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Gastroenterology  (Expert Forum)
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GERD? Laryngopharyngeal reflux?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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MedHelp Member's Question

GERD? Laryngopharyngeal reflux?

by TrustGod, Jul 26, 2005 12:00AM
My symptoms may have started in Feb 05, with a bad taste in mouth that lasted about a week following a round of zithromax.  That was it. Then at the end of April, the bad taste returned, along with a choking feeling during the night. I visited my PCP, she prescribed Protonix. I took it for 2 weeks - no change.  She told me to try Prilosec. I took the over-the-counter for 2 days, had a slice of pizza, and had the WORST heartburn. I stopped the Prilosec, and took Zantac for a couple days - nothing. Then I stopped taking everything and for the next few days felt pretty good.  I saw a naturopath, changed my diet completely, elevated my bed, lost weight, etc. About a week later, the sore throat started, along with a cough, and the choking sensation again.  I saw an ENT, and he looked through my nose and down my throat. Said it was the worst case of acid reflux he'd ever seen - my throat was "fiery red"  He put me back on Protonix. Took it for 1 week, no change, had a small salad with a little bit of tomatoes and onions, and heartburn again. I stopped again - the heartburn stopped.  But the sore throat and cough continued.  I returned to the ENT - he wanted to do a 24 hour probe and said he would schedule one, but he never called me.  A week later I started on Prevacid - and felt GREAT for 3 days. The 4th day, heartburn pain right in the middle of my chest all day long.   Called my PCP, she said she'd get me in to see a gastroenterologist ASAP.  Saw him 2 days later, and stopped all meds.  He said that he wanted to do an endoscopy and said I probably wasn't taking ENOUGH medication.  This made no sense to me as the ONLY time I had heartburn was when I was on the PPI's.  We scheduled the endoscopy for yesterday. Last weekend, my sis in law convinces me to take her Zantac - 150 mgs. I take it for two days - I feel awesome again.  I tell the doctor I think this is it and want to postpone the endoscopy. He feels I should still have it done, but I'm questioning why? I haven't had acid reflux that long, although off and on over the past years, I've had minor sore throats that would last a few hours - maybe about 2x a month.  And now, after 4 days on 300 mgs of Zantac, the sore throat and cough are starting up again.  



Can you help advise me? Why do I only get heartburn when on the PPI's? Should I have the scope? I'm TERRIFIED of having it - scared of something going wrong.  Sorry this was so long, I hope you can help me understand why the symptoms are happening the way they are. One last thing - when all this started in April I weighed 158 (I'm 5'8") My weight is now 145. I'm not overweight and I don't wear tight clothes. I've given up all spicy and fried food, chocolate, soda, don't drink coffee or alcohol or smoke, I've cut out dairy and wheat - and increased my daily intake of fruit and veggies. The only meds I take is 5 mgs of Paxil a day for anxiety. Oh - my gallbladder was removed 10 years ago and I'm 43, female.
Doctor's Answer

by Kevin Pho, MD, Jul 28, 2005 12:00AM
I would go ahead with the endoscopy.  The symptoms sound like refractory reflux and this can lead to inflammation of the upper digestive tract, and what's called Barrett's esophagus.



If the symptoms continue despite medication (which sounds like the case), you can go forward with the 24-hr pH study to confirm the presence of disease.



If there continues to be GERD, then there are various surgical or endoscopic treatments that can be considered.



These options can be discussed with your GI physician.



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Kevin, M.D.

http://www.straightfromthedoc.com
Member Comments (29)

by TrustGod, Jul 27, 2005 12:00AM
I forgot to add that my symptoms usually get worse as the day progresses. Generally I start off feeling pretty good but by day's end, I'm coughing and my throat is raw.  Right now my stomach feels all bloated.  Anyone got any suggestions for me?  Thanks

by Julie1111, Jul 27, 2005 12:00AM
Hi TrustGod, I have just been through a very similar experience! Although I didn't have the heartburn, the waking up at night choking and general shortness of breath have taken me to my family MD, an allergist and finally a gastroenterologist. I too have been diagnosed with GERD and was prescribed various meds: Aciphex (did not work for me); Pepcid Complete (good-but not strong enough) and now Zegerid (has helped a lot!!) Granted, my life has changed as well: no more caffine, no alcohol, no "trigger foods" (onions, garlic, tomatoes, spicy things, chocolate, etc.) I no longer eat dinner late-by 7 PM at the latest, no snacks after dinner. Bed is elevated, drink enormous amounts of water (no juice). All this has helped.



