Discussion | FAQ | Responses

Discussion: Responses

This section includes selected questions submitted to mydyspepsia.com. One each month will be addressed by a specialist. 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. Back to top Nexium® Effects 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 prescribed 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. Back to top Hiatal Hernia 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 - pantoprazole 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 suppertime 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. Back to top Functional Dyspepsia 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 Gastroenterology 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. Back to top