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Rekool-L Tablet Sr Tips

What Causes Acid Reflux? 8 Tips to Deal With it

Dr.Pranjal Deka 93% (1388ratings)
MCh HPB Surgery, Fellow European Board of Surgery, MS - General Surgery, MBBS
Gastroenterologist, Guwahati
What Causes Acid Reflux? 8 Tips to Deal With it

The LES valve in the stomach is designed in such a way that as soon as food passes through it, it closes. If however, LES remains partially or fully open, acid produced by the stomach can move up to the esophagus resulting in a burning sensation called acid reflux or heartburn. This condition is commonly known as the hital hernia.

Some of the common symptoms of acid reflux:
1. Consumption of large meals at one go.
2. Lying down immediately after having a meal.
3. Obesity or being overweight.
4. Consumption of snacks just before bedtime .
5. Consumption of certain food items such as chocolate, garlic, onion and citrus-related food.
6. Consumption of caffeine related products such as coffee, liquor and cigarettes.
7. Certain medicines such as aspirin is also known to be a trigger for acid reflux.
8. Pregnant women or patients with blood pressure are known to be suffering from acid reflux.

Tips to deal with acid reflux
There is a wide range of treatment options available for acid reflux. If you are suffering from occasional heartburn, there are some wonderful home remedies that can be tried. However, if the acid reflux recurs more than once in a week, it is best to consult a doctor. Home remedies to deal with acid reflux:
1. Sleeping on the left side is known to reduce acid reflux.
2. Reducing weight greatly helps in tackling acid burn. Patients with obesity are more vulnerable to acid burn.

3. It is best to avoid food that triggers acid burn.
4. Chewing gum greatly helps in countering acid burn. It helps in producing saliva which soothe the esophagus.
5. Intake of One spoon of baking soda every day proves to be extremely effective. Baking soda contains sodium bicarbonate which has a pH of more than 7 and can effectively neutralize the acid from stomach.
6. Intake of aloe vera, apple, banana or ginger is known to have very positive effects on acid burn.
7. Intake of 1 table-spoon of mustard can give instant relief from acid burn. Mustard’s alkaline properties can make the acid neutral in the system.
8. Regular intake (one after every meal) of almond helps to fight acid burn

Medication:
1. If you are buying over the counter, Histamine 2 blockers is a great medicine that instantly gives relief from an acid burn. Typically Doctors suggest this medicine with a higher dosage. This medicine can be consumed half an hour before the consumption of a meal. However, It is best to consult a doctor before consuming any medication.
2. Doctors often suggest medicine from the PPI family. It effectively blocks acid production in the esophagus for a longer duration. Some common medicine from this group includes Lansoprazole, Pantoprazole and Rabeprazole

In case you have a concern or query you can always consult an expert & get answers to your questions!

2214 people found this helpful

GERD - Complications Associated With It!

MS, MBBS, Clinical Fellow Pancreatic Surgery, FMBS
General Surgeon, Delhi
GERD - Complications Associated With It!

GERD or acid reflux is caused by the regurgitation of acidic liquid stomach contents back up into the esophagus. It is a long-term condition where stomach contents come back upwards from the gastro-intestinal tract resulting in either symptoms or complications. It is a commonly occurring digestion condition. A burning sensation in the chest is usually caused by acid reflux which radiates up from the stomach to the mid-chest or throat. This condition is also known as the heartburn. A sour taste in the back of the mouth is a common experience amongst the patients. Long term reflux of gastric contents causes the condition to become chronic which can lead to difficulty in swallowing. In some cases the erosion of the tract lining can also cause breathing problems.

Symptoms:

  1. Heartburn is a burning sensation felt in the retrosternal area. Most commonly it occurs post-prandial or nocturnally. Consumption of fatty foods, spicy foods, acidic foods aggravates the condition. Burning sensation is relieved with antacids, water or milk.
  2. Perception of gastric content reflux in the mouth or hypopharynx is termed as acid regurgitation. It is also known as water brash. A bitter or acidic taste is felt in the mouth.
  3. Other symptoms include dysphagia, odynophagia, nausea, chest pain, dyspepsia, epigastric fullness, bloating, frequent belching
  4. Extra-esophageal symptoms like chronic cough, hoarseness, laryngitis, dysfunction of the vocal cords, bronchospasm can also be observed.

Complications:

  1. Peptic stricture
  2. Ulcers of the esophagus
  3. Metaplastic disease (Barrett’s esophagus)
  4. Dysplastic disease (Adenocarcinoma)
  5. Laryngitis or bronchitis
  6. Pulmonary disease
  7. Fluid in the sinuses and the middle ear

Diagnosis:

The diagnosis of GERD is made by its most commonly presenting symptom- heartburn. To confirm the diagnosis of GERD, the physicians treat patients with medications for suppression of the production of acid by stomach. If heartburn diminishes to a large extent by the medications, diagnosis of GERD is considered confirmed.

 

Conditions like an ulcer caused by bacterial infection, mimic the symptoms of GERD. To get a clearer diagnosis, an endoscopy is then performed. The common diagnostic modality for GERD is Upper intestinal gastro-endoscopy. A tube containing an optical system for visualization is swallowed, the tube progresses down the gastrointestinal tract, and then the lining of the esophagus, stomach, and duodenum can be examined. A normal esophagus is observed in most patients with symptoms of reflux.

