Concluded Case

Gastro Esophageal Reflux Disease

A 38 year old male presented to OPD with complaints of excessive belching almost after all meals, abdominal bloating on/off.. He says sometimes he even get mouth ulcers too. He has had in the past rabprazole + levosulpiride, rifagut 200, udiliv 150mg BD from a quack for quite a long time. He doesn't have any warning signs to indicate for a UGI Endoscopy. Neither weight loss, nor anemia etc. He is a tobacco chewer and takes almost 3 to 5 sachets per day. I have advised him for LSM like delaying water intake after meals and lying down 1.5 hours after meals and reducing tobacco slowly and gradually. As far as medicines are concerned, I ahve advised him the following - Tab Actapro 100mg BD before meals, Protera L 30 mins before bfast, Tryptomer 10mg HS at bedtime, Becasoule Z OD Limcee 500mg BD Please give me valuable suggestions. Is tryptomer good or fluoxetine would have been a good choice?

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Concluded answer

Excessive belching is almost always psychological. Mostly due to excessive swallowing of air which rapidly swallowing food without chewing. As the patient has already received levosulpiride, there is no point of giving it again. Also acotiamide is for those with impaired gastic accomodation and the patient doesn't have any complaint suggestive of that. So, for this patient, treatment would be LSM, PPI, SSRI/TCA. Can go for an UGIscopy if patient has no improvement just to rule out a GERD. Smoking cessation is to be advised.

All Answers

Excessive belching is almost always psychological. Mostly due to excessive swallowing of air which rapidly swallowing food without chewing. As the patient has already received levosulpiride, there is no point of giving it again. Also acotiamide is for those with impaired gastic accomodation and the patient doesn't have any complaint suggestive of that. So, for this patient, treatment would be LSM, PPI, SSRI/TCA. Can go for an UGIscopy if patient has no improvement just to rule out a GERD. Smoking cessation is to be advised.

Valuable opinion
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From history he appears to be a c/o GERD R/o HITUS HERNIA Adv upper G I Meanwhile keep him on gasterokinetics Like Pantaprazole-dsr or ilaprozole dsr Antacids suspension+sucralfil-o suspension before meals Tab pankreon flat 1bd after food Tab Baclofen 10mg to 25mg bd Tranquillisers at bed time

Thanx dr Hemant Joshi
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DD Chronic gastritis H pylori infection GERD Gall bladder pathology Needs abdominal ultrasound, Upper GI endoscopy ,urea breath test . Treatment after diagnosis

As you said he is tobacco chewer and takes almost 3 to 5 sachets per day rule out cancers of the lip, mouth, tongue, throat, and esophagus

Abdominal fullness can be due to acid peptic disease .Rule out other abdominal pathology by usg abdo

? APD ..WITH .. STRESS.. ? H.. PYLORI .. NEED'S.. GI.. ENDOSCOPY.. CAPSULE ENDOSCOPY.. NEED'S

Tnx
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Fluoxetin

Eat or drink more slowly. You're less likely to swallow air. Don't eat things like broccoli, cabbage, beans, or dairy products. ... Stay away from soda and beer. Don't chew gum. Stop smoking. ... Take a walk after eating. ... Take an antacid.

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