When my college athlete started college, she developed acid reflux issues with her symptoms including nausea, vomiting, no or small appetite, and tightness in her chest while exercising. We think these probably arose due to stress. She has gone to the campus health clinic and had blood work done. She does not have celiac disease and is not pregnant : ) She has an appointment at a gastroenterologist in February.
Until she can get in to see a gastroenterologist, she is currently taking 20 mg of omeprazole twice a day to alleviate her symptoms. However, she still has mornings when she has little appetite. And she still experiences acid reflux episodes during exercise which affects her breathing and therefore her performance. She will also get heartburn if she forgets a dose of omeprazole.
Does anyone have any recommendations on how to help her? Is Nexium better than omeprazole? Thank you.
I haven’t any suggestions but wanted to say that sounds frightening to me, especially as she’s an athlete. Honestly I’d pull out of sports right now until a thorough examination has been done and medication that works is involved.
Sending virtual hugs. Being a parent from afar isn’t easy.
Did someone (a doctor) at the campus health office diagnose her with (suspected) acid reflux? My concern would be she has something other than acid reflux.
Nexium (esomeprazole) is more potent than omeprazole (which is often used first line). Pantoprazole is the most potent PPI, but I would not recommend switching drugs until she talks with a doc who knows about acid reflux (I am not a doctor). There are also non-PPI products to treat acid reflux.
Many primary care physicians are very facile at dealing with acid reflux/gerd…perhaps there is someone local she can see before she sees the gastro?
Does she feel she is getting any symptom relief with omeprazole?
My H suffers greatly from Gerd. But he has never lost his appetite or felt nauseas. Occasionally he may spit up a bit if his meal triggers an esophageal spasm, but no outright vomiting. I concur with previous posters to not assume that acid reflux is what is going on or is the only thing going on. Having said that, when he was in college he went to the emergency room with chest pains (tightening of the chest) which was confirmed acid reflux. Maybe her anxiety is causing the other non-typical symptoms.
Until she gets the meds worked out, basic lifestyle tips include:
don’t eat 3 hours before bedtime
don’t lie down after eating
avoid trigger foods and fatty/greasy foods
small meals
elevate the head/neck while sleeping
don’t wear clothing that is tight around the waist
Ugh. If there’s a possibility that her symptoms are exacerbated by certain foods, she could keep a food log to identify correlations, then eliminate the suspect items. Also, sleeping with an elevated pillow or head of the mattress may help the morning symptoms.
Yes - trigger foods are unique to each person and not always the usual suspects. I have silent reflux, and bananas before exercising are a trigger for me.
Which reminds me that another lifestyle tip which may be pertinent to her as an athlete is to allow a couple of hours between eating and strenuous exercise.
Poor thing! Digestive issues are no fun! I’ll add to the great list shared above: no belts or tight clothes than restrict her stomach, at least until she figures things out. Does she get the classic heart burn (or throat burn), or mostly nausea?
Her symptoms sound more like maybe gastritis or slow stomach emptying (don’t remember what it’s called). I’m not a doctor, but a fellow sufferer in the GI department. I don’t have acid reflux but a very disrupted motility of the digestive tract, due to massive emergency abdominal surgery that has left me with adhesions (scar tissue) attached to various organs. Has she ever had abdominal surgery? What has helped me is digestive enzymes (makes digestion easier) and natural pro-kinetics like ginger and magnesium (I like the Calm drink). I’ve also been on antacids but they didn’t help me. Instead I found they slowed down my digestion even more and made things worse. Going to the GI doc is a good next step. There are meds they can prescribe specifically for the nausea and vomiting that might prove helpful. I’ve tried them all in the past so let me know if you want a run-down. I’m hoping she gets this figured out.
Has anyone looked at her gallbladder? Many of these symptoms seem like they could easily be something beyond reflux. If she has not had a PCP exam beyond the school clinic, I’d get her in soon. It would be good to make sure reflux is all she’s dealing with. My husband is a physician and agrees. FWIW- I had to have my gallbladder removed after similar symptoms that got worse before landing me in the ER with an acute episode. I’d written the symptoms off as reflux.
