GERD, allergies, or something else?
Question:
I have been experiencing difficulty swallowing persistantly for about 2 months. I am actively persuing this with my gastroenterologist as well as my allergist, however I am am looking for insight and ideas of what might be causing this. A bit about my medical history… I am 25 years old male, 5′ 11" tall, and weigh 135 lbs (underweight for my height, but healthy). I bike or run 2-3 times a week, and lift weights 1-2 times a week. I typically eat a lot (perhaps sometimes overeat). I was diagnosed with "erosive esophagus" during an endoscopy about 1.5 years ago and have been on prevacid 30mg since then. I also have significant nasal allergies, and have been getting allergy injections for about 2 years now. Don’t know if any of that is relavent, but just in case… My symptoms…It feels like my throat is swollen. Not sore, just swollen/irritated. In the morning when I wake up, it is typically fine, but as the day wears on it begins to become worse, and it is definitely worse after meals. If I eat a full meal (or especially if I overeat, it becomes accutely worse, to the point where I feel short of breath, although I can really still breath fine). The sensation is not painful, but just very uncomfortable…like I have to keep swallowing, but can’t get everything down, if that makes sense. There have only been a few instances where it was bad enough that I could not eat. Usually I feel fine WHILE I am eating but then the problem is worse once I am done, and persists for several hours afterwards. I frequently feel like I need to burp, but can’t. Sometimes when I do burb, it makes the feeling in my throat worse (perhaps stomach juices are making it the whole way up to my throat?). I have not had much heartburn, because I take the prevacid. Doubling my prevacid to 30mg twice daily did not help. If anything, it made the problem worse. When this first started, my allergies were flaring up and I had a significant amount of drainage, so I thought the problem might be allergy related. Since then, my allergies have cleared up, but the problem persists (this is when it became more apparent that it was worsened by eating full meals). A couple of questions…. If this is GERD related, why isn’t the prevacid keeping my stomach acid at bay? Is there another medication I should try? Prilosec or Nexium perhaps? I was fine on Prevacid for over a year. Might this be an allergic reaction to the medication? Could this be allergy related? Would it make sense that my drainage from allergies makes it worse? Any insight is appreciated. -mark
Response:
– Hide quoted text — Show quoted text -> I have been experiencing difficulty swallowing persistantly for about > 2 months. I am actively persuing this with my gastroenterologist as > well as my allergist, however I am am looking for insight and ideas of > what might be causing this. > A bit about my medical history… I am 25 years old male, 5′ 11" tall, > and weigh 135 lbs (underweight for my height, but healthy). I bike or > run 2-3 times a week, and lift weights 1-2 times a week. I typically > eat a lot (perhaps sometimes overeat). I was diagnosed with "erosive > esophagus" during an endoscopy about 1.5 years ago and have been on > prevacid 30mg since then. I also have significant nasal allergies, > and have been getting allergy injections for about 2 years now. Don’t > know if any of that is relavent, but just in case… > My symptoms…It feels like my throat is swollen. Not sore, just > swollen/irritated. In the morning when I wake up, it is typically > fine, but as the day wears on it begins to become worse, and it is > definitely worse after meals.
Sounds like Gerd. Feel like you have the lump in the throat? If I eat a full meal (or especially if – Hide quoted text — Show quoted text -> I overeat, it becomes accutely worse, to the point where I feel short > of breath, although I can really still breath fine). The sensation is > not painful, but just very uncomfortable…like I have to keep > swallowing, but can’t get everything down, if that makes sense. There > have only been a few instances where it was bad enough that I could > not eat. Usually I feel fine WHILE I am eating but then the problem > is worse once I am done, and persists for several hours afterwards. I > frequently feel like I need to burp, but can’t. Sometimes when I do > burb, it makes the feeling in my throat worse (perhaps stomach juices > are making it the whole way up to my throat?). I have not had much > heartburn, because I take the prevacid. Doubling my prevacid to 30mg > twice daily did not help. If anything, it made the problem worse. > When this first started, my allergies were flaring up and I had a > significant amount of drainage, so I thought the problem might be > allergy related. Since then, my allergies have cleared up, but the > problem persists (this is when it became more apparent that it was > worsened by eating full meals). > A couple of questions…. > If this is GERD related, why isn’t the prevacid keeping my stomach > acid at bay?
It doesnt work on everyone… > Is there another medication I should try? Prilosec or Nexium perhaps?
yes > I was fine on Prevacid for over a year. Might this be an allergic > reaction to the medication?
No but ask your doctor to change your meds. > Could this be allergy related? Would it make sense that my drainage > from allergies makes it worse?
Alot of people have allergies and gerd. I dont think the two are related but you can ask your doctor. > Any insight is appreciated. > -mark
I have the lump in the throat feeling, asthmatic feeling because of acid, and sometimes pains… it is acid reflux. I have never had the endeoscopy like you have but plan too… There are surgeries that can be done because of them but its up to you and your doctor to discuss the alternatives. Ask me any questions.
Response:
I think you need to see a specialist. Perhaps visit a swallowing clinic. There are many good ones in the US. Where are you located?
