DEAR DR. DONOHUE: I have serious gastric reflux (heartburn). I have been treating it with a careful diet, a raised bed and Nexium, but I still need antacids to control it. Am I doing something wrong? – W.J.

ANSWER: You’re doing everything right. You’ve propped up the head of your bed to keep stomach acid and juices in the stomach and out of the esophagus. You’re watching your diet, meaning you are staying away from fried foods, fatty foods, chocolate, spearmint, peppermint, coffee, tea, colas, tomato juice, citrus fruit and alcohol. Incidentally, frequent smaller meals are better than three large ones.

Nexium belongs to a family of medicines that turn off or greatly reduce stomach acid production. You are not getting 100 percent results. Sometimes medicines don’t achieve complete success.

There are several strategies that help people like you. One is to increase the medicine dose. Another is to add another control drug.

If you get no relief after upping the dose or adding another drug, that’s a point to consider reassessing the diagnosis. That can be done by measuring the acidity in your esophagus. If there is no acid there yet you still have pain, the conclusion is that the pain is not due to reflux, and another cause for the pain must be found.

Then, too, there are surgeries and other procedures not involving medicines that are ideal for people in your shoes. Standard gastric reflux surgery can often be done with a scope and small incisions. Recovery is rapid. Doctors can also heat the lowermost part of the esophagus to create scar tissue that tightens it and abolishes the upward flow of stomach juices into it. It is done with a gastroscope that is passed through the mouth. Another gastroscopic procedure employs a device that puts sutures in the lower esophagus to tighten it to prevent reflux of gastric juices.

The pamphlet on hiatal hernia, heartburn and gastroesophageal reflux disease (GERD) covers this topic in depth. Readers can obtain a copy by writing: Dr. Donohue – No. 501, P.O. Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have had a cough for the past two months. I often notice that before I cough, I have a bitter or salty taste in my mouth, and I can feel some fluid entering it. I don’t have burning in my esophagus. I have been on 20 mg of Pariet, but the cough has not become any better. What might the problem be? – B.P.

ANSWER: Pariet is the Canadian brand name of the generic drug rabeprazole. In the United States, the brand name is Aciphex. It greatly reduces stomach acid production and is used for control of heartburn – GERD, gastroesophageal reflux disease. Heartburn can cause coughing, and you make it an even more likely cause by saying you detect something bitter or salty in your mouth before coughing. If this medicine is not working, then the case for heartburn as being the cause becomes less likely.

Other causes for a cough include the mucus of postnasal drip trickling down the throat to trigger a coughing spell. Coughing can be a symptom of asthma. Prescription medicines can also provoke coughing. The classic examples are ACE inhibitors used for blood pressure control.

You must return to your physician for re-evaluation. Even though it is not the most common cause of a persistent cough, cancer is the most serious cause, and the search for it ought to be made.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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