Type 2 diabetes causes acid problems

Chat Log: Hoarseness from Heartburn

Status: 09/18/2019 2:18 p.m. | archive
The gastroenterologist Dr. Ulrich Rosien answered questions in the Visite Chat.

Sour belching after a large meal, plus a sharp burning sensation behind the breastbone - the cause is often obvious: acidic gastric juice sloshes into the esophagus and attacks the sensitive mucous membrane there. But stomach acid problems can also be behind coughs and hoarseness. As the finest droplets of mist, the aggressive liquid rises unnoticed into the throat and is inhaled. This irritates the lungs, bronchi and irritates the vocal cords. A common cause of throat and breathing problems that is all too easily overlooked.

The gastroenterologist Dr. Ulrich Rosien answered questions about heartburn in the Visite Chat. The protocol for reading.

Conny: What kind of bread can you get? eat for heartburn?

Dr. Ulrich Rosien: There is no scientific evidence to support any strain. Basically, cereals that take longer to digest are healthier, such as whole grains.

Joma: I have been taking omeprazole 40 mg for a number of years because of chronic esophagitis and I am not entirely comfortable with it because this drug causes significant side effects, including bad for the bones and so on. When I asked if I could stop, I was told that if I didn't want to get esophageal cancer, I would have to continue taking it for life. Is there possibly an alternative to omeprazole, and what should be made of this statement? Despite omeprazole, I occasionally have stomach pain and distended upper abdomen.

Rosien: With chronic inflammation confirmed, the advantages clearly outweigh the disadvantages of years of treatment. Nevertheless, even with severe esophagitis, the dose will be reduced or tapered off after a year. The risk of cancer development without medication is relatively low. On the other hand, many of the side effects of the acid blockers, including the ones you mentioned, are mostly just a socialization and not a causal relationship. People with serious illnesses often take acid blockers, which does not mean, conversely, that the illnesses come from the acid blocker. I do not think it is necessary to change the preparation because of occasional complaints, a bloated stomach usually has other causes (for example lactose indigestion).

Oliver S .: I suffer from one Diaphragmatic herniawhich is why I often have heartburn. Probably because of this I have a constant cough with phlegm. Other causes have already been largely ruled out. What can you still do in the long run in order not to constantly take proton pump inhibitors, which are also harmful in the long run? Diaphragmatic hernia surgery is not a real option.

Rosien: Heartburn, especially if changes in the mucous membrane have been seen endoscopically, is a good justification for taking acid blockers. The lowest effective dose should always be aimed for; for many, treatment if necessary is sufficient. In particular, if the cough has responded to the acid blocker in the past, I would even recommend long-term treatment, as even intermittent refluxes in the airways can lead to persistent irritation.

Alexandra: I am a teacher - so I have to rely on my voice - and I suffer from the hoarseness caused by gastric acid and frequent compulsion to clear my throat. The treatment only works partly, partly, especially since I often have to speak loudly and a lot. Now I am concerned that my voice could suffer lasting damage. How can I support my vocal cords and pharynx in such a way that the voice is preserved?

Rosien: In addition to purely medicinal treatment, general measures are often helpful: Do not lie down two hours after eating, do not drink alcohol in the evening, and avoid anything that causes heartburn in your own experience (citrus fruits). Speech training can also be helpful in your job.

Gera: I suffer from forced throat clearing and the feeling of constantly having a lump in my throat. Is it possible to determine with the temporary use of acid blockers whether the (silent) reflux is the cause?

Rosien: A trial treatment in consultation with your doctor can be useful and, in contrast to the treatment for heartburn, should be carried out for two months before a final evaluation can be made.

Hillu: I have difficulty swallowing and sometimes pain when swallowing. A Schatzki ring was found after a gastroscopy. What to do?

Rosien: If the Schatzki ring makes any relevant constriction, it should be stretched endoscopically.

Marie-Luise: I no longer have a stomach, hence no stomach acid. Nevertheless, I have frequent clearing of my throat and hoarseness to voice failure. One ENT said that I could suffer from reflux despite the lack of a stomach.

Rosien: Your ENT doctor may well be right. Under certain conditions, digestive enzymes can flow back from the bile and pancreas. Often an inflammation of the esophagus is also found endoscopically. This would be the next diagnostic step.

Kathy: I've had a sore throat, hoarseness, swallowing problems and a globus feeling for decades. Proton pump inhibitors (PPIs) don't help. The Restech pH metry showed that the pH value in the throat drops, especially at night. Symptoms are also worst in the morning. I am desperate and even had an operation on my stomach (use of a net for a small diaphragmatic hernia), which didn't help either. What else can I do if PPIs don't help?

