'Milkshake froth' in your throat

I thought it might be helpful for others to share some advice about the problem that some people have when you keep accumulating foamy stuff in your throat that you cannot swallow, and have to spend time spitting out after eating, perhaps for an hour or so to clear it.

It may not be that everyone is the same, but what seems to happen is that saliva and gastric juices are accumulating in what is left of the stomach. With the absence of the valve at the top with the junction of the oesophagus, air mixes with this cocktail and it becomes like a milkshake froth. Domperidone is seen as the normal solution to this problem, but it has to be used in a certain way. One needs to take Domperidone 30 – 40 minutes before eating. Domperidone as well as being an anti-sickness drug is also a muscle relaxant so it relaxes the muscles of the digestive system so that everything moves downhill a little more quickly and moves this gunk out of the chest area. Taking it 30 -40 minutes before eating can be the most important bit.’

So if you have this problem, and find that domperidone is not working, it might be worth thinking about when you take the medication as that can make a difference.

The other thing to think about is whether you swallow a lot more air than normal with food. This can sometimes result in smelly wind. So eating fairly slowly, and chewing everything well can also make a difference.

19 Replies

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  • Useful post Alan. Thanks

  • Alan ,thanks for that . What I would like to know ,though I guess it's a question for a pharmacist ,is - how effective is domperidone if it is only taken occasionally ?

    Any ideas ?

  • Though I have no experience with domperidone (it is not approved in the US by the FDA), I do have first hand experience with other similar agents (metoclopramide and cisapride). I was given metoclopramide liquid through the J-tube four times daily for thirty days following my esophagectomy. I am also a licensed pharmacist in the US.

    These agents work by increasing GI motility, thereby forcing food downstream. They do have side-effects, but are very useful in their intended purpose.

    Episodic or occasional use would not be nearly as effective as scheduled or routine usage, because to be effective "as needed" they would need to work immediately. But as Alan has said, they are best taken 30 minutes before a meal.

    Saliva is a big cause of the "frothy" consistency, and this foamy regurgitation is likely a sign that saliva and food are staying in the esophagus or stomach longer than the body intends. And inability to swallow it is probably a sign of spasm of the remaining esophaghus. In absence of other disease states (ie diabetes), it could be due to a narrowing of the site where the esophagus was attached to the stomach or just due to the massive physiological change. In case of narrowing, endoscopy is the best treatment. If all appears normal, then scheduled agents like the ones mentioned above are probably the best treatment.

  • Thanks chris - I had expected that ( about taking a drug " as needed " ) really ,but good to have expert guidance !

    I'm anxious and confused about long term use of metaclopromide and of domperidone . I was orginally told that domperidone was preferred for long term use but then domperidone was dropped in favour of metaclopromide .

    I'm really not keen to take metaclopromide long term . I'm nervous about this business of " crossing the brain barrier " and side effects .

    Perhaps you could put this " crossing the blood- brain barrier " into context for me ? Maybe lots of drugs do and it's only because I've heard this mentioned that I'm nervous . It has a dramatic ring to it ,but maybe it's nothing to be concerned about ?

    I don't know why domperidone is no longer the drug of choice ,but metaclopromide makes me very drowsy .

    Have you any thoughts on these two drugs and which has least/lesser side effects ?

    I appreciate it would only be your thoughts .

  • Metoclopramide certainly has possible side-effects, and the longer a person takes it the more likely these effects are to surface.

    The blood brain barrier (BBB) is mostly an issue with drugs that affect neurotransmitters, such as dopamine. That is the advantage of domperidone over metoclopramide. They both work in the same way, but metoclopramide does cross the BBB whereas domperidone does not. The drugs' site of action is on the muscles of the GI tract. Any activity outside of the GI tract are unwanted effect or side-effects. And when the drug in question crosses the BBB, then the side effects are more numerous and do include things such as the drowsiness that you mentioned.

    Many drugs cross the BBB without any problem, and some are meant to work by crossing the BBB. The most important item is what effect the drug in question has on the individual patient. And certainly when a patient has neurological conditions (ie Parkinson's) then a certain drug that crosses the BBB may be contraindicated, or not allowed because of its effect on neurotransmitters.

    Without knowing specifics of the dose you're taking or the exact nature of your surgery and recovery, it's hard to say very much. I would consider halving the dose to see if the drowsiness improves. It's also possible that your doctor only intends for you to take it for a specified period after your surgery. A lot of patients have improvement with the regurgitation about 4-6 weeks after the surgery. I think that domperidone will work the same as the metoclopramide without the drowsiness. I would talk to your doc about why the switch was made.