However, sometimes the lining of the esophagus appears inflamed. If erosions (superficial breaks in the esophageal lining) or ulcers (deeper breaks in the lining) are seen, a diagnosis of GERD can be made definitely. Other complications of GERD like ulcers, strictures, and Barrett's esophagus are also identified. Biopsies also may be obtained. Other common problems that may be causing GERD like symptoms can be diagnosed (for example ulcers, inflammation, or cancers of the stomach or duodenum) with EGD. Previously, barium meal x-ray was undertaken to diagnose GERD. It is now discontinued.

Other tests that are carried out are esophageal acid testing, esophageal motility testing, gastric emptying studies and acid perfusion test.

Treatment:

  1. Lifestyle modifications – Avoiding acidic foods, quitting smoking, weight loss, abstaining from alcohol consumption improves symptoms in people with GERD.
  2. Medications – Proton pump inhibitors (Pantoprazole, Omeprazole, Rabeprazole), H2 receptor blockers (Ranitidine, Cimetidine) and antacids.
  3. Surgery – In cases where the proton pump inhibitors are unsuccessful in relieving symptoms of GERD, a surgical procedure called Nissen fundo-plication is done.

In case you have a concern or query you can always consult an expert & get answers to your questions!






 

2010 people found this helpful

Avoid The Ban Medicines To Be Safe

Dr.Sumit Gupta 87% (17ratings)
BHMS
Homeopathy Doctor, Singrauli
Avoid The Ban Medicines To Be Safe