– Hide quoted text — Show quoted text -> I have been experiencing difficulty swallowing persistantly for about > 2 months. I am actively persuing this with my gastroenterologist as > well as my allergist, however I am am looking for insight and ideas of > what might be causing this. > A bit about my medical history… I am 25 years old male, 5′ 11" tall, > and weigh 135 lbs (underweight for my height, but healthy). I bike or > run 2-3 times a week, and lift weights 1-2 times a week. I typically > eat a lot (perhaps sometimes overeat). I was diagnosed with "erosive > esophagus" during an endoscopy about 1.5 years ago and have been on > prevacid 30mg since then. I also have significant nasal allergies, > and have been getting allergy injections for about 2 years now. Don’t > know if any of that is relavent, but just in case… > My symptoms…It feels like my throat is swollen. Not sore, just > swollen/irritated. In the morning when I wake up, it is typically > fine, but as the day wears on it begins to become worse, and it is > definitely worse after meals. If I eat a full meal (or especially if > I overeat, it becomes accutely worse, to the point where I feel short > of breath, although I can really still breath fine). The sensation is > not painful, but just very uncomfortable…like I have to keep > swallowing, but can’t get everything down, if that makes sense. There > have only been a few instances where it was bad enough that I could > not eat. Usually I feel fine WHILE I am eating but then the problem > is worse once I am done, and persists for several hours afterwards. I > frequently feel like I need to burp, but can’t. Sometimes when I do > burb, it makes the feeling in my throat worse (perhaps stomach juices > are making it the whole way up to my throat?). I have not had much > heartburn, because I take the prevacid. Doubling my prevacid to 30mg > twice daily did not help. If anything, it made the problem worse. > When this first started, my allergies were flaring up and I had a > significant amount of drainage, so I thought the problem might be > allergy related. Since then, my allergies have cleared up, but the > problem persists (this is when it became more apparent that it was > worsened by eating full meals). > A couple of questions…. > If this is GERD related, why isn’t the prevacid keeping my stomach > acid at bay? > Is there another medication I should try? Prilosec or Nexium perhaps? > I was fine on Prevacid for over a year. Might this be an allergic > reaction to the medication? > Could this be allergy related? Would it make sense that my drainage > from allergies makes it worse? > Any insight is appreciated. > -mark
Response:
Can H. Pylori cause esophagitis? Has anyone had symptoms where it just feels like the esophagus is swollen/irritated? I rarely ever get heartburn anymore, but the one thing I have noticed is, if I take prevacid 30mg twice a day, the symptoms become accutely worse. This almost seems like an infection to me. Interestingly, if I stop the prevacid for a day or so, I do get mild heartburn, but it actually feels sort of soothing, and I don’t have the swollen feeling or difficulty swallowing while the heartburn is there. I just can’t stand this uncomfortable swallowing feeling. Anyone have any experience with something like this? I have an endoscopy scheduled for sept 2nd, and am doing a 24hour pH test on Sept 11, so hopefully those 2 tests will reveal something… -mark – Hide quoted text — Show quoted text – > I think you need to see a specialist. Perhaps visit a swallowing clinic. > There are many good ones in the US. Where are you located? > I have been experiencing difficulty swallowing persistantly for about > 2 months. I am actively persuing this with my gastroenterologist as > well as my allergist, however I am am looking for insight and ideas of > what might be causing this. > A bit about my medical history… I am 25 years old male, 5′ 11" tall, > and weigh 135 lbs (underweight for my height, but healthy). I bike or > run 2-3 times a week, and lift weights 1-2 times a week. I typically > eat a lot (perhaps sometimes overeat). I was diagnosed with "erosive > esophagus" during an endoscopy about 1.5 years ago and have been on > prevacid 30mg since then. I also have significant nasal allergies, > and have been getting allergy injections for about 2 years now. Don’t > know if any of that is relavent, but just in case… > My symptoms…It feels like my throat is swollen. Not sore, just > swollen/irritated. In the morning when I wake up, it is typically > fine, but as the day wears on it begins to become worse, and it is > definitely worse after meals. If I eat a full meal (or especially if > I overeat, it becomes accutely worse, to the point where I feel short > of breath, although I can really still breath fine). The sensation is > not painful, but just very uncomfortable…like I have to keep > swallowing, but can’t get everything down, if that makes sense. There > have only been a few instances where it was bad enough that I could > not eat. Usually I feel fine WHILE I am eating but then the problem > is worse once I am done, and persists for several hours afterwards. I > frequently feel like I need to burp, but can’t. Sometimes when I do > burb, it makes the feeling in my throat worse (perhaps stomach juices > are making it the whole way up to my throat?). I have not had much > heartburn, because I take the prevacid. Doubling my prevacid to 30mg > twice daily did not help. If anything, it made the problem worse. > When this first started, my allergies were flaring up and I had a > significant amount of drainage, so I thought the problem might be > allergy related. Since then, my allergies have cleared up, but the > problem persists (this is when it became more apparent that it was > worsened by eating full meals). > A couple of questions…. > If this is GERD related, why isn’t the prevacid keeping my stomach > acid at bay? > Is there another medication I should try? Prilosec or Nexium perhaps? > I was fine on Prevacid for over a year. Might this be an allergic > reaction to the medication? > Could this be allergy related? Would it make sense that my drainage > from allergies makes it worse? > Any insight is appreciated. > -mark
