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Topics
Vomiting in children
Nexium
effects
Hiatal hernia
Functional Dyspepsia
Responses
The following
questions have been reviewed and answered by a Gastroenterologist.
Vomiting in Children
Question:
I have a six year old nephew who vomits in his sleep. He sleeps
so hard that he does not even realize that he is vomiting. I am so scared
that one day, he is going to drown in his vomit. Is this a common symptom
of mydyspespsia?
Answer:
Dyspepsia is common in adults but is much less common in children. However,
in children and adults, there are some 'warning' symptoms that are very
unusual in straightforward dyspepsia. The vomiting that you describe for
your 6-year old nephew is definitely not a normal symptom of dyspepsia
or recurrent abdominal pain of childhood. It is unusual for symptoms to
wake a child from his or her sleep and it is also unusual for a child
to vomit repeatedly. In some cases, the appearance of stomach contents
on the pillow at night is due to "gastroesophageal
reflux
disease" (GERD) rather than vomiting but, if the problem is frequent
as you indicate, it should still be brought to the attention of your nephew's
doctor.
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Question:
How long should it take for drugs like prevacid and nexium to take effect?
I have been on nexium for a week now and my symptom (burning in the throat)
is still there. My doctor has now presrcibed Prevacid.
Answer:
Nexium (esomeprazole) and Prevacid (lansoprazole) are examples of class
of drugs known as proton pump inhibitors (PPIs). PPIs have been studied
mainly in reflux disease (GERD) and, in GERD,
the most common symptoms are heartburn or acid regurgitation. Generally,
PPIs will produce complete (sustained) resolution of heartburn in about
50% of patients by 1 week and in about 70% by 4 weeks. Reflux symptoms
may also improve in many other patients even if they do not disappear
completely.
However, burning in the throat is less typical as a symptom of GERD and,
as such, it may not respond as well or as quickly to PPI therapy. It is
not unexpected that you still have symptoms after a week of therapy and
there is still plenty of time for the drug to take effect.
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Question:
my problem with 'hiatus hernia', as diagnosed by my physician , is that
it only bothers me at night after I go to bed. I have elevated the bed
and found no relief - I can sit up all night in my recliner and it gives
me no relief, so I end up coughing the night away until I fall asleep
out of utter exhaustion. I take prescribed medication - Pantoprozole before
supper and metoclopramide before bed - as instructed. It sometimes helps
but not for the last while. Is there a list of foods I should avoid at
supper time, or foods I should avoid all the time.
Answer:
For most people with reflux, there are no specific foods to be avoided
but, if night-time reflux is a problem, it may be important to ensure
that
evening meals are light, so that they empty completely from the stomach
before bedtime. Big meals and meals that contain a lot of fat leave the
stomach more slowly and so should be avoided in the evening. Similarly,
late evening snacks can remain in the stomach and cause ongoing acid secretion
which can then reflux during the night to cause heartburn or episodes
of coughing and choking. Unfortunately, stomach contents, including stomach
acid, can pool in a hiatus hernia and
it is much more difficult to prevent night-time reflux if one has a hiatus
hernia. If you still have symptoms with a night-time dose, it may be worth
taking the pantoprazole twice daily (30 minutes before breakfast and 30
minutes before supper). It may also be worth trying a dose of metoclopramide
before supper as well as before bedtime. However, you should discuss this
with your physician before changing your medication. In addition, a few
people may also have delayed gastric emptying (stomach is slow to empty
its contents) - if tests such as endoscopy
or an upper GI series of X-rays
show no scarring or hold up, a specialised gastric emptying test may help
identify a problem.
Question:
I suffer from functional Dyspepsia and GERD. I have constant
extreme nausea and pain mostly on the upper sides of my stomach. I have
been to many GI's and have been on many medications including Clonidine
and Metoclopramide without any success. My GI's are at a loss and don't
know what to do for me, so I would like to know what the next step for
me would be.
Answer:
Yours is clearly a difficult problem to resolve. Although dyspeptic
symptoms can be treated successfully in a high proportion of cases using
standard medications such as acid suppressing drugs, drugs to cure Helicobacter
pylori infection or drugs that modify motility (speed of contents moving
through the digestive tract), some people do not respond to these medications.
Sometimes, GERD symptoms, in particular, will
require higher doses of acid suppressing drugs than those used under normal
circumstances. Alternatively, if standard investigations such as endoscopy
or ultrasound do not
show any obvious cause for the symptoms, it may be necessary to proceed
to more sophisticated tests to assess gastric emptying, esophageal acid
exposure or esophageal motility. Occasionally, it may be helpful to consult
with a specialist Gastroenterolgy unit that deals specifically with severe
or unresponsive dyspeptic symptoms; your family doctor will probably be
able to help you identify such a unit, if it is felt that this is needed
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