The most important aspect of your symptoms so far is that you have had an endoscopy which has ruled out the possibility that you have cancer. The findings from the endoscopy tell you that the symptoms you are suffering from are just "acid reflux", meaning that the acid from your stomach is managing to flow back up to your throat. The stomach is naturally protected from its own acid by the type of tissue it is made from and the mucus it produces to protect itself. However, the oesophagus (the food pipe) does not have this protection and so when acid reaches up to your throat it will give you the problems that you are having now.
Why should acid reach your throat? There is a natural valve at the junction of your oesophagus and stomach which normally prevents the acid from migrating up into the oesophagus. There are also several other mechanisms which also help to prevent this from occurring. When you have acid reflux it means that this valve is faulty and not functioning properly. Most of these case is due to a very lax muscle valve or that you may have a small hernia of the stomach making that valve not function properly. The acid reaching your throat is causing the red bumps. The earache occurs because there is a draining tube from your ear that sits in that part of the throat. If you have acid reflux which reaches this part of the throat then it will give you the pain in the ear.
How should you prevent the acid reflux? The overall treatment is to prevent the acid from reaching your throat and this can be achieved in several ways.
1. Eat regular meals and do not have a late evening meal just before you go to sleep. Eat 2-3 hrs before you go to sleep so that your stomach is not full of food when you lie down and this will lead to the acid reflux.
2. Reduce on foods that can induce lots of acid production or relaxes the oesophageal valve eg. alcohol, smoking, caffeine as found in coffee and coke cola, sour/bitter and spicy food
3. Reduce weight if you are deemed overweight
4. Medication which stops acid production such as omeprazole (this is the first drug that was ever developed and since then there have been numerous others which have been developed and will have better acid production)
5. Other medication can also be added which helps to speed up the food leaving your stomach can help eg. Motilium
6. If you find that you have a lot of symptoms at night when you are sleeping then elevate the head end of your bed with books or bricks so that you are not sleeping flat. By elevating it, then you are trying to lift the head up let gravity keep the acid down in your stomach
7. During your endoscopy, your doctor would have tested for the presence of a bacteria (Helicobacter pylori) which can cause an increase in the amount of acid that your stomach produces. If it is present then you need this to be eradicated with a 2-week course of antibiotics. Once this is done you may find that the acid reflux will subside a lot and your symptoms will improve.
8. Failing all the simple measures, the next step is to consider surgery to restore the oesophageal valve (fundoplication). This is performed by keyhole surgery and it involves wrapping the top of the stomach to the lower part of the food pipe to strengthen that valve and hence prevent the acid reflux. This is an option for those who don't want to take the acid tablets for the rest of their life or for those where the medication still fail to work. Once the surgery is done all the medication for the acid reflux can be totally stopped. Prior to performing surgery, you will need one other test (pH Manometry) to ascertain for sure that you do have acid reflux causing your symptoms.
One thing to remember, is that prolong acid reflux in the oesophagus can lead to damage to the oesophagus and in a small proportion of patient this can lead to changes in the tissue lining of the oesophagus. This in turn for a small percentage of people can lead to cancer. It is therefore important to adopt all those treatments above and stop the acid reflux either with the medication or surgical treatment. If you should have persistent symptoms then make show you have regular endoscopy to assess the lining of the oesophagus.