Response:
> Can H. Pylori cause esophagitis? Has anyone had symptoms where it > just feels like the esophagus is swollen/irritated? I rarely ever get > heartburn anymore, but the one thing I have noticed is, if I take > prevacid 30mg twice a day, the symptoms become accutely worse. This > almost seems like an infection to me. Interestingly, if I stop the > prevacid for a day or so, I do get mild heartburn, but it actually > feels sort of soothing, and I don’t have the swollen feeling or > difficulty swallowing while the heartburn is there. I just can’t > stand this uncomfortable swallowing feeling. > Anyone have any experience with something like this? > I have an endoscopy scheduled for sept 2nd, and am doing a 24hour pH > test on Sept 11, so hopefully those 2 tests will reveal something…
No, H. Pylori has nothing to do with GERD. In fact, for reasons that aren’t entirely clear, an H. pylori infection tends to ameliorate GERD. The EGD and 24 hour ambulatory pH test will be definitive. The pH test will tell whether or not you do have esophageal reflux, and the EGD will demonstrate whether or not you have the COMPLICATIONS of GERD, such as erosive esophagitis, stricture, or Barrett’s esophagus. 24 hour catheter-based ambulatory pH testing is a little problematic and its accuracy is impaired compared to more modern methods. It’s important, while the catheter is in place, to live a normal life. That is, eat the things you normally eat, do your normal activities etc. These things are hard to do when you have a tube down your nose connected to a device on your belt. A better test is 48 hour wireless ambulatory pH testing. This test uses a small, capsule-sized pH sensor that wireless transmits pH data to a pager-sized device you wear on your belt, or keep within 4 or 5 feet of you. There is no cather, it is completely comfortable, you can shower, eat or do any other normal activity. It is far more accurate than catheter-based pH testing. Look at http://tinyurl.com/k4yz for information on this method of pH testing and ask your gastroenterologist if it’s available to you. HMc
Response:
> Since then, my allergies have cleared up, but the >problem persists (this is when it became more apparent that it was >worsened by eating full meals).
I suggest you try a completely gluten-free meal and see if you get the symptoms. You have some characteristics of undiagnosed celiac disease. Don <donwiss at panix.com>.
Response:
- Hide quoted text — Show quoted text -> Can H. Pylori cause esophagitis? Has anyone had symptoms where it > just feels like the esophagus is swollen/irritated? I rarely ever get > heartburn anymore, but the one thing I have noticed is, if I take > prevacid 30mg twice a day, the symptoms become accutely worse. This > almost seems like an infection to me. Interestingly, if I stop the > prevacid for a day or so, I do get mild heartburn, but it actually > feels sort of soothing, and I don’t have the swollen feeling or > difficulty swallowing while the heartburn is there. I just can’t > stand this uncomfortable swallowing feeling. > Anyone have any experience with something like this? > I have an endoscopy scheduled for sept 2nd, and am doing a 24hour pH > test on Sept 11, so hopefully those 2 tests will reveal something… > No, H. Pylori has nothing to do with GERD. In fact, for reasons that aren’t > entirely clear, an H. pylori infection tends to ameliorate GERD. > The EGD and 24 hour ambulatory pH test will be definitive. The pH test will > tell whether or not you do have esophageal reflux, and the EGD will > demonstrate whether or not you have the COMPLICATIONS of GERD, such as > erosive esophagitis, stricture, or Barrett’s esophagus. > 24 hour catheter-based ambulatory pH testing is a little problematic and its > accuracy is impaired compared to more modern methods. It’s important, while > the catheter is in place, to live a normal life. That is, eat the things you > normally eat, do your normal activities etc. These things are hard to do > when you have a tube down your nose connected to a device on your belt. A > better test is 48 hour wireless ambulatory pH testing. This test uses a > small, capsule-sized pH sensor that wireless transmits pH data to a > pager-sized device you wear on your belt, or keep within 4 or 5 feet of you. > There is no cather, it is completely comfortable, you can shower, eat or do > any other normal activity. It is far more accurate than catheter-based pH > testing. > Look at http://tinyurl.com/k4yz for information on this method of pH testing > and ask your gastroenterologist if it’s available to you. > HMc
Thanks for the info. I will definitely ask my doctor about the "wireless" verysion of the pH test. That sounds much more reasonable. I guess if its not available, I will still do the catheter-based test, as it sounds like that test can provide a lot of good information. I already know from a past endoscopy that I have (or at least HAD) erosive esophagus. I didn’t have any heartburn at the time of that diagnosis, but was prescribed prevacid 30mg, and have taken that daily since then (about 1.5 years ago). I am very young for this, and I know that surgery might be a good option for me, based on the results of the pH test. I read about the Stretta procedure, which sounds interesting. Has anyone had that procedure, or does anyone have any advice on it? -mark
Response:
> I read about the Stretta procedure, which sounds > interesting. Has anyone had that procedure, or does anyone have any > advice on it?
