Persistent Acid Reflux: Causes and Solutions - Gastroenterology and Hepatology

Constantly vomiting bile?

Hello doctor, my mother has been taking anticoagulants, steroids, and heart-related medications for many years due to her blood vessels being prone to blockage.
Earlier this year, she was hospitalized after a fall and a wound infection.
During her hospital stay, she experienced a loss of appetite and frequently vomited bile.
The doctor prescribed medication to help with nausea.
Shortly after being discharged, she was hospitalized again due to a COVID-19 diagnosis.
During this period, her vomiting did not improve, and even after discharge, she continued to vomit throughout the day and night (she has a poor appetite, so she eats very little).
The doctor during her follow-up visit suggested that it might be due to taking too many medications, which could cause nausea, but even after reducing her medication dosage, there was no improvement.
Last night, she was taken to the hospital again due to extreme weakness from vomiting.
She previously underwent an endoscopy that showed mild gastroesophageal reflux disease (GERD), but I am unsure if her current condition is due to GERD or medication side effects.
How can I help her?

Amy, 30~39 year old female. Ask Date: 2022/05/28

Dr. Chen Shidian reply Gastroenterology and Hepatology

Gastroenterology outpatient clinic appointment.

Reply Date: 2022/05/28

More Info

Understanding persistent acid reflux, especially in the context of your mother's complex medical history, requires a multifaceted approach. Acid reflux, or gastroesophageal reflux disease (GERD), occurs when stomach acid flows back into the esophagus, leading to symptoms such as heartburn, regurgitation, and nausea. Given your mother's history of taking anticoagulants, steroids, and other medications, as well as her recent hospitalizations, several factors could be contributing to her persistent symptoms.

Causes of Persistent Acid Reflux
1. Medication Side Effects: Many medications, including certain pain relievers, steroids, and anticoagulants, can irritate the stomach lining or relax the lower esophageal sphincter (LES), which normally prevents acid from flowing back into the esophagus. This can exacerbate reflux symptoms.

2. Dietary Changes: During her hospital stays, your mother may have experienced changes in her diet, which can affect her gastrointestinal health. Reduced food intake can lead to increased acidity in the stomach, as there is less food to buffer the acid.

3. Gastrointestinal Motility Issues: Conditions such as gastroparesis, where the stomach empties slowly, can lead to increased pressure in the stomach and contribute to reflux. This could be a concern, especially if she has been eating less.

4. Stress and Anxiety: Hospitalization and illness can lead to increased stress and anxiety, which can further exacerbate gastrointestinal symptoms, including acid reflux.

5. Underlying Conditions: Given her history of vascular issues and hospitalization, it’s essential to consider whether there are underlying conditions affecting her gastrointestinal health, such as esophagitis or peptic ulcers.

Solutions and Management Strategies
1. Medication Review: It is crucial to have a thorough review of all medications your mother is taking. A healthcare provider can assess whether any of her current medications could be contributing to her reflux symptoms and consider alternatives or adjustments.

2. Dietary Modifications: Encourage small, frequent meals rather than large ones, and avoid foods that are known to trigger reflux, such as spicy foods, citrus, chocolate, caffeine, and fatty foods. Keeping a food diary may help identify specific triggers.

3. Elevate the Head of the Bed: Elevating the head of the bed by 6 to 8 inches can help prevent nighttime reflux. Gravity can assist in keeping stomach contents from flowing back into the esophagus while she sleeps.

4. Hydration and Nutrition: Ensure she stays hydrated and receives adequate nutrition, even if her appetite is low. Nutritional supplements may be beneficial if she struggles to consume enough calories.

5. Consult a Gastroenterologist: Given her history of acid reflux and recent complications, a referral to a gastroenterologist may be warranted. They can perform further evaluations, such as a repeat endoscopy, to assess the current state of her esophagus and stomach.

6. Consider Proton Pump Inhibitors (PPIs): If not already prescribed, PPIs can be effective in reducing stomach acid production and managing symptoms of GERD. However, they should be used under medical supervision, especially considering her medication regimen.

7. Monitor for Complications: Persistent acid reflux can lead to complications such as esophagitis, Barrett's esophagus, or strictures. Regular follow-up with her healthcare provider is essential to monitor for these potential issues.

Conclusion
Managing persistent acid reflux, particularly in a patient with a complex medical history, requires a comprehensive approach that includes medication management, dietary adjustments, and possibly further evaluation by a specialist. It is essential to work closely with her healthcare team to ensure that her symptoms are adequately addressed while considering her overall health and medication regimen. Encourage open communication with her doctors about her symptoms, medication side effects, and any changes in her condition, as this will help tailor the best treatment plan for her needs.

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