Govt bans 344 drugs, including phensedyl, corex
Sr. No. Product name (irrational fdc) 
1 aceclofenac + paracetamol + rabeprazole
2 nimesulide + diclofenac
3 nimesulide + cetirizine + caffeine
4 nimesulide + tizanidine
5 paracetamol + cetirizine + caffeine
6 diclofenac + tramadol + chlorzoxazone
7 dicyclomine + paracetamol + domperidone
8 nimesulide + paracetamol
9 paracetamol + phenylephrine + caffeine
10 diclofenac+ tramadol + paracetamol
11 diclofenac + paracetamol + chlorzoxazone + famotidine
12 naproxen + paracetamol
13 nimesulide + serratiopeptidase
14 paracetamol + diclofenac + famotidine
15 nimesulide + pifofenone + fenpiverinium + benzyl alcohol
16 omeprazole + paracetamol + diclofenac
17 nimesulide + paracetamol injection
18 tamsulosin + diclofenac
19 paracetamol + phenylephrine + chlorpheniramine + dextromethorphan + caffeine
20 diclofenac + zinc carnosine
21 diclofenac + paracetamol + chlorpheniramine maleate + magnesium trisillicate
22 paracetamol + pseudoephedrine + cetrizine
23 phenylbutazone + sodium salicylate
24 lornoxicam + paracetamol + trypsin
25 paracetamol + mefenamic acid + ranitidine + dicylomine
26 nimesulide + dicyclomine
27 heparin + diclofenac
28 glucosamine + methyl sulfonyl methane + vitamini d3 + maganese + boron + copper + zinc
29 paracetamol + tapentadol
30 tranexamic acid + proanthocyanidin
31 benzoxonium chloride + lidocaine
32 lornoxicam + paracetamol + tramadol
33 lornoxicam + paracetamol + serratiopeptidase
34 diclofenac + paracetamol + magnesium trisilicate
35 paracetamol + domperidone + caffeine
36 ammonium chloride + sodium citrate + chlorpheniramine maleate + menthol
37 paracetamol + prochlorperazine maleate
38 serratiopeptidase (enteric coated 20000 units) + diclofenac potassium & 2 tablets of doxycycline
39 nimesulide + paracetamol suspension
40 aceclofenac + paracetamol + famotidine
41 aceclofenac + zinc carnosine
42 paracetamol + disodium hydrogen citrate + caffeine
43 paracetamol + dl methionine
44 disodium hydrogen citrate + paracetamol
45 paracetamol + caffeine + codeine
46 aceclofenac (sr) + paracetamol
47 diclofenac + paracetamol injection
48 azithromycin + cefixime
49 amoxicillin + dicloxacillin
50 amoxicillin 250 mg + potassium clavulanate diluted 62.5 mg
51 azithromycin + levofloxacin
52 cefixime + linezolid
53 amoxicillin + cefixime + potassium clavulanic acid
54 ofloxacin + nitazoxanide
55 cefpodoxime proxetil + levofloxacin
56 azithromycin, secnidazole and fluconazole kit
57 levofloxacin + ornidazole + alpha tocopherol acetate
58 nimorazole + ofloxacin
59 azithromycin + ofloxacin
60 amoxycillin + tinidazole
61 doxycycline + serratiopeptidase
62 cefixime + levofloxacin
63 ofloxacin + metronidazole + zinc acetate
64 diphenoxylate + atropine + furazolidonee
65 fluconazole tablet, azithromycin tablet and ornidazole tablets
66 ciprofloxacin + phenazopyridine
67 amoxycillin + dicloxacillin + serratiopeptidase
68 azithromycin + cefpodoxime
69 lignocaine + clotrimazole + ofloxacin + beclomethasone
70 cefuroxime + linezolid
71 ofloxacin + ornidazole + zinc bisglycinate
72 metronidazole + norfloxacin
73 amoxicillin + bromhexine
74 ciprofloxacin + fluticasone + clotrimazole + neomycin is
75 metronidazole + tetracycline
76 cephalexin + neomycin + prednisolone
77 azithromycin + ambroxol
78 cilnidipine + metoprolol succinate + metoprolol tartrate
79 l-arginine + sildenafil
80 atorvastatin + vitamin d3 + folic acid + vitamin b12 + pyridoxine
81 metformin + atorvastatin
82 clindamycin + telmisartan
83 olmesartan + hydrochlorothiazide + chlorthalidone
84 l-5-methyltetrahydrofolate calcium + escitalopram
85 pholcodine + promethazine
86 paracetamol + promethazine
87 betahistine + ginkgo biloba extract + vinpocetine + piracetam
88 cetirizine + diethyl carbamazine
89 doxylamine + pyridoxine + mefenamic acid + paracetamol
90 drotaverine + clidinium + chlordiazepoxide
91 imipramine + diazepam
92 flupentixol + escitalopram
93 paracetamol + prochloperazine
94 gabapentin + mecobalamin + pyridoxine + thiamine
95 imipramine + chlordiazepoxide + trifluoperazine + trihexyphenidyl
96 chlorpromazine + trihexyphenidyl
97 ursodeoxycholic acid + silymarin
98 metformin 1000/1000/500/500mg + pioglitazone 7.5/7.5/7.5/7.5mg + glimepiride
99 gliclazide 80 mg + metformin 325 mg
100 voglibose+ metformin + chromium picolinate
101 pioglitazone 7.5/7.5mg + metformin 500/1000mg
102 glimepiride 1mg/2mg/3mg + pioglitazone 15mg/15mg/15mg + metformin 1000mg/1000mg/1000mg
103 glimepiride 1mg/2mg+ pioglitazone 15mg/15mg + metformin 850mg/850mg
104 metformin 850mg + pioglitazone 7.5 mg + glimepiride 2mg
105 metformin 850mg + pioglitazone 7.5 mg + glimepiride 1mg
106 metformin 500mg/500mg+gliclazide sr 30mg/60mg + pioglitazone 7.5mg/7.5mg
107 voglibose + pioglitazone + metformin
108 metformin + bromocriptine
109 metformin + glimepiride + methylcobalamin
110 pioglitazone 30 mg + metformin 500 mg
111 glimepiride + pioglitazone + metformin
112 glipizide 2.5mg + metformin 400 mg
113 pioglitazone 15mg + metformin 850 mg
114 metformin er + gliclazide Mr. + voglibose
115 chromium polynicotinate + metformin
116 metformin + gliclazide + piogllitazone + chromium polynicotinate
117 metformin + gliclazide + chromium polynicotinate
118 glibenclamide + metformin (sr)+ pioglitazone
119 metformin (sustainded release) 500mg + pioglitazone 15 mg + glimepiride 3mg
120 metformin (sr) 500mg + pioglitazone 5mg
121 chloramphenicol + beclomethasone + clomitrimazole + lignocaine
122 of clotrimazole + ofloxaxin + lignocaine + glycerine and propylene glycol
123 chloramphennicol + lignocaine + betamethasone + clotrimazole + ofloxacin + antipyrine
124 ofloxacin + clotrimazole + betamethasone + lignocaine
125 gentamicin sulphate + clotrimazole + betamethasone + lignocaine
126 clotrimazole + beclomethasone + ofloxacin + lignocaine
127 becloemthasone + clotrimazole + chloramphenicol + gentamycin + lignocaine ear
128 flunarizine + paracetamole + domperidone
129 rabeprazole + zinc carnosine
130 magaldrate + famotidine + simethicone
131 cyproheptadine + thiamine
132 magaldrate + ranitidine + pancreatin + domperidone
133 ranitidine + magaldrate + simethicone
134 magaldrate + papain + fungul diastase + simethicone
135 rabeprazole + zinc + domperidone
136 famotidine + oxytacaine + magaldrate
137 ranitidine + domperidone + simethicone
138 alginic acid + sodium bicarbonate + dried aluminium hydroxide + magnesium hydroxide
139 clidinium + paracetamol + dicyclomine + activated dimethicone
140 furazolidone + metronidazole + loperamide
141 rabeprazole + diclofenac + paracetamol
142 ranitidine + magaldrate
143 norfloxacin+ metronidazole + zinc acetate
144 zinc carnosine + oxetacaine
145 oxetacaine + magaldrate + famotidine
146 pantoprazole (as enteric coated tablet) + zinc carnosine (as film coated tablets)
147 zinc carnosine + magnesium hydroxide + dried aluminium hydroxide + simethicone
148 zinc carnosine + sucralfate
149 mebeverine & inner hpmc capsule (streptococcus faecalis + clostridium butyricum + bacillus
Mesentricus + lactic acid bacillus)
150 clindamycin + clotrimazole + lactic acid bacillus

