Weight Loss and GERD: Causes and Management Tips - Gastroenterology and Hepatology

Gastroesophageal reflux disease (GERD) and weight loss?

Hello Doctor: I often feel liquid rising from my stomach, so I visited a gastroenterologist.
I was diagnosed with mild gastric ulcers and gallstones, but there were no signs of reflux.
Initially, I was prescribed a milder medication, but since there was no improvement, the doctor prescribed Pantoprazole 40 mg for me, to be taken once a day.
After taking the medication for almost a month, the daytime acid reflux has lessened, but I still experience acid reflux every night, waking up in the middle of the night with a sour taste in my mouth, and sometimes I cough.
I sometimes have to sleep sitting up.
Over the past month, I haven't been on a special diet, but my appetite hasn't been great, and I often feel bloated and uncomfortable in my upper abdomen, frequently experiencing acid reflux (my menstrual cycle is regular).
I also feel a sensation of something stuck in my throat and have chest tightness, which has led me to eat less, resulting in a weight loss of 4 kg.
How much weight loss in a month is considered normal? Is the weight loss related to my reduced food intake, or could there be another reason? Recently, I have also been straining a lot during bowel movements (I drink about 1500 cc of water and consume a lot of vegetables).
How can I improve this? Aside from not exercising, I have made all the necessary lifestyle adjustments for managing gastroesophageal reflux.
Is there anything else I should pay attention to? Do I need to return for any further examinations? Thank you, Doctor, for taking the time to respond!

Xiao Qing, 30~39 year old female. Ask Date: 2019/12/28

Dr. Chen Shidian reply Gastroenterology and Hepatology

You may consider taking the medication before bedtime to see how it affects you.
Please discuss the weight loss aspect further with your physician.

Reply Date: 2019/12/28

More Info

Understanding weight loss, especially in the context of gastroesophageal reflux disease (GERD), requires a multifaceted approach that considers both physiological and lifestyle factors. Your experience with weight loss, coupled with symptoms of acid reflux and gastrointestinal discomfort, highlights the complexity of managing these conditions.

Firstly, it's important to recognize that weight loss can be influenced by various factors, including dietary habits, physical activity, and underlying health issues. In your case, the weight loss of 4 kilograms over a month can be considered significant, especially if it is unintentional. Generally, a safe and sustainable rate of weight loss is about 0.5 to 1 kilogram per week. Rapid weight loss can sometimes indicate an underlying health issue, particularly if accompanied by symptoms like nausea, vomiting, or changes in appetite.

Your symptoms of acid reflux, including the sensation of liquid rising from your stomach, night-time awakenings due to acid regurgitation, and the bitter taste in your mouth, are classic signs of GERD. The fact that you have been prescribed a proton pump inhibitor (PPI) like pantoprazole (耐適恩) suggests that your doctor is addressing the excess stomach acid production that contributes to these symptoms. While PPIs can be effective in reducing acid production and alleviating symptoms, they may take some time to show full effects, and it’s not uncommon for patients to still experience symptoms during the initial treatment phase.

The relationship between GERD and weight loss can be intricate. On one hand, weight loss can sometimes improve GERD symptoms, as excess weight can increase abdominal pressure and exacerbate reflux. On the other hand, if weight loss is due to decreased appetite or gastrointestinal discomfort, it may not be beneficial and could lead to further complications, including nutritional deficiencies.

To manage your symptoms and improve your overall health, consider the following tips:
1. Dietary Adjustments: Focus on a balanced diet that is low in acidic and spicy foods, caffeine, and alcohol, which can exacerbate GERD symptoms. Instead, emphasize whole grains, lean proteins, and plenty of vegetables. Eating smaller, more frequent meals can also help reduce pressure on the stomach.

2. Hydration: While you mentioned drinking around 1500cc of water daily, ensure that you are adequately hydrated, especially if you are experiencing gastrointestinal symptoms. However, avoid drinking large amounts of water during meals, as this can increase stomach pressure.

3. Lifestyle Modifications: Elevate the head of your bed to prevent nighttime reflux, and avoid lying down immediately after eating. Additionally, consider incorporating gentle physical activity, as exercise can help with digestion and overall well-being.

4. Monitor Symptoms: Keep a diary of your food intake and symptoms to identify potential triggers for your acid reflux. This can help you and your healthcare provider tailor a management plan that works for you.

5. Follow-Up Care: Since you are experiencing persistent symptoms despite medication, it may be beneficial to follow up with your gastroenterologist. They might consider additional tests, such as an upper endoscopy, to assess the condition of your esophagus and stomach more thoroughly.

6. Mental Health: Weight loss and chronic gastrointestinal issues can take a toll on mental health. If you find yourself feeling anxious or depressed about your symptoms or weight, consider speaking with a mental health professional.

In summary, while weight loss can be a natural response to changes in appetite and dietary habits, it’s crucial to ensure that it is not occurring at the expense of your overall health. By making thoughtful dietary choices, maintaining hydration, and following up with your healthcare provider, you can work towards managing your GERD symptoms effectively while also addressing your weight concerns.

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