Gastroesophageal Reflux: Symptoms and Management Tips

Gastroesophageal reflux disease (GERD)

Before the consultation, I experienced severe bloating that did not improve with burping, and I was unable to have a bowel movement.
I also had no appetite.
For about three months, I had recurrent gastrointestinal issues approximately three times.
When I visited the gastroenterology clinic, I was prescribed medication.
Although my bloating has improved compared to the previous two weeks and my appetite has also gotten better, I still cannot alleviate my discomfort despite taking medication and controlling my diet.
I am also experiencing constipation, and the stool color is brown, which is normal.
However, my stomach often makes gurgling noises, and I feel very sleepy.
Sometimes, upon waking, I feel dizzy, but I do not experience any liquid flowing into my throat or heartburn.
I have only been on the medication for three days.
I would like to know if this is a normal occurrence at this stage.

xu, 10~19 year old female. Ask Date: 2017/04/02

Dr. Hong Yuanbin reply Internal Medicine

Based on your symptom description, there are several possible conditions to consider.

First, the most likely cause is chronic constipation, especially if your intake of vegetables is low and you have little time for exercise.
This can easily lead to the symptoms you described.
If this is the case, consider increasing your vegetable intake, exercising more, and possibly taking probiotics, which usually helps improve symptoms.
Second, it could be gastroesophageal reflux disease (GERD).
Symptoms of reflux can vary from person to person.
You might try avoiding coffee and tea, eating smaller, more frequent meals, exercising, and avoiding lying down after meals, which can help alleviate symptoms.
Third, if discomfort persists, it may be worth considering a peptic ulcer.
In this case, you might need to visit a gastroenterology clinic for an endoscopy to confirm the diagnosis.
Fourth, if the above conditions are ruled out, it could be irritable bowel syndrome (IBS) or functional bowel issues caused by stress or irregular routines.
In this case, it is advisable to maintain a regular schedule, manage stress, and increase physical activity, which should lead to improvement.
Thank you for your inquiry.

Reply Date: 2017/04/02

More Info

Gastroesophageal reflux disease (GERD) is a common condition that occurs when stomach acid flows back into the esophagus, leading to various symptoms and complications. Understanding the symptoms and management strategies is crucial for individuals experiencing discomfort related to this condition.

Symptoms of GERD
The symptoms of GERD can vary widely among individuals, but common manifestations include:
1. Heartburn: A burning sensation in the chest, often after eating or when lying down.

2. Regurgitation: The sensation of acid backing up into the throat or mouth, which can sometimes lead to a sour taste.

3. Dysphagia: Difficulty swallowing, which may feel like food is stuck in the throat or chest.

4. Chest Pain: This can mimic heart-related issues, making it essential to differentiate between the two.

5. Chronic Cough or Hoarseness: Acid can irritate the throat, leading to a persistent cough or voice changes.

6. Nausea: Some individuals may experience nausea, especially after meals.

In your case, the symptoms of bloating, lack of appetite, and constipation are significant. The presence of a "gurgling" sound in the abdomen and feelings of dizziness upon waking could indicate gastrointestinal distress, possibly exacerbated by GERD or related conditions.

Management of GERD
1. Medications: Proton pump inhibitors (PPIs) like Nexium or Pantoloc are commonly prescribed to reduce stomach acid production. Antacids may also provide temporary relief. However, it’s essential to follow the prescribed dosage and duration, as prolonged use can lead to side effects, including potential impacts on calcium absorption, which is a concern for individuals with osteoporosis.

2. Dietary Modifications: Certain foods can exacerbate GERD symptoms. It’s advisable to avoid:
- Spicy foods
- Citrus fruits
- Chocolate
- Caffeinated beverages
- Alcohol
- Fatty or fried foods
Instead, focus on a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Eating smaller, more frequent meals rather than large meals can also help manage symptoms.

3. Lifestyle Changes:
- Weight Management: Excess weight can put pressure on the abdomen, worsening reflux symptoms.

- Elevate the Head of the Bed: Sleeping with the head elevated can help prevent nighttime symptoms.

- Avoid Lying Down After Eating: Wait at least three hours after eating before lying down to allow for proper digestion.

4. Hydration and Fiber: To address constipation, ensure adequate hydration and incorporate fiber-rich foods into your diet. This can help regulate bowel movements and reduce bloating.

5. Regular Follow-ups: Since you’ve been experiencing ongoing symptoms despite medication, it’s crucial to maintain regular follow-ups with your healthcare provider. They may consider further investigations, such as an esophageal pH test or an upper endoscopy, to assess the severity of GERD and rule out other conditions.

Conclusion
Your symptoms, including persistent bloating, lack of appetite, and constipation, warrant careful monitoring and possibly further evaluation. While some discomfort may be expected during the initial phase of treatment, ongoing symptoms should be addressed with your healthcare provider. They can help tailor a management plan that considers your specific symptoms and overall health, ensuring that you achieve the best possible outcome in managing GERD and any related gastrointestinal issues.

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