151 sildenafil + estradiol valerate
152 clomifene citrate + ubidecarenone + zinc + folic acid + methylcobalamin + pyridoxine + lycopene
+ selenium + levocarnitine tartrate + l-arginine
153 thyroxine + pyridoxine + folic acid
154 gentamycin + dexamethasone + chloramphenicol + tobramycin + ofloxacin
155 dextromethorphan + levocetirizine + phenylephrine + zinc
156 nimesulide + loratadine + phenylephrine + ambroxol
157 bromhexine + phenylephrine + chlorepheniramine maleate
158 dextromethorphan + bromhexine + guaiphenesin
159 paracetamol + loratadine + phenylephrine + dextromethorphan + caffeine
160 nimesulide + phenylephrine + caffeine + levocetirizine
161 azithromycin + acebrophylline
162 diphenhydramine + terpine + ammonium chloride + sodium chloride + menthol
163 nimesulide + paracetamol + cetirizine + phenylephrine
164 paracetamol + loratadine + dextromethophan + pseudoepheridine + caffeine
165 chlorpheniramine maleate + dextromethorphan + dextromethophan + guaiphenesin + ammonium
Chloride + menthol
166 chlorpheniramine maleate + ammonium chloride + sodium citrate
167 cetirizine + phenylephrine + paracetamol + zinc gluconate
168 ambroxol
+ guaiphenesin + ammonium chloride + phenylephrine + chlorpheniramine maleate + menthol
169 dextromethorphen + bromhexine + chlorpheniramine maleate + guaiphenesin
170 levocetirizine + ambroxol + phenylephrine + guaiphenesin
171 dextromethorphan + chlorpheniramine + chlorpheniramine maleate 
172 cetirizine + ambroxol + guaiphenesin + ammonium chloride + phenylephrine +
Menthol
173 hlorpheniramine + phenylephrine + caffeine
174 dextromethorphan + triprolidine + phenylephrine
175 dextromethorphan + phenylephrine + zinc gluconate + menthol
176 chlorpheniramine + codeine + sodium citrate + menthol syrup
177 enrofloxacin + bromhexin
178 bromhexine + dextromethorphan + phenylephrine + menthol
179 levofloxacin + bromhexine
180 levocetirizine + phenylephrine + ambroxol + guaiphenesin + paracetamol
181 cetirizine + dextromethorphan + phenylephrine + zinc gluconate + paracetamol + menthol
182 paracetamol + pseudoephedrine + dextromethorphan+cetirizine
183 diphenhydramine + guaiphenesin + ammonium chloride + bromhexine
184 chlorpheniramine + dextromethorphan + phenylephrine + paracetamol
185 dextromethorphen + promethazine
186 diethylcabamazine citrate + cetirizine + guaiphenesin
187 chlorpheniramine + phenylephrine + dextromethophan + menthol
188 ambroxol + terbutaline + dextromethorphan
189 dextromethorphan + chlorpheniramine + guaiphenesin
190 terbutaline + bromhexine + guaiphenesin + dextromethorphan
191 dextromethorphan + tripolidine + phenylephirine
192 paracetamol + dextromethorphan + chlorpheniramine
193 codeine + levocetirizine + menthol
194 dextromethorphan + ambroxol + guaifenesin + phenylephrine + chlorpheniramine
195 cetirizine + phenylephrine + dextromethorphan + menthol
196 roxithromycin + serratiopeptidase
197 paracetamol + phenylephrine + triprolidine
198 cetirizine + acetaminophen + dextromethorphan + phenyephrine + zinc gluconate 
199 diphenhydramine + guaifenesin + bromhexine + ammonium chloride + menthol
200 chlopheniramine maleate + codeine syrup
201 cetirizine + dextromethorphan + zinc gluconate + menthol
202 paracetamol + phenylephrine + desloratadine + zinc gluconate + ambroxol
203 levocetirizine + montelukast + acebrophylline
204 dextromethorphan + phenylephrine + ammonium chloride + menthol
205 acrivastine + paracetamol + caffeine + phenylephrine
206 naphazoline + carboxy methyl cellulose + menthol + camphor + phenylephrine
207 dextromethorphan + cetirizine
208 nimesulide + paracetamol + levocetirizine + phenylephrine + caffeine
209 terbutaline + ambroxol + guaiphenesin + zinc + menthol
210 dextromethorphan + phenylephrine + guaifenesin + triprolidine
211 ammomium chloride + bromhexine + dextromethorphan 
212 diethylcarbamazine + cetirizine + ambroxol
213 ethylmorphine + noscapine + chlorpheniramine
214 cetirizine + dextromethorphan + ambroxol
215 ambroxol + guaifenesin + phenylephrine + chlorpheniramine
216 paracetamol + phenylephrine + chlorpheniramine + zinc gluconate
217 dextromethorphan + phenylephrine + cetirizine + paracetamol + caffeine
218 dextromethophan + chlorpheniramine + guaifenesin + ammonium chloride
219 levocetirizine + dextromethorphan + zinc
220 paracetamol + phenylephrine + levocetirizine + caffeine
221 chlorphaniramine + ammonium chloride + sodium chloride
222 paracetamol + dextromethorphan + bromhexine + phenylephrine + diphenhydramine
223 salbutamol + bromhexine + guaiphenesin + menthol
224 cetirizine + dextromethorphan + bromhexine + guaifenesin
225 diethyl carbamazine + chlorpheniramine + guaifenesin
226 ketotifen + cetirizine
227 terbutaline + bromhexine + etofylline
228 ketotifen + theophylline
229 ambroxol + salbutamol + theophylline
230 cetririzine + nimesulide + phenylephrine
231 chlorpheniramine + phenylephrine + paracetamol + zink gluconate
232 acetaminophen + guaifenesin + dextromethorphan + chlorpheniramine
233 cetirizine + dextromethorphan + phenylephrine + tulsi
234 cetirizine + phenylephrine + paracetamol + ambroxol + caffeine
235 guaifenesin + dextromethorphan
236 levocetirizine + paracetamol + phenylephirine + caffeine
237 caffeine + paracetamol + phenylephrine + chlorpheniramine
238 levocetirizine + paracetamol + phenylephirine + caffeine
239 caffeine + paracetamol + phenylephrine + chlorpheniramine
240 ketotifen + levocetrizine
241 paracetamol + levocetirizine + phenylephirine + zink gluconate
242 paracetamol + phenylephrine + triprolidine + caffeine