Rosien: Acid is a decisive, but not the only, influencing factor for the symptoms you have described. I assume that other causes (for example from the area of ​​the paranasal sinuses) have already been ruled out. In addition to general measures, which in your case would include sleeping on an incline, you could also try preparations that lead to a layer formation on the acid (Gavescon).

Maria: After repeated chemical burns to the esophagus, I was diagnosed with a hiatal hernia. What treatment options are there and how can I "prevent" to reduce further acid problems? Thanks in advance.

Rosien: Since you obviously have symptoms very regularly, I recommend consistently taking acid blockers first. If these help then, one can still think about a mechanical barrier through surgery as an alternative.

Baerbel: I have a small hiatal hernia and reflux disease. I have been taking omeprazole since the beginning of the year, still have a cough and currently have a lot of stomach and stomach ache.

Rosien: The reflux disease you diagnosed should be treatable well with omeprazole. However, there are patients in whom the cough is caused by reflux, but not caused by the acid, but by the enzymes contained in the gastric juice. If other causes of the cough are ruled out and you are following general precautions, you may want to try barrier-building drugs. I don't see abdominal pain and stomach pain in connection with reflux disease.

Edith: I've been taking ranitidine for antral gastritis for a week and a half. I have just read in the news that ranitidine has been recalled. What alternative is there for me because I don't want to take pantoprazole because of side effects?

Rosien: Antrum gastritis (inflammation of the gastric mucous membrane in the exit area of ​​the stomach) only requires treatment if it is particularly severe in connection with symptoms. Ranitidine was recalled due to manufacturing contamination. If you have experienced side effects while taking pantoprazole, it makes sense to switch to another acid blocker.

Ilona: I am now 40 years old and have been taking omeprazole 20 mg for about ten years. I would like to stop taking this medication because it has significant side effects. However, immediately after a day, notice that I develop heartburn. I was told by two gastroscopy that there was little reflux. Are there any other alternatives besides omeprazole?

Rosien: A number of side effects have been associated with the use of acid blockers. These are exclusively retrospective investigations in which only socialization, not a causal connection, can be established. The results are in part contradicting each other: in one study, for example, the risk of Alzheimer's disease increases by 20 percent, in the other it decreases by 20 percent. There is a study with forward-looking data on therapy safety (prospective), in which no increase in risk could be ascertained so far. The following always applies: Acid blockers only with justification as in your case and in the lowest possible dose.

Trude Mann: I was diagnosed with Barrett's esophagus over 20 years ago. Since then I have been prescribed various acid blockers, Antra, Pantozol and currently Pariet 10 mg. I take one tablet once a day, temporarily I had to take two tablets because of a small ulcer. In the beginning I had to have a gastroscopy once a year, since it has stabilized while taking it, I only need it every three years. My questions: Does long-term use of acid blockers do any harm? And does a frequent gastroscopy harm, because samples are always taken from the mucous membrane?

Rosien: Obviously, you are in a very well executed surveillance program designed to protect you from the development of advanced esophageal cancer. All of the measures you have described are to be welcomed as professional. You don't need to worry that the reflections will harm you.

Lola: I have had heartburn for a long time and I have reflux. Can taking healing clay or baking soda relieve these symptoms? I recently learned from an HP that most heartburn sufferers are more likely to be caused by a lack of stomach acid.

Rosien: As shown in the program, alternative preparations can be taken if they actually help. This also includes the healing earth. In the case of recurring complaints, however, a diagnosis should rule out a secondary disease of permanent reflux (e.g. tumor development) before long-term treatment. Helicobakter pylori (HP) infection can actually lead to decreased acid production in the stomach. The damage that Helicobacter can cause to the stomach outweighs that of any acid protection on the esophagus!

Ulrich: For years I have suffered from breathing in stomach acid, especially at night. After that, I may cough for half an hour until I can breathe normally and sleep again. The following day I can still feel the incident in my bronchi. My question: how damaging can these events be to the lungs?

Rosien: Typically only a massive transfer of gastric acid (called aspiration) is damaging to the lungs. This is typically more associated with gastric emptying disorder than with reflux disease.

Loni: Once goblet cells have been diagnosed, can pantoprazole make them disappear again?

Rosien: Goblet cells are a diagnostic criterion for Barrett's esophagus. This is a possible chronic change in the esophagus and mucous membrane that is associated with an increased risk of tumors (but not as high as we have thought for many years). Acid blockers cannot reverse this change, but suppress the persistent inflammatory stimulus.

X: My wife has had a constant dry cough for over ten years. A few years ago, her gallbladder was removed. She also takes tablets to lower blood pressure. Is there a connection?

Rosien: Your wife should talk to your doctor about dry cough as a side effect of blood pressure pills. This is a typical side effect of at least some of these drugs.

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Visit | 09/17/2019 | 8:15 pm