I have done the Stretta procedure many times. Patient selection is critical to success of this procedure, but in the appropriate patient, it is an excellent option. It is entirely outpatient, has very few complications, very few side effects, and no activity or diet restrictions. The major disadvantage is that it can take months for the effects to manifest themselves. It has about an 80% – 90% success rate (off all meds within 1 year). Can’t be done in patients with a large hiatus hernia. Relative to anti-reflux procedures, I do about 60% lap fundoplications and 40% Stretta. If you have a history of erosive esophagitis observed on EGD, then the pH testing has little value since it is already established that you have severe GERD and that is the point of pH testing. You will need esophageal manometry, however, to make sure you have adequate esophageal function and no underlying motility disorders. HMc
Response:
Actually, I am on a gluten free diet full time already 
I was diagnosed with celiac disease about 8 years ago. The GERD symptoms started shortly afterwards, and became severe about 3 months ago. It hasn’t been a very fun summer… -mark – Hide quoted text — Show quoted text -> Since then, my allergies have cleared up, but the >problem persists (this is when it became more apparent that it was >worsened by eating full meals). > I suggest you try a completely gluten-free meal and see if you get the > symptoms. You have some characteristics of undiagnosed celiac disease. > Don <donwiss at panix.com>.
Response:
Thanks for the feedback. I am definitely intrigued by the Stretta procedure. I am very young (25 years old) to be having GERD this bad. I want to weigh my options and make the appropriate choices, in terms of meds, or surgery, and if surgery, which one. I have heard that the long term relapse rate is quite high with the lap fundoplications, and the complications such as dysphagia, difficulty belching, vomiting, etc., scare me a bit. I like the idea of the Stretta procedure, but I guess it is too new to know if it will work long term (like for the rest of my life). Do you have any thoughts on this? Can a Stretta procedure be done more than once if needed? Last endoscopy, i was diagnosed with erosive esophagus (just 1 ulcer, I believe). No hiatus hernia at that time (1.5 years ago). I was on 30mg of prevacid since then, until it stopped working earlier this summer. I am trying aciphex 20mg right now, but I can’t tell if it is helping any better yet. It just seems surprising to me that I could still have symptoms, while on prevacid 30mg, which is pretty strong, right? I will find out more results in a little over a week when I have another endoscopy done. Are there any chances that being on a moderate/high dose of PPIs can allow problems such as yeast esophagitis, or something of that nature to happen in an immuno-competant person? I feel like I am digging with a question like that, but this came on very suddenly, and has been very persistant for a couple months. -mark – Hide quoted text — Show quoted text -> I read about the Stretta procedure, which sounds > interesting. Has anyone had that procedure, or does anyone have any > advice on it? > I have done the Stretta procedure many times. Patient selection is critical > to success of this procedure, but in the appropriate patient, it is an > excellent option. It is entirely outpatient, has very few complications, > very few side effects, and no activity or diet restrictions. The major > disadvantage is that it can take months for the effects to manifest > themselves. It has about an 80% – 90% success rate (off all meds within 1 > year). Can’t be done in patients with a large hiatus hernia. Relative to > anti-reflux procedures, I do about 60% lap fundoplications and 40% Stretta. > If you have a history of erosive esophagitis observed on EGD, then the pH > testing has little value since it is already established that you have > severe GERD and that is the point of pH testing. You will need esophageal > manometry, however, to make sure you have adequate esophageal function and > no underlying motility disorders. > HMc
Response:
– Hide quoted text — Show quoted text -> Thanks for the feedback. I am definitely intrigued by the Stretta > procedure. I am very young (25 years old) to be having GERD this bad. > I want to weigh my options and make the appropriate choices, in terms > of meds, or surgery, and if surgery, which one. I have heard that the > long term relapse rate is quite high with the lap fundoplications, and > the complications such as dysphagia, difficulty belching, vomiting, > etc., scare me a bit. I like the idea of the Stretta procedure, but I > guess it is too new to know if it will work long term (like for the > rest of my life). Do you have any thoughts on this? Can a Stretta > procedure be done more than once if needed? > Last endoscopy, i was diagnosed with erosive esophagus (just 1 ulcer, > I believe). No hiatus hernia at that time (1.5 years ago). I was on > 30mg of prevacid since then, until it stopped working earlier this > summer. I am trying aciphex 20mg right now, but I can’t tell if it is > helping any better yet. It just seems surprising to me that I could > still have symptoms, while on prevacid 30mg, which is pretty strong, > right? > I will find out more results in a little over a week when I have > another endoscopy done. > Are there any chances that being on a moderate/high dose of PPIs can > allow problems such as yeast esophagitis, or something of that nature > to happen in an immuno-competant person? I feel like I am digging > with a question like that, but this came on very suddenly, and has > been very persistant for a couple months.