243 caffeine + paracetamol + phenylephrine + cetirizine
244 caffeine + paracetamol + chlorpheniramine
245 ammonium chloride + dextromethorphan + cetirizine + menthol
246 dextromethorphan + paracetamol + cetirizine + phenylephrine
247 chlorpheniramine + terpin + antimony potassium tartrate + ammonium chloride + sodium
Citrate + menthol
248 terbutaline + etofylline + ambroxol
249 paracetamol + codeine + chlorpheniramine
250 paracetamol+pseudoephedrine+certirizine+caffeine
251 chlorpheniramine+ammonium chloride + menthol
252 n-acetyl cysteine + ambroxol + phenylephrine + levocertirizine
253 dextromethorphan + phenylephrine + tripolidine + menthol
254 salbutamol + certirizine + ambroxol
255 dextromethorphan + phenylephrine + bromhexine + guaifenesin + chlorpheniramine
256 nimesulide + certirizine + phenylephrine
257 naphazoline + chlorpheniramine + zinc sulphate + boric acid + sodium chloride + chlorobutol
258 paracetamol + bromhexine + phenylephrine + chlorpheniramine + guaifenesin
259 salbutamol + bromhexine
260 dextromethorphan + phenylephrine + guaifenesin + certirizine + acetaminophen
261 guaifenesin + bromhexine + chlorpheniramine + paracetamo
262 chlorpheniramine + ammonium chloride + chloroform + menthol
263 salbutamol + choline theophylinate + ambroxol
264 chlorpheniramine + codeine phosphate + menthol syrup
265 pseudoephedrine + bromhexine
266 certirizine + phenylephrine + paracetamol + caffeine + nimesulide
267 dextromethorphan + cetirizine + guaifenesin + ammonium chloride
268 dextromethorphan + cetirizine + guaifenesin + ammonium chloride
269 ambroxol + salbutamol + choline theophyllinate + menthol
270 paracetamol + chlorpheniramine + ambroxol + guaifenesin + phenylephrine
271 chlorpheniramine + vasaka + tolubalsm + ammonium chloride + sodium citrate + menthol
272 bromhexine + cetrizine + phenylephrine ip+guaifenesin + menthol
273 dextromethorphan + ambroxol + ammonium chloride + chlorpheniramine + menthol
274 dextromethorphan + phenylephrine + cetirizine + zinc + menthol
275 terbutaline + n-acetyl l-cysteine + guaifenesin
276 calcium gluconate + levocetirizine
277 paracetamol + levocetirizine + pseudoephedrine
278 salbutamol + choline theophylinate + carbocisteine
279 chlorpheniramine + vitamin c
280 calcium gluconate + chlorpheniramine + vitamin c
281 chlorpheniramine + paracetamol + pseudoephedrine + caffeine
282 guaifenesin + bromhexine + chlorpheniramine + phenylephrine + paracetamol + serratiopeptidase
(as enteric coated granules) 10000 sp units
283 paracetamol + pheniramine
284 betamethasone + fusidic acid + gentamycin + tolnaftate + lodochlorhydroxyquinoline (ichq
285 clobetasol + ofloxacin + miconazole + zinc sulphate
286 clobetasole + gentamicin + miconazole + zinc sulphate
287 levocetirizine + ambroxol + phenylephrine + paracetamol
288 permethrin + cetrimide + menthol
289 beclomethasone + clotimazole + neomycin + lodochlorohydroxyquinone
290 neomycin + doxycycline
291 ciprofloxacin + fluocinolone + clotrimazole + neomycin + chlorocresol
292 clobetasol + ofloxacin + ketoconazol + zinc sulphate
293 betamethasone + gentamicin + tolnaftate + lodochlorhydroxyquinoline
294 clobetasol + gentamicin + tolnaftate + lodochlorhydroxyquinone + ketoconazole
295 allantoin + dimethieone + urea + propylene + glycerin + liquid paraffin
296 acriflavine + thymol + cetrimide
297 betamethasone + neomycin + tolnaftate + lodochlorohydroxyquinoline + cholorocresol
298 clobetasol + neomycin + miconazole + clotrimazole
299 ketoconazole + tea tree oil + allantion + zinc oxide + aloe vera + jojoba oil +
Lavander oil + soa noodels
300 clobetasol propionate + ofloxacin + ornidazole + terbinafine
301 clobetasol + neomycin + miconazole + zinc sulphate
302 beclomethasone diproprionate + neomycin + tolnaftate + lodochlorhydroxyquinoline +
Chlorocresol
303 betamethasone + gentamycin + zinc sulphate + clotrimoazole + chlorocresol
304 borax + boric acid + naphazoline + menthol + camphor + methyl hydroxy benzoate
305 bromhexine + dextromethorphan
306 dextromethophan + chlopheniramine + bromhexine
307 menthol + anesthetic ether
308 dextrometharphan + chlopheniramine + ammonium + sodium citrate + menthol
309 ergotamine tartrate + belladona dry extarct+caffeine + paracetamol
310 phenytoin + phenobarbitone
311 gliclazide 40mg + metformin 400mg
312 paracetamol + ambroxol + phenylephrine + chlorpheniramine
313 oflaxacin + ornidazole suspension
314 albuterol + etofylline + bromhexine + menthol
315 albuterol + bromhexine + theophylline
316 salbutamol+hydroxyethyltheophylline (etofylline) + bromhexine
317 paracetamol+phenylephrine+levocetirizine+sodium citrate
318 paracetamol + propyphenazone + caffeine
319 guaifenesin + diphenhydramine + bromhexine + phenylephrine
320 dried alumnium hydroxie gel + prophantheline + diazepam
321 bromhenxine + phenylephrine + chlorpheniramine + paracetamol
322 beclomethasone + clotrimazole + gentamicin + lodochlorhydroxyquinoline
323 telmisartan + metformin
324 ammonium citrate + vitamin b 12 + folic acid + zinc sulphate
325 levothyroxine + phyridoxine + nicotinamide
326 benfotiamine + metformin
327 thyroid + thiamine + riboflavin + phyridoxine + calcium pantothenate + tocopheryl acetate +
Nicotinamide
328 ascorbic acid + manadione sodium bisulphate + rutin + dibasic calcium phosphate +
Adrenochrome mono semicarbazone
329 phenylephrine + chlorpheniramine + paracetamol + bromhexine + caffeine
330 clotrimazole + beclomethasone + lignocaine + ofloxacin + acetic aicd + sodium methyl paraben +
Propyl paraben

