously explained lifestyle modification. Because, anatomical laxity of the sphincter can't be repaired by medication.

It can only be repaired by surgery. But that has its own set of failure rates and complications.

And when things can be managed by diet and medicines, why go for surgery.

So i would suggest that you dont take stress about this, and follow a good and healthy diet and i am sure after sometime you wont be needing Nexium daily.

Regards
Dr. Ashish Verma

---

Brief Answer:
yes, of course

Detailed Answer:
Hi,

Nexium has to be take on empty stomach only, one hour before food.

Pamelor, being an antidepressants causes relaxation and thus induces sleep. So its given at bed time, so that you can have a sound and stress free sleep. This reduces the stress related gastric acid production throught the night, thus helping in healing.

If your pain tends to increase by the end of the day, you can take nexium twice a day for a few days then when it has improved then you can revert back to morning only schedule.

Regards
Dr. Ashish Verma

---