instruction: hi doctor I have persistent heartburn related symptoms for the last four to five months I visited a gastro and he prescribed me medicines for 14 days my conditions got better but not fully cured so I was given another 14 days of medicine including a proton pump inhibitor soon the lockdown kicked in and I went back to my home I meanwhile took ayurvedic medicines for a month here while it has reduced the duration of heartburn episodes the problem has not gone yet for the last month I have mild heartburn pain in chest for 20 60 minutes in a day spread across three to four intervals 14 30 days my throat felt different 30 last days had acid refluxes but heartburn occurs daily I have tried varying my diet but have not found any significant changes is this a cause of concern that despite having medicines for 42 days I still have mild heartburn occurring daily what should I do how long will it take for a medicine to show the effect should I continue the course and if so for how long and if yes does prolonged usage of medicine have side effects or if left untreated do they have side effects I took somproz initially for four days lesuride 25 and deltone for 14 days and for the next 14 days I took lesuride 25 and nexpro 40
output: hello you have briefly and well described your history and I understand that you have very genuine concerns so the problem you have is called gastroesophageal reflux disease herd this is basically reflux of acid from the stomach to food pipe causing heartburn sore throat sometimes cough and shortness of breath our stomach produces approximately liter of acidic juices to help digest food the acid produced does not usually come into food pipe unless someone has loose sphincter at the lower end of our food pipe which prevents acid refluxing into the food pipe there are two further classifications of herd pi responsive herd and pi refractory herd your symptoms suggest that you have pi proton pump inhibitor responsive herd since your symptoms are significantly improved when you are taking pi even in pi responsive herd the symptoms may not completely vanish but are declined to a reasonable level and this may be in your case for this you just need to increase the dose of pi instead of once daily dose you can start taking it twice a day before meals the rest of your symptoms like sore throat will go away once your acid reflux is suppressed well diet may or may not affect the herd however there are certain precautions that you can do to prevent heartburn avoiding large volume meals instead take small but frequent meals avoid taking large meals at night or before going to bed give at least three to four hours gap after night meals before going to bed for sleeping raise the head end of your bed by placing a cement or wooden block down the head side of your bed or there are commercially available anti reflux mattresses that can be used instead avoid wearing tight fitting clothes and belts so your concern about the presence of symptoms despite 42 days of treatment is valid but you see the acid is produced daily and the medicines can decrease the acid production for the duration of time they are in the blood once the level of the drug declines from a certain point the acid production takes over back so taking a daily pill to control your acid production is the only effective way of treating your condition no long term use and side effects well all pi are relatively safe and do not cause significant side effects if taken for years and years however there are studies that have shown renal damage bone protein loss and aspiration pneumonia but in practice these side effects are not that common as elaborated in studies the one daily pill to control your acid and prevailing a normal lifestyle is much more important than unforeseen and often unestablished side effects from long term use of pi I would recommend if pi helps you to do well then there is no reason for stopping for the sake of unforeseen complications but if you still have a concern about the long use of pi then I would recommend you to get oh impedance 24 hours testing to confirm herd and if present then pi again is the therapy but if the test comes out negative then pi can be stopped I hope this helps pi responsive herd ambulatory 24 hours oh impedance testing non erosive reflux disease herd tablet pantoprazole 40 my before breakfast you can increase it to 40 my bid before meals follow up if want to discuss more