Avoid this combinations and be safe.

382 people found this helpful

Acid Reflux And Oesophagitis Heartburn

Dr.Vijan Sharan 92% (24ratings)
MBBS, Doctor of Medicine, Member of the Royal College of Physicians, UK (MRCP UK)
General Physician, Patna
Acid Reflux And Oesophagitis Heartburn

Acid Reflux and Oesophagitis Heartburn

Acid Reflux and heartburn are a very common problem faced by many of us. And so I decided to discuss in a very simplified way.

Let us understand the oesophagus and stomach first

When we eat, food passes down the gullet (oesophagus) into the stomach. Cells in the lining of the stomach make acid and other chemicals which help to digest food. Stomach cells also make mucus which protects them from damage from the acid. The cells lining the oesophagus are different and have little protection from acid.
There is a circular band of muscle (a sphincter) at the junction between the oesophagus and stomach. This relaxes to allow food down but then normally tightens up and stops food and acid leaking up (refluxing) into the oesophagus. In effect, the sphincter acts like a valve.

What are Acid reflux and oesophagitis?

Acid reflux means that some acid leaks up (refluxes) into the gullet (oesophagus).

Oesophagitis means inflammation of the lining of the oesophagus. Most cases of oesophagitis are due to reflux of stomach acid which irritates the inside lining of the oesophagus.

The lining of the oesophagus can cope with a certain amount of acid. However, it is more sensitive to acid in some people. Therefore, some people develop symptoms with only a small amount of reflux. However, some people have a lot of reflux without developing oesophagitis or symptoms.

What is Gastro-oesophageal reflux disease (GORD)

This is a general term which describes the range of situations - acid reflux, with or without oesophagitis and symptoms.

What are the symptoms of acid reflux and oesophagitis?

Heartburn: this is the main symptom. This is a burning feeling which rises from the upper tummy (abdomen) or lower chest up towards the neck. (It is confusing, as it has nothing to do with the heart!)
Other common symptoms: these include pain in the upper abdomen and chest, feeling sick, an acid taste in the mouth, bloating, belching, indigestion and a burning pain when we swallow hot drinks. Like heartburn, these symptoms tend to come and go and tend to be worse after a meal.
Some other uncommon symptoms: these may occur and if they do, can make the diagnosis difficult, as these symptoms can mimic other conditions. For example A persistent cough, particularly at night, sometimes occurs. This is due to the refluxed acid irritating the windpipe (trachea). Asthma symptoms of cough and wheeze can sometimes be due to acid leaking up (reflux).
Other mouth and throat symptoms sometimes occur, such as gum problems, bad breath, sore throat, hoarseness and a feeling of a lump in the throat.
Severe chest pain develops in some cases (and may be mistaken for a heart attack).

What causes acid reflux and whom does it affect?

The circular band of muscle (sphincter) at the bottom of the gullet (oesophagus) normally prevents acid leaking up (refux). Problems occur if the sphincter does not work very well. This is common but in most cases it is not known why it does not work so well. In some cases, the pressure in the stomach rises higher than the sphincter can withstand - for example, during pregnancy, after a large meal, or when bending forward.

What are the causes of  Heartburn and what are the  Treatment options
Most people have heartburn at some time, perhaps after a large meal. However, about 1 adult in 3 has some heartburn every few days, and nearly 1 adult in 10 has heartburn at least once a day. In many cases it is mild and soon passes. However, it is quite common for symptoms to be frequent or severe enough to affect the quality of life. Regular heartburn is more common in smokers, pregnant women, heavy drinkers, those who are overweight and those aged between 35 and 64 years.