    Metoclopramide is a safe and very effective drug that can safely be taken long-term. When the positives no longer outweigh the negatives (side effects) then a call to your doc would be in order. And if your doc really wants metoclopramide over domperidone, then maybe you could ask if 5mg would be OK instead of the normal 10mg dose. Would give the a lot of the benefits with less side effects.

  • I was told that metaclopramide can take six weeks before it becomes fully effective, but whether the body then manages to cope with the drowsiness effect better I do not know.

    Thank you so much for that information, Chris. Much appreciated!

  • Thank you for the useful info. Been suffering with this for a while now and I will try retiming my taking of my dose.

  • Metoclopramide has slight possibility of serious side effects, that mainly show after a person has been on the drug for 1-2 months. Any person on metoclopramide that shows signs of involuntary muscle movements, severe jitteriness, or unexplained fever should seek medical help immediately.

    It works well, and the minor side effects such as drowsiness become less noticeable with time. But any major side effects (as listed above) will not go away with time and are an emergent situation.

    Domperidone does not carry these severe side effects due it not crossing the BBB, but it has its own rare serious cardiac side effects.

  • Thanks chris ,really helpful .

  • I suffered with this 'crazy foam' for several months after surgery, so much so that I was constantly throwing up, day and night, as this awful stuff kept triggering the gag reflex. This is one part of the digestive system that hasn't been messed with by the cutting of the vagus nerve. Probably just as well, as I can see the possibility of choking in ones sleep.

    My surgeon told me that it should resolve itself eventually. The metaclopramide and domperidone I had were not specifically prescribed for this (I was overjoyed when I was told I would be having Domperignon...Doh!), and indeed they didn't help at all. Mr. B, the surgeon, thinking outside the box, suggested I try something that had worked for his very young children. This was 'infacol', and relieves wind, infant colic and griping pain in babies and toddlers.

    To my astonishment it worked, to a degree anyway. I would take this on going to bed, through the night if I woke up, and occasionally during the day too. I don't think there's any scientific reason why this should have been of help, but sometimes these things happen.

    One of the best things about the OPA is that we can share our experiences, and if this suggestion helps anyone else then that's a great result.

    I wish you well.

  • My feeling is that we have not got to the bottom of this issue.

    What are the possible culprits?

    1) Saliva

    2)Post nasal drip

    3)Lung secretions

    4)Bicarbonate mucus secreted for digestive/protective purposes by the remaining tissue of the pulled-up stomach.

    There are timing and postural factors involved and I am quite certain that I suffer from each of the above both singly and in combination.

    Number (4) is the most critical and it's characteristics [colour/viscosity/bubble content] are quite distinct from the other three.

    Is this of sufficient concern to others?

    What do you think?

  • I think we probably need to consult a gastroenterologist /ear nose and throat specialist for some advice.

    I'll put my thinking cap on!

    Alan

  • thanks Alan, The post nasel drip mentioned by Shack is a never ending source of annoyance especially in the winter, any thought on this would be gratefully received too

    Cheers Lizzy

  • I have asked a surgeon for his comments and will post these when I receive them. Can you expand on the 'post nasal drip' issue as I am not sure I understand it properly?

  • I have now received the surgeon's response as follows:

    "The four secretions are correct. Difficult to distinguish. My experience is that these problems are more significant in the presence of an anastomotic stricture. That would be my first thought. Reflux and failure conduit emptying also contribute"

  • Alan,it seems to me that this topic is worthy of further investigation.

    As far as I am concerned the principal annoyance is continual throat clearing/coughing,which must be very tedious for those in one's vicinity.

    The phenomenon is quite separate from the various types of reflux or choking on food.

    Good to hear that we are on the right track with the four secretions,distinguishing each is possible if they can be expectorated -- photography anyone ?

    I have some ENT data which I will try to dig out.

    Should we re-post as a new thread ?

  • We could perhaps have a new poll on the site to test how many have problems? I would welcome suggestions about how it would be worded!

  • Imwas on domperidone prescribed by a consultant at my last review my dr said come straight off it..looked it,up had comments about taking it when older..to be,truthful it didn't make me feel,any better anyhow

  • Sometimes what works for a period becomes less necessary or effective after a period. Or it might cure a problem short term and no longer ne necessary. Sometimes what works for some may not work for everyone; or it might be that trying one medication is a good option that should be tried, but there is a percentage of patients that need to try second or third options.

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