I had the upper endoscopy today. They found major irritation in my esophagus, and confirmed the GERD diagnosis. I have never had these problems before and LOVE the foods I've had to cut out. But my doc claims with another 3 weeks of the med I should be back to normal and need it only for flair-ups. I would suggest the endoscopy-it was not bad and I am a real baby about things!! I was sedated, so felt nothing (only the IV pinched a little, like giving blood) and woke up after the whole thing! I had this procedure 4 hours ago, sedation has worn off and I have no soreness or anything.



Also, judging by your screen name, you might understand this: I of course was terrified by what I've been through in the past 3 weeks (suddenly began 3 weeks ago). But in retrospect, God sometimes uses situations to get our attention and draw us closer to Him. I know that is the case for me-I've found reading Psalms to be very helpful and have really focused on the trust issue that we all struggle with. Good luck and don't be afraid of the endoscopy-it will help you know what this is and move on. It will also tell you if you have ulcers, for which you'll need special meds beyond the PPIs.

by wassupwassabi, Jul 27, 2005 12:00AM
To: TrustGod
It's interesting that you only have heartburn when you're on the medication.  Kevin Trudeau says that in most people heartburn is caused by not enough acid as opposed to too much acid.



Have you had a barium swallow?  It can show you the extent of your reflux.  But don't be afraid of the endoscopy, I've had it done...it's pretty safe.  They knocked me out and I don't remember a thing about it.  

by TrustGod, Jul 27, 2005 12:00AM
Thanks for both your comments. I thought it odd that the only time I have heartburn is when I'm taking the PPI's.  I tried drinking a teaspoon of vinegar with a glass of water, but that didn't seem to work either.  I keep telling the doctors that the medication brings on heartburn pain, but they don't seem to listen, or just want to increase the medication.  That makes no sense to me.



And thanks Julie.  I have made all those diet changes. It's funny - I can eat pizza or tomatoes when I'm NOT on the PPI's - and don't have heartburn. Still, the sore throat continues regardless of what I do. Two great days on Zantac - now two "so-so" days with the sore throat returning. ARGH - the frustration of it all!

by astros18, Jul 27, 2005 12:00AM
To: TrustGod
I wonder if you have read The Makers Diet or any of Dr. Jordan Rubin's books.If not I encourage you to do so.Your story is very much like mine. I had my gallbladder out 12 years ago and have had digestive problems pretty much ever since.If you try the apple cider vinegar, do not dilute it with a glass of water. Also, try not to drink with your meal, it dilutes stomach acid and slows digestion.Zirthromax is a strong antibiotic which probably caused an unhealthy balance of yeast in your digestive tract.Most people who suffer from acid reflux are very yeasty. Acidophilos is not strong enough to make much difference, you need a biphidophilos probiotic.You should also be taking a digestive food enzyme, especially a hi lipase enzyme to help you digest fats since you do not have a gallbladder.You shouldn't take the reflux meds for longer than 8 weeks. They are not good for you, in my opinion.I cannot stress enough how important it is you drink Lots of distilled pure water and make sure your bowels move daily if not more.I wish you good luck and good health.

by TrustGod, Jul 28, 2005 12:00AM
Thanks Astros. I took a month's course of saccromythes boulardii and then acidophilos for a month.  I spent all afternoon yesterday in the ER with severe stomach cramps. These medications aren't treating what I have - they just cause further problems two-three days after starting on them. I'm at wits end, cause they work the first two days - then, not only stop working, but make me feel worse. But doing nothing doesn't fix the cough and sore throat either...