Thank you everyone for your responses! I really appreciate it! It has been a rough 4 months and I am so proud of her for dealing with the health issues, her sport, and academics. I appreciate people’s virtual hugs because it hasn’t been easy. In addition to the digestive issues, she has had multiple sinus and middle ear infections and migraines.
She did a telehealth apt with her PCP who just recommended she go on anti anxiety meds. Not terribly helpful.
She hasn’t had the vomiting since she started on the omeprazole.
I have a friend’s daughter who has slow stomach emptying. I will have to ask her about it.
She already keeps a food log for migraines and I have asked her to try to keep track of when she has heartburn or no appetite. I think spicy food and tomato sauce are both triggers.
@gwcc and @teleia That is worrying that it could be gallbladder. I will have her ask about that. I actually trust the NP she sees at the health clinic over our PCP (we are pretty healthy so we haven’t needed a good PCP and the kids had great pediatricians).
The addition of migraine to the story is interesting. Migraine and GI issues go hand in hand. Have family members with migraine and they have been helped by the John Hopkins migraine diet. It’s essentially a low-histamine diet. Hard to do at college. But yes, stress and diet changes could have made things flair. I’ll share a document from their webpage for reference. Good luck again!
H2 blockers are better for overnight basal acid secretion. She could take 40 of omeprazole immediately upon awakening in the morning if she needs it, for better daytime control, and try 40 of Pepcid at bedtime for overnight acid control. I have seen patients who did better with Protonix than with any other proton pump inhibitor, but the fact is that they all work. The tips mentioned above all help, but she would need to tilt the entire bed, not just sleep on a wedge or extra pillows, since the bend in the middle of the body could actually increase reflux. She could put big cans under the feet of the bed, and use flannel sheets so she doesn’t slide down.
HOWEVER, when stress is the cause (as it surely is), sometimes even double doses of both the proton pump inhibitor AND the H2 blocker twice a day are still not enough. Clearly, she needs to remove stress. Is the college sport stressing her out? Then it seems pretty obvious that she needs to stop, and prioritize academics. I would have a serious conversation with her about how the stress of the sport is making her sick, and that her primary responsibility at college is schoolwork. BTW, migraines are also stress-related. Their frequency is greatly increased when one is under stress.
Has she been taking a lot of NSAIDs to cope with migraines, etc? My D did that & ended up with horrible heartburn and GI issues. She finally found an internist who evaluated everything going on. I can’t remember the details - not sure I knew the whole story, because she was on her own, living five hours away & traveling for work - but this doctor helped her get to the bottom of things and get her health back on track. Things got so out of hand before she ended up with this doctor, because everyone was looking at treating symptoms rather than the underlying issues. Best to you as you help your D work through this. (I had to do a lot of long distance helping with D when she was in college, for other issues. It’s not always easy when you aren’t with them.)
DH has silent reflux. As a singer it’s common due to use of muscles. So before auditions or performances it was no red meat, caffeine, citrus, mint or menthol mints, chocolate. We always went for burger fries coke and chocolate desert afterwards also elevate head while sleeping and took nexium.
Poor kid! I had this problem for years, and it turned out that it was a non-celiac gluten intolerance. My most recent gastroenterologist informed me that there is a correlation between food poisoning and non-celiac gluten and/or lactose intolerance and that more research is needed. It could also be another food intolerance, so an elimination diet can help identify the culprit. I also wound up with small intestinal bacterial overgrowth recently that gave me symptoms that are very similar to reflux. If the gastroenterologist route doesn’t result in any answers (and hopefully it does!), definitely try a second opinion or even send her to one of the hippie-dippie functional medicine types.
Has she been tested for H pylori? That was the cause of my heartburn after a stressful situation, and a course of antibiotics took care of that problem. I’m glad she is seeing a gastroenterologist.
Also… vocal cord dysfunction (VCD) can be the cause of asthma-like symptoms in some female athletes. Acid reflux can exacerbate this.
also elevate head while sleeping and took nexium.