At 25, with a history of erosive esophagitis , the chances that PPI’s will control your GERD for the rest of your life are negligible, even with lifestyle modifications. Long term use of PPI’s will result in increasing polyp formation in your stomach due to the trophic changes of unopposed gastrin, but there is no evidence to support the assertion that it will increase your risk of gastric cancer. Stretta is new. It’s specific long-term effect isn’t known. However, the long term effects of radiofrequency energy on human tissue are known. Once collagen is deposited in the LES, and the afferent nerves are ablated, the science of the issue would lead one to believe that the effects are permanent. There are no long term studies to prove this, however. Yes, Stretta can be done more than once. Lap fundoplication is a good operation. The recurrence rate is 6-10% at 5 years in competent hands, the specific recurrence rate is surgeon-dependant. Dysphagia tends to be a temporary phenomenon, about 2-6 weeks and depends very much on the pre-operative motility of the esophagus. The decreased ability to belch can be problematic, but tends to decrease with time as the patient learns to not swallow air (now that he doesn’t need to do that to clear acid from the esophagus). IME, most patients find that to be an acceptable trade-off compared to a lifetime of poorly-controlled, or uncontrolled, GERD. HMc
Response:
>Actually, I am on a gluten free diet full time already I was >diagnosed with celiac disease about 8 years ago. The GERD symptoms >started shortly afterwards, and became severe about 3 months ago. It >hasn’t been a very fun summer…
Are you on a dairy-free diet? Don <donwiss at panix.com>.
Response:
Hello again. I just had my endoscopy today. They said things looked "normal", which sounds like good news to me. They gave me 4 pictures that they said we would discuss at my follow-up appointment (2 weeks from now). I don’t know what each picture is of. Just for fun, are there any gastroenterologists out there that could respond telling me exactly what I am looking at in each picture? I posted them at: http://members.verizon.net/~vze23dzw/Pictures/marksinners_ed.jpg Thanks! -mark – Hide quoted text — Show quoted text -> Thanks for the feedback. I am definitely intrigued by the Stretta > procedure. I am very young (25 years old) to be having GERD this bad. > I want to weigh my options and make the appropriate choices, in terms > of meds, or surgery, and if surgery, which one. I have heard that the > long term relapse rate is quite high with the lap fundoplications, and > the complications such as dysphagia, difficulty belching, vomiting, > etc., scare me a bit. I like the idea of the Stretta procedure, but I > guess it is too new to know if it will work long term (like for the > rest of my life). Do you have any thoughts on this? Can a Stretta > procedure be done more than once if needed? > Last endoscopy, i was diagnosed with erosive esophagus (just 1 ulcer, > I believe). No hiatus hernia at that time (1.5 years ago). I was on > 30mg of prevacid since then, until it stopped working earlier this > summer. I am trying aciphex 20mg right now, but I can’t tell if it is > helping any better yet. It just seems surprising to me that I could > still have symptoms, while on prevacid 30mg, which is pretty strong, > right? > I will find out more results in a little over a week when I have > another endoscopy done. > Are there any chances that being on a moderate/high dose of PPIs can > allow problems such as yeast esophagitis, or something of that nature > to happen in an immuno-competant person? I feel like I am digging > with a question like that, but this came on very suddenly, and has > been very persistant for a couple months. > At 25, with a history of erosive esophagitis , the chances that PPI’s will > control your GERD for the rest of your life are negligible, even with > lifestyle modifications. Long term use of PPI’s will result in increasing > polyp formation in your stomach due to the trophic changes of unopposed > gastrin, but there is no evidence to support the assertion that it will > increase your risk of gastric cancer. > Stretta is new. It’s specific long-term effect isn’t known. However, the > long term effects of radiofrequency energy on human tissue are known. Once > collagen is deposited in the LES, and the afferent nerves are ablated, the > science of the issue would lead one to believe that the effects are > permanent. There are no long term studies to prove this, however. Yes, > Stretta can be done more than once. > Lap fundoplication is a good operation. The recurrence rate is 6-10% at 5 > years in competent hands, the specific recurrence rate is surgeon-dependant. > Dysphagia tends to be a temporary phenomenon, about 2-6 weeks and depends > very much on the pre-operative motility of the esophagus. The decreased > ability to belch can be problematic, but tends to decrease with time as the > patient learns to not swallow air (now that he doesn’t need to do that to > clear acid from the esophagus). IME, most patients find that to be an > acceptable trade-off compared to a lifetime of poorly-controlled, or > uncontrolled, GERD. > HMc
Response:
> Hello again. I just had my endoscopy today. They said things looked > "normal", which sounds like good news to me. They gave me 4 pictures > that they said we would discuss at my follow-up appointment (2 weeks > from now). I don’t know what each picture is of. Just for fun, are > there any gastroenterologists out there that could respond telling me > exactly what I am looking at in each picture? I posted them at: > http://members.verizon.net/~vze23dzw/Pictures/marksinners_ed.jpg
#1 is the gastroesophageal junction from above, #2 is the distal stomach (antrum) and pylorus, #3 is a retroflexed view of the GE junction from underneath, #4 is the upper part of the stomach. I agree, they all look normal. HMc
Response:
