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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17551
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Intermittent nausea suffer reflux vary between upper and

Customer Question

intermittent nausea
suffer reflux vary between upper and lower git
perineal rash started 3 weeks ago
dry flaky skin in beard, [post occipital region and on cheeks
episodic cramping, bloating and sensation of incomplete emptying which can last a few weeks
anxious abdomainal sx
Submitted: 8 months ago.
Category: Medical
Expert:  Dr. D. Love replied 8 months ago.

Hello from JustAnswer.

Have you been taking any medicine for the reflux?

Which antibiotic have you been taking?

Could you attach a picture of the rash?

Expert:  Dr. D. Love replied 8 months ago.

I had asked for some additional information and have not heard back.

Nausea, abdominal cramping, bloating, and incomplete emptying can occur with acid reflux. The next step would depend upon what has been tried to this point. The usual first-line treatment would be medicines that suppress stomach acid, such as ranitidine or omeprazole. It also may help to each smaller, more frequent meals. Since reflux frequently is worse at night, it would also be reasonable to avoid oral intake for a few hours before bedtime and to place 10-15 cm blocks under the feet at the head of the bed so that you are sleeping at a angle. Sleeping on extra pillows is not as effective, since it will cause you to bend at the middle, increasing the pressure in the abdomen.

Without seeing a picture of the rash or flaky skin, I can only comment upon what would usually be the next step if there is a failure or oral antibiotics and topical cortisone cream. If there is an infection of the skin that does not respond to an initial antibiotic, the usual next step would be to change to a different antibiotic. If a cortisone cream is not effective, then there are a couple options, including a more potent steroid ceam or a short course of oral steroids.

If I can provide any additional information, please let me know.

Customer: replied 8 months ago.
the rash is now clearing, been using nexium for 12 years.
Expert:  Dr. D. Love replied 8 months ago.

If the rash is clearing with the antibiotic and cortisone cream, then there is no need for additional treatment.

If someone is having persistent reflux and abdominal symptoms despite Nexium, there are a couple of next steps. It would be reasonable to consider whether there is an H. pylori infection of the stomach. H. pylori is primarily an issue with acid irritation in the stomach, rather than in the esophagus, but it also is the most common reason why Nexium and similar medicines do not work well at healing an acid irritation syndrome. Some people need a higher dose of the Nexium. It also would be an option to augment the Nexium with a medicine that works by a different mechanism, such as liquid antacids or an H2 blocker, such a ranitidine. You do not comment upon whether you have adopted the lifestyle changes noted above, but they would be appropriate in combination with any medical treatment regimen.

The ultimate treatment for persistent reflux despite maximal medical treatment would be surgery, such as a fundoplication, in which a portion of the stomach is wrapped around the lower esophagus. We do not need to do surgery for reflux anywhere near as often as we once did, because the medicines generally work quite well, but there still are some people in whom surgery is still needed.

Customer: replied 8 months ago.
Do you have any other differential diagnosis?
Expert:  Dr. D. Love replied 8 months ago.

If you aare having reflux, then the only differential would be whether there are other conditions that may be contributing to the reflux, such as a hiatal hernia, a diorder of muscle contraction of the esophagus, or gastroparesis, a weakness of the muscles of the stomach, but the original evaluation to diagnose the reflux would typically have identified whether one of the were present.

There is a long list of conditions that can cause abdominal pain, bloating, and cramping, the most common being other acid irritation syndromes, pancreatic disease, gallbladder disease, and irritable bowel syndrome. These other conditions, though, typically do not cause reflux,so would only be a primary concern if these symptoms persist despite adequate control of the reflux. Therefore, the usual next step would be obtaining better control of the reflux, which is why these are the next steps that I addressed above.

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