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Epiglottis burned by heartburn due to heavy drinking

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Hello, I'm a 23 male in Hawaii. I'm a nurse so I have sort of a familiarity with medicine. My situation involves my throat. About 2 years ago I drank heavily and started getting heartburn. It felt like the area that got burned was my epiglottis. I never experienced heartburn unless I drank. I recently went to military training in Texas and tested my limits with the drinking, and my throat felt like it swelled up for a week. After this, heartburn was frequent. I started taking Omeprazole which weakened the acid coming into contact with this raw part of my epiglottis. For a while there I felt good, until last week when I did a little impromtu singing in the car. I mean I really pushed my limits, it didn't quite sound like Michael Jackson. Afterwards, I feel like I did some damage because my throat almost feels burnt in that same location. I know the outer layer of that area is damaged. I now obviously refrain from alcohol and soda, but this raw skin doesn't seem to heal. I'm 23, and I feel like it should have healed by now. Could there be a bacterial infection, because I also notice a bad smell when touch the area with my finger. A stool sample was negative for H.pylori. I'm wondering what would be the right route to go with this. Thanks for your time.
-Jake

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Hello,

Thank you for asking your query at DoctorSpring.

One striking feature in you medical history is the relationship with alcohol and the symptoms. So we can safely assume that your symptoms are due to alcohol related gastritis and more of an esophagitis. A negative H.Pylori is expected as this is more like an irritant damage than because of an acid peptic disease caused by bacteria.

Regarding your localisation to epiglottis, well I do agree the pain might be more pronounced in the upper throat, but if you look at the etiopathology (the alcohol related damage) the damage should be there throughout the oesophagus and stomach. It’s just that you feel the discomfort more the in the epiglottis. Moreover being a medical personal you would be well aware that visceral pain is poorly localised. Being said that there could be considerable damage in the outer surface of the epiglottis (which might aggravate by the voice induced damage). But there is less chance the singing per se caused much damage, as the pressure build up and friction affects the larynx and vocal cord mostly. No other bacteria other than H.Pylori can cause similar symptoms. The foul smell seems unrelated and need investigation only if the symptoms persist further.

The right approach would be to –
1. Continue Omeprazole 20mg once daily just before sleep (that is at least 1hour interval with food) – 14 days
2. Syrup Sucralfate 1 tsp at least half an hour before food thrice a day. Sucralfate forms a protective coating and helps in healing. This is a prescription drug in certain countries, in that case get in touch with your Doctor.
3. Strictly avoid alcohol, spices and irritant food items. Take meals are regular intervals.

4. An Upper GI endoscopy – This will help in assessing the damage and also rare caused like pharyngeal pouch abscess can be ruled out (which can caused foul smell)

Hope this helps. Please take care not to consume alcohol in immediate future.
Please feel free to ask followup queries.
Thank you


Patient replied :

Hello, I appreciate your quick response. I'm going to recommend the upper GI endoscopy. It's going to be tough to get the military to go through with it because last time I was told they need to see a "strong indication" that it is necessary. I will push for it. I guess what I dont fully understand is the healing rate of the mucosa that were damaged. I mean...i have stopped drinking since really about over a year ago and ive been on omeprazole for 6 months. I dont do spicy foods and i try to drink water. I this something that heals on it's own extremely slowly? Hopefully this damage won't last forever seeing as I'm very healthy.
Thank you again for your time,
Jacob


Hello Jacob,

Since you said “I recently went to military training in Texas and tested my limits with the drinking,…” I just assumed it was very recent. If it is isolated Alcohol Gastritis/Esophagitis with damaged only to mucosa the healing should occur in weeks. If there is an ulcer the healing can be delayed and might take months to completely heal. More over your symptoms are not very typical. Esophagitis can occur, but predominant symptom will be gastritis (stomach pain). So I guess the best logical step would be an Endoscopy. I feel you do have strong indication for that. Please discuss this with your Doctor. Even an isolated episode of vomiting up of small quantity blood can occur in this condition (which is a strong indication for scopy).

Hope this helps.
Thank you.


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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