Thanks for the information. I am very pleased that things look normal. I didn’t walk away with concrete answers as to what is causing my symptoms, but at least I know now that there is no active damage or anything like that causing the problem. In picture #1, the LES looks like it is open a little. Is that normal? Also, it looks to me like my esophagus is very wide at the bottom. Is this just my perception? Next is the pH test to determine how things are functioning. Fun, fun… -mark – Hide quoted text — Show quoted text -> Hello again. I just had my endoscopy today. They said things looked > "normal", which sounds like good news to me. They gave me 4 pictures > that they said we would discuss at my follow-up appointment (2 weeks > from now). I don’t know what each picture is of. Just for fun, are > there any gastroenterologists out there that could respond telling me > exactly what I am looking at in each picture? I posted them at: > http://members.verizon.net/~vze23dzw/Pictures/marksinners_ed.jpg > #1 is the gastroesophageal junction from above, #2 is the distal stomach > (antrum) and pylorus, #3 is a retroflexed view of the GE junction from > underneath, #4 is the upper part of the stomach. > I agree, they all look normal. > HMc
Response:
> Thanks for the information. I am very pleased that things look > normal. I didn’t walk away with concrete answers as to what is > causing my symptoms, but at least I know now that there is no active > damage or anything like that causing the problem. > In picture #1, the LES looks like it is open a little. Is that > normal? Also, it looks to me like my esophagus is very wide at the > bottom. Is this just my perception? > Next is the pH test to determine how things are functioning. Fun, > fun…
Nah, the LES looks normal. However, during the course of an EGD, it will relax and contract, so a single snapshot doesn’t necessarily convey the true overall state of the LES. I assume that the endoscopist took it as a representative picture, knowing he only had 4 shots that he could take on the Mavigraph on each sheet. HMc
Response:
Well, its been a while since I updated this thread, but I have some testing progress today. I had the esophageal manometry this morning, immediately followed by the insertion of the pH tube. I must say, this test is very unpleasant, but I do like that I can see the readout right on the display. I have had heartburn off and on all day, and typically when I check the pH, while feeling heartburn, it read, .8 – 2 or so. About half of the time the upper pH sensor reading is also near the same (.8 – 2). Looks to me like the reflux is significant. Of course I’ll get the real results tommorrow when they transfer the data from the digitrapper. Hope to also get the manometry results tomorrow… -mark – Hide quoted text — Show quoted text -> Thanks for the information. I am very pleased that things look > normal. I didn’t walk away with concrete answers as to what is > causing my symptoms, but at least I know now that there is no active > damage or anything like that causing the problem. > In picture #1, the LES looks like it is open a little. Is that > normal? Also, it looks to me like my esophagus is very wide at the > bottom. Is this just my perception? > Next is the pH test to determine how things are functioning. Fun, > fun… > Nah, the LES looks normal. However, during the course of an EGD, it will > relax and contract, so a single snapshot doesn’t necessarily convey the true > overall state of the LES. I assume that the endoscopist took it as a > representative picture, knowing he only had 4 shots that he could take on > the Mavigraph on each sheet. > HMc
Response:
> Well, its been a while since I updated this thread, but I have some > testing progress today. I had the esophageal manometry this morning, > immediately followed by the insertion of the pH tube. I must say, > this test is very unpleasant, but I do like that I can see the readout > right on the display. I have had heartburn off and on all day, and > typically when I check the pH, while feeling heartburn, it read, .8 – > 2 or so. About half of the time the upper pH sensor reading is also > near the same (.8 – 2). Looks to me like the reflux is significant. > Of course I’ll get the real results tommorrow when they transfer the > data from the digitrapper. Hope to also get the manometry results > tomorrow… > -mark
Yes, it does indeed sound like severe GERD. However, you have a history of erosive esophagitis, IIRC, so that severe GERD diagnosis has already been made. How did the manometry turn out. I’ll bet you have decreased motility and a low resting LES pressure. Keep us posted on your progress. I am interested to see what your doctor does with the diagnosis, and how well his/her proposed treatment works for you. HMc
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So glad the pH test is over. I have posted the results of manometry page, by page at: http://members.verizon.net/~vze23dzw/pictures/reflux/page1.jpg http://members.verizon.net/~vze23dzw/pictures/reflux/page2.jpg http://members.verizon.net/~vze23dzw/pictures/reflux/page3.jpg http://members.verizon.net/~vze23dzw/pictures/reflux/page4.jpg and the pH test at: http://members.verizon.net/~vze23dzw/pictures/reflux/page5.jpg http://members.verizon.net/~vze23dzw/pictures/reflux/page6.jpg My reflux was really bad during the day of the test, which I guess is good for testing purposes? Sounds like the LES is the prime cause, by looking at the results. I have a followup with my doc on Oct 2nd to discuss the results and future treatment. In the meantime, What’s the diagnosis, Doc? -mark – Hide quoted text — Show quoted text -> Well, its been a while since I updated this thread, but I have some > testing progress today. I had the esophageal manometry this morning, > immediately followed by the insertion of the pH tube. I must say, > this test is very unpleasant, but I do like that I can see the readout > right on the display. I have had heartburn off and on all day, and > typically when I check the pH, while feeling heartburn, it read, .8 – > 2 or so. About half of the time the upper pH sensor reading is also > near the same (.8 – 2). Looks to me like the reflux is significant. > Of course I’ll get the real results tommorrow when they transfer the > data from the digitrapper. Hope to also get the manometry results > tomorrow… > -mark > Yes, it does indeed sound like severe GERD. However, you have a history of > erosive esophagitis, IIRC, so that severe GERD diagnosis has already been > made. How did the manometry turn out. I’ll bet you have decreased motility > and a low resting LES pressure. > Keep us posted on your progress. I am interested to see what your doctor > does with the diagnosis, and how well his/her proposed treatment works for > you. > HMc