What tests can be done to arrive at the diagnosis?

Tests are not usually necessary if you have typical symptoms. Many people experiencing acid leaking up (refluxing) into the gullet (oesophagus) are diagnosed with 'presumed acid reflux'. In this situation, they have typical symptoms and the symptoms are eased by treatment. Tests may be advised if symptoms are severe, or do not improve with treatment, or are not typical of GORD.
Gastroscopy (endoscopy) is the common test. A thin, flexible telescope is passed down the oesophagus into the stomach. This allows a doctor to look inside. With inflammation of the lining of the oesophagus (oesophagitis), the lower part of the oesophagus looks red and inflamed. However, if it looks normal it does not rule out acid reflux. Some people are very sensitive to small amounts of acid and can have symptoms with little or no inflammation to see. Two terms that are often used after an endoscopy are:

Oesophagitis. This term is used when the oesophagus can be seen to be inflamed.

Endoscopy-negative reflux disease. This term is used when someone has typical symptoms of reflux but endoscopy is normal.A test to check the acidity inside the oesophagus may be done if the diagnosis is not clear. Other tests such as heart tracings, chest X-ray, etc, may be done to rule out other conditions if the symptoms are not typical.

What can be done to relieve with symptoms?

The following are commonly advised. However, there has been little research to prove how well these lifestyle changes help to ease reflux:

Smoking. The chemicals from cigarettes relax the circular band of muscle (sphincter) at the bottom of the gullet (oesophagus) and make acid leaking up (refluxing) more likely. Symptoms may ease if you are a smoker and stop smoking.Some foods and drinks may make reflux worse in some people. It is thought that some foods may relax the sphincter and allow more acid to rfleux. It is difcult to be certain how much foods contribute. Let common sense be your guide. If it seems that a food is causing symptoms then try avoiding it for a while to see if symptoms improve. Foods and drinks that have been suspected of making symptoms worse in some people include peppermint, tomatoes, chocolates, hot drinks, coffee and alcoholic drinks. Also, avoiding large-volume meals may help.

There are some medicines which can make symptoms worse. They may irritate the oesophagus or relax the sphincter muscle and make acid reflux more likely. The most common culprits are anti-inflammatory painkillers (such as ibuprofen or aspirin). Others include diazepam, theophylline, calcium-channel blockers (such as nifedipine) and nitrates. But this is not a complete list. 

Weight. If you are overweight it puts extra pressure on the stomach and encourages acid reflux. Losing some weight may ease the symptoms.

Posture. Lying down or bending forward a lot during the day encourages reflux. Sitting hunched or wearing tight belts may put extra pressure on the stomach, which may make any reflux worse.

Bedtime. If symptoms recur most nights, the following may help: Go to bed with an empty, dry stomach. To do this, don't eat in the last three hours before bedtime and don't drink in the last two hours before bedtime.

If you are able, try raising the head of the bed by 10-20 cm (for example, putting two normal sized pillows under your head. This helps gravity to keep acid from refluxing into the oesophagus. 

What are the treatments for acid reflux and oesophagitis?

Antacids
Antacids are alkaline liquids or tablets that reduce the amount of acid. A dose usually gives quick relief. There are many brands which you can buy. You can also obtain some on prescription. You can use antacids 'as required' for mild or infrequent bouts of heartburn.

Acid-suppressing medicines

If you have symptoms frequently then see a doctor. An acid-suppressing medicine will usually be advised. Two groups of acid-suppressing medicines are available - proton pump inhibitors (PPIs) and histamine receptor blockers (H2 blockers). They work in different ways but both reduce (suppress) the amount of acid that the stomach makes. PPIs include omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole. H2 blockers include cimetidine, famotidine, nizatidine and ranitidine.
In general, a PPI is used first, as these medicines tend to work better than H2 blockers. A common initial plan is to take a full-dose course of a PPI for a month or so. This often settles symptoms down and allows any inflammation in the gullet (oesophagus) to clear. After this, all that you may need is to go back to antacids 'as required' or to take a short course of an acid-suppressing medicine 'as required.
However, some people need long-term daily acid-suppressing treatment. Without medication, their symptoms return quickly. Long-term treatment with an acid-suppressing medicine is thought to be safe and side-effects are uncommon. The aim is to take a full-dose course for a month or so to settle symptoms. After this, it is common to 'step down' the dose to the lowest dose that prevents symptoms. However, the maximum full dose taken each day is needed by some people.

If you have any question you can write down to me.

8 people found this helpful

Slip Disc - Treating It With Sciatica!

Dr.Kailash Kothari 89% (59ratings)
MD - Anaesthesiology, MBBS
Pain Management Specialist, Mumbai
Slip Disc - Treating It With Sciatica!

Introduction The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc.

Symptoms -

This protrusion can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.

Causes of weak disc -

Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

How to deal with it?

- The first step to deal with a herniated or prolapsed lumbar disc is conservative management.

- Rest,

- Analgesic

- Anti-inflammatory medication

- Physical therapy.

At this point, Sometimes it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

What to do if pain does not improve?

