Frequently we hear from a RefluxMD member that has been struggling with acid reflux for 20 years or more. This question highlights the importance of being well educated on your disease. Diagnostic tests, treatment options, medications and their potential negative side affects are something that YOU must know about – it is YOUR life and YOUR disease, so take charge.
I have had indigestion symptoms for over 30 years, but now it seems to have become unmanageable. I just had a pH Bravo test and it came back with a reading of “6”. I have been on PPIs 10 years. My doctor told me not to stop Dexilant before the test. They found I had esophagitis, but they say I do not have excessive GERD. I have excessive bloating and cannot wear some of my clothing. The bloating is very painful. Over the years, I have had a HYDA scan performed twice and many other tests for gallbladder. My quality of life is not very good. I don’t know what to do.
Thank you for taking the time to share your experience with us, and I am so sorry for your pain and frustration. We are delighted that you are interested in learning more about your disease. Thirty years with indigestion symptoms and ten years on PPI medication suggests that it may be time to get a second opinion from a GERD expert. There are two issues here; first you have had three decades of stomach bloating, which does not appear to have been addressed by your physicians. Second, you have erosive reflux disease (ERD) as suggested by your esophagitis. Both symptoms may be a result of the same underlying cause, but with the information you have provided here, we can’t be sure. I would like to offer some thoughts on both symptoms, and then provide you with some ideas for your consideration.
Is GERD causing your indigestion symptoms?
There are many underlying conditions, including some related to GERD that might be the real cause of your bloating symptoms. Healthline lists almost fifty conditions that could result in bloating in an article titled, What causes abdominal bloating? 48 possible conditions. This highlights the fact that your symptoms could be a result of many issues including food allergies, lactose intolerance, irritable bowel syndrome, and an abdominal hernia to name a few. Many of the potential causes mentioned in the Healthline article will not apply to you, but since this has become such a problem for you, you should work closely with your doctor to test for the most probable underlying causes.
Bloating is a common “reported” symptom of GERD and there are also several conditions that are directly associated with a GERD diagnosis that could cause bloating, including hiatal hernia. You did not indicate that your physician discussed this diagnosis, but it would have been evident during your endoscopic examination. We suggest you follow up with your doctor and if you do have a hiatal hernia, you should consider antireflux surgery to fix this abnormality.
Finally, I found an excellent article written by the UNC Center for Functional GI & Motility Disorders titled Abdominal Bloating: A Mysterious Symptom, that you may find interesting. As you will see, you do not suffer alone; as many as 30% of adults have this symptom periodically.
Your current GERD treatment highlights some additional questions
As you know, GERD is a progressive disease. Time is the enemy here. The longer your esophagus is bathed in the contents from your stomach by regurgitation, the more likely you are to experience complications. Since you have been diagnosed with esophagitis, you are at risk of further complications. Here are some questions you should discuss with your physicians:
- Since your doctors diagnosed esophagitis and you have been on PPIs for 10 years, many physicians would consider taking a biopsy of the esophagus to test for Barrett’s esophagus. Was a biopsy performed and what were the results? For more information on this test, Dr. Chandrasoma wrote an excellent article on biopsies during endoscopy.
- Why did your doctor perform a 24-hour pH test (Bravo) while you were still taking Dexilant daily? This powerful PPI stops the production of stomach acid and can result in inaccurate pH readings. Dr. Dengler wrote an article highlighting the concern with pH testing during PPI use.
- Has your doctor informed you about the increased health risks associated with daily, long-term use of PPIs?
- Has your doctor performed tests to rule out other potential causes of your bloating leaving GERD as the primary factor?
- Did your doctor mention the absence or presence of a hiatal hernia after your recent endoscopic examination?
Some actions for your consideration
You may want to seek a second opinion since you have been symptomatic so long and it sounds as if your symptoms are increasing. We encourage you to seek a GERD specialist to evaluate your acid reflux and to discuss all the options available to reduce or eliminate your symptoms resulting from GERD. There are several other actions you can consider to reduce your bloating symptoms:
- Consider probiotics. This is something you should discuss with your doctor. Probiotics may assist in the development of “good bacteria” and balance off the “bad bacteria.” When out of balance, the bad bacterial can cause undigested food to ferment, resulting in gas and increased intra-abdominal pressure. (see Natural remedies for acid reflux: Probiotics)
- Reduce your sodium consumption. Be especially wary of processed foods that tend to have unusually high sodium content.
- Avoid carbonated drinks. These carbonated drinks can often increase stomach bloating and increase the pressure in your stomach.
- Increase your intake of high fiber foods. Do this slowly, and be sure to consume adequate amounts of water with the increase in fiber.
- Avoid fatty foods. These foods take longer to digest, require more acid, and can result in a bloated feeling.
- Exercise more. You may find some exercise will reduce your symptoms.
- Quit smoking (if you smoke). There is a link between smoking and bloating according to the staff at the Mayo clinic (see their article titled Gas and Gas Pains).
- Eat slowly and eat smaller meals more frequently. This strategy will allow your stomach to more quickly digest the food you consume and it may reduce your bloating symptoms.
- Avoid foods that are known to cause bloating. In the Mayo Clinic article noted above, they provide an excellent list that I am providing below:
- Brussels sprouts
- Carbonated drinks
- Chewing gum
- Fruits, such as apples, peaches and pears
- Hard candy
- Milk and milk products
- Sugar alcohols found in sugar-free foods (sorbitol, mannitol and xylitol)
- Whole-grain foods
I hope this helps