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– Hide quoted text — Show quoted text -> So glad the pH test is over. I have posted the results of manometry > page, by page at: > http://members.verizon.net/~vze23dzw/pictures/reflux/page1.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page2.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page3.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page4.jpg > and the pH test at: > http://members.verizon.net/~vze23dzw/pictures/reflux/page5.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page6.jpg > My reflux was really bad during the day of the test, which I guess is > good for testing purposes? Sounds like the LES is the prime cause, by > looking at the results. I have a followup with my doc on Oct 2nd to > discuss the results and future treatment. In the meantime, What’s the > diagnosis, Doc? > -mark
– Hide quoted text — Show quoted text -> > Well, its been a while since I updated this thread, but I have some > > testing progress today. I had the esophageal manometry this morning, > > immediately followed by the insertion of the pH tube. I must say, > > this test is very unpleasant, but I do like that I can see the readout > > right on the display. I have had heartburn off and on all day, and > > typically when I check the pH, while feeling heartburn, it read, .8 – > > 2 or so. About half of the time the upper pH sensor reading is also > > near the same (.8 – 2). Looks to me like the reflux is significant. > > Of course I’ll get the real results tommorrow when they transfer the > > data from the digitrapper. Hope to also get the manometry results > > tomorrow… > > -mark > Yes, it does indeed sound like severe GERD. However, you have a history of > erosive esophagitis, IIRC, so that severe GERD diagnosis has already been > made. How did the manometry turn out. I’ll bet you have decreased motility > and a low resting LES pressure. > Keep us posted on your progress. I am interested to see what your doctor > does with the diagnosis, and how well his/her proposed treatment works for > you. > HMc
OK, here’s the way I see it. Your esophagus functions OK – body peristalsis is satisfactory. Your lower esophageal sphincter functions OK – relaxes appropriately and has satisfactory residual pressure after wet swallows. The resting LES pressure is low indicating some laxity. Your esophagus is actually in pretty good shape – much better than I would have guessed. However, your pH test (which demonstrates really severe GERD, BTW) shows that most of your reflux occurs while upright, and after meals. There is very little reflux while supine. This indicates to me that your GERD is far more related to transient inappropriate LES relaxation than it is to low resting pressure, although both factors are playing a role. This, in conjunction with the relatively low resting pressure, your age, the severity of your GERD, and your history of erosive esophagitis, indicates that medical or lifestyle management is HIGHLY unlikely to control your symptoms or prevent damage / Barrett’s to your esophagus. I perceive that a laparoscopic gastric fundoplication is your only realistic option. HMc
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- Hide quoted text — Show quoted text -> So glad the pH test is over. I have posted the results of manometry > page, by page at: > http://members.verizon.net/~vze23dzw/pictures/reflux/page1.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page2.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page3.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page4.jpg > and the pH test at: > http://members.verizon.net/~vze23dzw/pictures/reflux/page5.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page6.jpg > My reflux was really bad during the day of the test, which I guess is > good for testing purposes? Sounds like the LES is the prime cause, by > looking at the results. I have a followup with my doc on Oct 2nd to > discuss the results and future treatment. In the meantime, What’s the > diagnosis, Doc? > -mark > > > Well, its been a while since I updated this thread, but I have some > > > testing progress today. I had the esophageal manometry this morning, > > > immediately followed by the insertion of the pH tube. I must say, > > > this test is very unpleasant, but I do like that I can see the readout > > > right on the display. I have had heartburn off and on all day, and > > > typically when I check the pH, while feeling heartburn, it read, .8 – > > > 2 or so. About half of the time the upper pH sensor reading is also > > > near the same (.8 – 2). Looks to me like the reflux is significant. > > > Of course I’ll get the real results tommorrow when they transfer the > > > data from the digitrapper. Hope to also get the manometry results > > > tomorrow… > > > -mark > > Yes, it does indeed sound like severe GERD. However, you have a history > of > > erosive esophagitis, IIRC, so that severe GERD diagnosis has already > been > > made. How did the manometry turn out. I’ll bet you have decreased > motility > > and a low resting LES pressure. > > Keep us posted on your progress. I