Severe infant reflux, now developed silent reflux, possible delayed gastric emptying caused by CMPA

Hello!

Our baby is 4 months 3 weeks old today. After a lot of doctor visits, we got the reflux diagnosis from our pediatrician, that was around 2 months ago. Here in our country we only have one medication for reflux in babies and that is Omeprazole, it's also extremely hard to get, it mostly comes in powdered form, only once have we managed to get the suspension. Anyway, she put us on Omeprazole 5mg once a day after she examined her throat which was red. At that time we didn't see a lot of symptoms. He was fussy after breast, constant spit up, but the spitting up didn't seem to bother him, slept well during days and nights. We were on Omeprazole for 20 days, then we came back, doctor said that throat redness is gone, we said that he still spits up like crazy, but she said it's normal and he will outgrow it. He came off the medicine cold turkey and nobody warned us what could happen then, so he started making sour faces during the day and to wake up screaming at night, he has never done that. We got back on the medicine and have been on it ever since. We have also been on AR formula and thickened breastmilk for about 1,5 months, hasn't help. So at 4 months we went back for another follow-up visit, still the same problems, a lot of spit up, she said it's ok to start solids. He has been on solids + the medicine + AR formula for 3 weeks now, and it keeps getting worse. When we ran out of the suspension, we luckily had another prescription for the powdered form so we continued with that. Yes, I know, suspension is better and the powdered form can be less effective. Also he has gained about 1,5kg and we are still on the same amount 5mg which I understood is on the lower side and for mild reflux.

Anyway for about 2 weeks the symptoms have gotten worse. He fusses, cries about 2 hours after feeding, he has just woken up from his nap so he isn't tired and has started playing. At first we suspected it's due do hunger cause he took to the bottle and breast really quickly. But as I understand, due to the thickness of AR formula, the stomach should empty a lot slower. Now I started suspecting that he might have delayed gastric emptying. I believe we were in a vicious cycle of overfeeding, refluxing more and that causing more to be uncomfortable. I think he only wants the bottle or breast because the liquid soothes his throat, but that is only a temporary fix since his stomach overfills which produces more reflux.

So now I have started lowering his intake. It used to be 200ml per bottle, now 170ml, and 3hr or more in-between feeds, no change. He used to fall asleep and not have the reflux bother him, only when he was active, but now he is smacking lips and making sour faces even when he's in my lap asleep, so he has developed silent reflux as well. For some miraculous reason, he still sleeps a solid 10hr without waking at night, I don't know how, but he does. I am almost certain that will disappear soon if things don't improve.

After a bad sleep/feed again, I read again about CMPA and delayed gastric emptying. He doesn't have the usual CMPA symptoms like rashes, hives, blood in the stool, severe vomiting, which is why I had been quick to dismiss this disorder at first months ago. Doctor didn't even mention it so I brushed it off. But now I read more and CMPA can worsen reflux, and cause delayed gastric emptying. I started my dairy free diet about 6 days ago and baby has been on Pepti MCT for 3 days. I know it's really early to tell whether he actually has CMPA or not, but his symptoms are even worse. More silent reflux, almost constant, he absorbs the nutrients better as the Pepti formula is fast, but now he spits up clear and yellow liquid almost 2-3hr later. We keep him up for 30-40 minutes as well, and he spits up then too but it's milky. Anyway the more he spits up, the more it hurts and today he even spat out mucous when it was the 4th time after one feed, which suggests his body has started making mucous to protect itself from the irritation and acid overflow. He keeps waking up from naps with a sour face and only thing that calms him is me bouncing on a fitness ball, I think it helps somehow with the reflux, I don't know how. He wants to move constantly, can't keep him still, which is also normal because he wants to explore and play, but that only worsens his symptoms of reflux. He should be doing a lot of tummy time but we have been restricting him because he spits up.

I don't know what else to add at this point, it's hard to see him upset, cry and be uncomfortable, but I have just run out of ideas how to help him.

If anyone has had babies with similar symptoms, conditions and have tried the things I have tried, how has it been for you? Did you find relief anywhere else that I haven't yet thought of? Is it a completely different condition?

Please help.