If in a few weeks (4 weeks) these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc pathology, the space behind it (Spinal canal) and the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Diagnosis -

Using precision diagnostic & therapeutic blocks in chronic LBP, the following pain generators in lower back have been found:

- Isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients.

Treatment -

Once the diagnosis has been confirmed, there are a variety of treatment options which are non-surgical:

First Method:

  • Image-guided Epidural injection (70% of patients do very well with this)
  • Indicated in  Acute radicular pain due to irritation or inflammation.
  • Symptomatic herniated disc with failed conservative therapy
  • Acute exacerbation of discogenic pain or pain of spinal stenosis
  • Neoplastic infiltration of roots
  • Epidural fibrosis
  • Chronic LBP with acute radicular symptoms
  • Epidural Lumbar injection

ESI Treatment Plan Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.

Second Method:

If pain doesn't subside and diagnosis is in doubt we perform Provocative Discography - Coupled with CT.

A diagnostic procedure & prognostic indicator is necessary for the evaluation of patients with suspected discogenic pain. This test has the ability to reproduce pain on injection of the affected disc, to determine type of disc herniation/tear by performing post discography CT scan.

Once we know which disc is painful and what type of disc prolapse it is, we may plan further intradiscal treatments.

Third Method:

One of the best alternatives existing today is the Disc Fx and disc biculoplasty RF ablation, as the results obtained are excellent and practically has minimal to no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. The popularity of this technique is that it achives similar or better success rates in well selected patients.

Fourth Method:

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for multilevel cervical & lumbar disc herniation with radiculopathy.

The total cost of these procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Fifth Method:

Nucleoplasty and Dekompressor discectomy are other common techniques in some patients. This helps in debulking the disc and thereby reduces the nerve compression.

Sixth Method:

Epidural Adhesiolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS). A spring-loaded catheter is inserted in epidural space via caudal/interlaminar/transforaminal approach.

After epidurography, testing volumetric irrigation with normal saline/LA/hyalase/steroids/hypertonic saline in different combinations is then performed along with mechanical adhesiolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

Seventh Method:

Some patients (less than 2 %) do need surgery if pain doesn't improve. In today's time, open surgery is not required in most cases. Percutaneous endoscopic discectomy is most advanced and stitchless surgery which is done under local anesthesia. Patients recover very fast and go home on same or next day.

Conclusion - In today's time, back pain due to disc herniation is managed best by pain management doctors as they offer range of nonsurgical of minimally invasive surgical options with better success rates and minimal complication rates. The patients do recover very fast without the need to be in the hospital.

4809 people found this helpful

How To Treat Slip Disc With Sciatica?

MBBS Bachelor of Medicine and Bachelor of Surgery, MD - Anaesthesia, PDCC - Pain Management, Fellow of Interventional Pain Practice
Pain Management Specialist, Delhi
How To Treat Slip Disc With Sciatica?

The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.

Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.

If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.

Once the conservative treatment fails:

Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.

Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.

Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.

LESI: Lumbar Epidural Steroid Injection

Indicated in – Acute radicular pain due to irritation or inflammation.

  • Symptomatic herniated disc with failed conservative therapy
  • Acute exacerbation of discogenic pain or pain of spinal stenosis
  • Neoplastic infiltration of roots
  • Epidural fibrosis
  • Chronic LBP with acute radicular symptoms
  • Epidural- lumbar injection

ESI Treatment Plan

Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.

SNRB- Selective Nerve Root Block 

Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if

  • There is minimal or no radiological finding.
  • Multilevel imaging abnormalities
  • Equivocal neurological examination finding or discrepancy between clinical & radiological signs
  • Postop patient with unexplainable or recurrent pain
  • Combined canal & lateral recess stenosis.
  • To find out the pathological dermatome for more invasive procedures, if needed

Intradiscal Procedures 

Provocative Discography - Coupled with CT

A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.

Percutaneous Disc Decompression (PDD)

After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.

Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)

A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

4354 people found this helpful

Procedures That Can Help Treat Slip Disc & Sciatica!

Dr.Neeraj Jain 86% (20ratings)
MBBS, MD, FIMSA, FIPP, CIPS - Certified Interventional Pain Sonologist
Pain Management Specialist, Delhi
Procedures That Can Help Treat Slip Disc & Sciatica!

The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.

Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.

If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.

Once the conservative treatment fails:

Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.

Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.

Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.

LESI: Lumbar Epidural Steroid Injection

Indicated in – Acute radicular pain due to irritation or inflammation.

  • Symptomatic herniated disc with failed conservative therapy
  • Acute exacerbation of discogenic pain or pain of spinal stenosis
  • Neoplastic infiltration of roots
  • Epidural fibrosis
  • Chronic LBP with acute radicular symptoms
  • Epidural- lumbar injection

ESI Treatment Plan

Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.

SNRB- Selective Nerve Root Block 

Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if

  • There is minimal or no radiological finding.
  • Multilevel imaging abnormalities
  • Equivocal neurological examination finding or discrepancy between clinical & radiological signs
  • Postop patient with unexplainable or recurrent pain
  • Combined canal & lateral recess stenosis.
  • To find out the pathological dermatome for more invasive procedures, if needed

Intradiscal Procedures 

Provocative Discography - Coupled with CT

A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.

Percutaneous Disc Decompression (PDD)

After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.

Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)

A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

In case you have a concern or query you can always consult an expert & get answers to your questions!

4501 people found this helpful