am interested to see what your doctor > > does with the diagnosis, and how well his/her proposed treatment works > for > > you. > > HMc > OK, here’s the way I see it. > Your esophagus functions OK – body peristalsis is satisfactory. > Your lower esophageal sphincter functions OK – relaxes appropriately and has > satisfactory residual pressure after wet swallows. The resting LES pressure > is low indicating some laxity. Your esophagus is actually in pretty good > shape – much better than I would have guessed. > However, your pH test (which demonstrates really severe GERD, BTW) shows > that most of your reflux occurs while upright, and after meals. There is > very little reflux while supine. This indicates to me that your GERD is far > more related to transient inappropriate LES relaxation than it is to low > resting pressure, although both factors are playing a role. This, in > conjunction with the relatively low resting pressure, your age, the severity > of your GERD, and your history of erosive esophagitis, indicates that > medical or lifestyle management is HIGHLY unlikely to control your symptoms > or prevent damage / Barrett’s to your esophagus. I perceive that a > laparoscopic gastric fundoplication is your only realistic option. > HMc
Thanks for the evaluation. I don’t suppose I am a candidate for the Stretta procedure? The laparoscopic gastric fundoplication worries me a little because of the possible complications. I don’t know…maybe in my case it would be very straight forward, and unlikely to have complications, but it is definitely a little scary to me. Also, I have heard other doctors say that it is unlikely for it to last long term (I’m talking 10 years +, or for a lifetime…). Do you have an opinion about that? Thanks again for taking time to give me advice through this process… -mark
Response:
– Hide quoted text — Show quoted text -> > So glad the pH test is over. I have posted the results of manometry > > page, by page at: > > http://members.verizon.net/~vze23dzw/pictures/reflux/page1.jpg > > http://members.verizon.net/~vze23dzw/pictures/reflux/page2.jpg > > http://members.verizon.net/~vze23dzw/pictures/reflux/page3.jpg > > http://members.verizon.net/~vze23dzw/pictures/reflux/page4.jpg > > and the pH test at: > > http://members.verizon.net/~vze23dzw/pictures/reflux/page5.jpg > > http://members.verizon.net/~vze23dzw/pictures/reflux/page6.jpg > > My reflux was really bad during the day of the test, which I guess is > > good for testing purposes? Sounds like the LES is the prime cause, by > > looking at the results. I have a followup with my doc on Oct 2nd to > > discuss the results and future treatment. In the meantime, What’s the > > diagnosis, Doc? > > -mark > > > > Well, its been a while since I updated this thread, but I have some > > > > testing progress today. I had the esophageal manometry this morning, > > > > immediately followed by the insertion of the pH tube. I must say, > > > > this test is very unpleasant, but I do like that I can see the readout > > > > right on the display. I have had heartburn off and on all day, and > > > > typically when I check the pH, while feeling heartburn, it read, .8 – > > > > 2 or so. About half of the time the upper pH sensor reading is also > > > > near the same (.8 – 2). Looks to me like the reflux is significant. > > > > Of course I’ll get the real results tommorrow when they transfer the > > > > data from the digitrapper. Hope to also get the manometry results > > > > tomorrow… > > > > -mark > > > Yes, it does indeed sound like severe GERD. However, you have a history > of > > > erosive esophagitis, IIRC, so that severe GERD diagnosis has already > been > > > made. How did the manometry turn out. I’ll bet you have decreased > motility > > > and a low resting LES pressure. > > > Keep us posted on your progress. I am interested to see what your doctor > > > does with the diagnosis, and how well his/her proposed treatment works > for > > > you. > > > HMc > OK, here’s the way I see it. > Your esophagus functions OK – body peristalsis is satisfactory. > Your lower esophageal sphincter functions OK – relaxes appropriately and has > satisfactory residual pressure after wet swallows. The resting LES pressure > is low indicating some laxity. Your esophagus is actually in pretty good > shape – much better than I would have guessed. > However, your pH test (which demonstrates really severe GERD, BTW) shows > that most of your reflux occurs while upright, and after meals. There is > very little reflux while supine. This indicates to me that your GERD is far > more related to transient inappropriate LES relaxation than it is to low > resting pressure, although both factors are playing a role. This, in > conjunction with the relatively low resting pressure, your age, the severity > of your GERD, and your history of erosive esophagitis, indicates that > medical or lifestyle management is HIGHLY unlikely to control your symptoms > or prevent damage / Barrett’s to your esophagus. I perceive that a > laparoscopic gastric fundoplication is your only realistic option. > HMc > Thanks for the evaluation. I don’t suppose I am a candidate for the > Stretta procedure? The laparoscopic gastric fundoplication worries me > a little because of the possible complications. I don’t know…maybe > in my case it would be very straight forward, and unlikely to have > complications, but it is definitely a little scary to me. Also, I > have heard other doctors say that it is unlikely for it to last long > term (I’m talking 10 years +, or for a lifetime…). Do you have an > opinion about that? Thanks again for taking time to give me advice > through this process…
If I recall your situation, you would be a candidate for Stretta and that may be a good option for you. Very little downside to that procedure, except for the fact that it may take up to a year for the effects to fully manifest themselves. HMc
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