Acid reflux and blisters in throat

[RandolphGB]

My wife's dad in rural Surin started suffering a couple of weeks ago with very bad throat pain. 

 

The first doctors did very little but then she took him to hospital to stay in for two nights. Doctors told them it was acid reflux and possibly that the sores in his neck were infected. 

 

They gave antibiotics and other medicine but a week later and it still hasn't cleared up. Should he go to hospital in Bangkok? Is there anything more that can be given to him other than what the doctors in Surin have already done? 

 

It's quite worrying for my wife as she doesn't like seeing him in pain. He's also unable to eat food other than rice soup and the taste in his mouth has been affected. So this is making him quite weak. 

 

Thank you

 

 

 

 

[tonray]

Does he present with a fever?  (elevated temperature) 

 

Have they ruled out strep as the cause of the sores? 

[RandolphGB]

He doesn't have a fever just generally feeling unwell. 

[Sheryl]

 

Without knowing what investigations were done and what treatment has been provided I have no way of assessing the likely accuracy of the diagnosis nor the adequacy of the treatment - though I can tell you the usual treatment for ulcerations due to GERD would be PPIs (omeprazole etc) and it would take several weeks to see improvement, as the medication just prevents further irritation but the ulcers still have to heal on their own.

 

If the ulcers are high up in the throat, gargling with viscous liquid lidocaine may help give some temporary pain relief, but this is not practical if it is down in the esophagus as the stuff is not to be swallowed. Would probably have to get it fro ma hospital.

 

A drug called sucralfate or apo-sucralfate may also give some temporary relief, it provides a soothing coating. Should gargle with it first then swallow slowly. It does nto require a prescription.

 

Are these sores actually in his throat (pharynx) or in his esophagus? Did they do an endoscopy?

 

GERD if severe can cause ulcerations in the esophagus  -- in which case it is essential to do a biopsy to rule out pre-cancerous changes to the lining of the esophagus - but it  would be very unusual  for GERD to cause ulcerations in the throat itself.

 

More common causes of ulcers in the throat are bacterial infections of the throat or tonsils, thrush (in which case HIV needs to be ruled out) , herpes and other viral infections.

 

Where was he treated? The provincial hospital in Surin town (which is a regional level facility) or a district hospital? (He will not have had an endoscopy if the latter, may have if the former).

 

If he was treated at other than the provincial/regional hospital, they should try to get a letter of referral to take him to see a specialist at the regional hospital in Surin town.

 

If he was already treated there, try to find out if an endoscopy was done and also clearly whether the lesions are in his throat or esophagus, and post thsi info.

 

Also please clarify exactly what term they used to describe the lesions, as  a blister is different from an ulcer and suggestive of herpes or other viral infection whereas ulceration would be more consistent with GERD.

 

 

 

[RandolphGB]

Hi, he went first to a district doctors and then to the main hospital in Surin town. No endoscopy. 

 

The legions are in his throat and neck area. The doctors said that these were an infection. Nothing more detail on that and they gave him antibiotics. This was about a week ago and they don't seem to have cleared it up yet.

 

I'll try to post shortly some of the documentation from the hospital.

[Sheryl]

Please do. "Throat and neck" and "infection" do nto sound like GERD.

[scoutman360]

Agree with Sheryl. I have had GERD most my life and never had serious ulcers from it. Sounds like a bacterial infection. (or even viral?). You need a good doctor to sort it out.

[RandolphGB]

The most sense I can get out of them is that the doctor said it was acid reflux which had caused the problems in the throat and neck area (I'm not sure whether they called them ulcers or blisters of legions). Whether or not the infection is something separate or related to the wounds in the neck, I don't know. They were given a leaflet about acid reflux. And a bill, which I have attached. They were also told to go to the smaller district doctor if problems persisted. 

 

The wife says the hospital was the best one in Surin town. It may not be serious, but she's just very stressed and worried about seeing her dad in discomfort because of it. Especially because he's struggling to eat and getting a bad taste in his mouth.

 

The acid reflux medicine they were given was one month's supply. Is it worth her taking him to a doctor in Bangkok or would it be more of the same? I think she just wants to do something and try to be pro-active but if it is acid reflux and ulcers, how long should that take to clear up?

 

 

[Sheryl]

If he goes to Bangkok (and to a good GI specialist) they will do an endsocopy. This will confirm or rule out GERD and also determine if there is a hiatal hernia present which might be contributing to the GERD. In addition -- and very important - they will do a biopsy of the lining of the Esophagus to determine if there are pre-cancerous changes (something called Barrett's esophagus), if there are then he will need annual endoscopies to monitor so that if he develops esophageal cancer it is caught early enough to cure. If there appear to be infected lesions they may also do a culture which may allow for prescribing a more effective antibiotic.

 

However if it proves to be the case that this is all due solely to GERD, , they will not be able to provide an immediate relief of symptoms because IF this is all due to GERD, resolution does take many weeks. However they might be willing to give him a viscous lidocaine mouth wash he can gargle with which will reduce pain. If the diagnosis is wrong then everything changes and they may be able to provide a more effective treatment.

 

At a private hospital in Bangkok this is going to cost some 30K baht, give or take.

 

He could try going to the cancer hospital in Bangkok (since excluding esophageal cancer or pre-cancerous changes is an issue), endoscopy there is much cheaper at about 6,000 baht  and I hear it is less crowded than other government hospitals  https://www.facebook.com/Chulabhorn-Hospital-143178505731188/

Total cost there likely to be around 10K

 

BTW they could have avoided paying anything in Surin if they had gotten a letter of referral from the district hospital where he lives  (I'm assuming they went to the government regional hospital in Surin and not the private hospital).  I doubt they can get a letter of referral to Bangkok though no harm in asking. They should specifically ask for a referral to the Cancer hospital in Bkk saying they want to rule out esophageal cancer, that may spook the local docs into agreeing.

 

I think there is enough chance here of mis-diagnosis or incomplete diagnosis that it is worth going to Bangkok. He should get an HIV test and at least a Complete Blood count (CBC) before going to Bangkok and bring that with him to help contain costs.

 

Menawhile she should buy some sucralfate (large pharmacy should have) and have him take it say 15 minutes before trying to eact and again at bedtime, it may give some symptomatic relief and regardless of what these lesions are it will nto hurt.