Severe Acid Reflux Problem

Dear Doctor,

I am currently in a severe acid reflux flare.  I have had reflux for almost three years, which began during a pregnancy.  My reflux is episodic; I can have months where I am symptom-free and then weeks or months where I am struggling with it.  I am a hard case to treat.  PPI's are not helping -- I have been on all of them, on double doses.  Last year, had an endoscopy [showed mild esophagitis] and 24 ph test was negative [however, I had no reflux symptoms on the day of the test].  Manometry was normal.  These studies were all one year ago.  Differing doc opinions -- one says I have hard-to-treat reflux; two others say I probably have non-erosive reflux disease.

Six months ago, I had a test for gastropareisis -- normal.  Ultrasound of upper abdomen -- gallbladder normal.  No HIDA scan done.

These flares are very hard for me to deal with.  The burning is severe.  I often have shortness of breath and sharp pain in my upper back between shoulder blades, more on right side than left [feels like my lungs].  I believe the acid is getting into my lungs.  Can't imagine that I have non-erosive reflux if it is affecting my lungs like this.  I also cough up mucous almost every day.  Burning in esophagus and throat.  I have eliminated all items from my diet that are bad for gerd, sleep elevated, and don't eat anything for hours before I go to bed, yet these symptoms persist.  I've also tried DGL, Gastrex, Gaviscon, Zantac, and every other product you can imagine for heartburn.  Currently I'm on Protonix and other antacids.  I'm noticing a pattern that the reflux is brought on after I take antibiotics, and/or after I have a respiratory infection like bronchitis.

The only other thing happening is that I'm having some green mucous in my stool.  Is there any way that gallbladder can be involved here?  Can gallbladder problems worsen reflux symptoms?  Is a HIDA scan a good idea?

I'm thinking more and more about talking to a surgeon about the Nissen procedure.  These flares tend to last a long while; I have little to no relief from meds, and my quality of life is not good at those times.  I'm also thinking that I should have another 24 hour ph study, since it's been a year and I felt no refluxing on the day of the last study.  

Sorry for such a long post, but this is a rather complicated and confusing situation.  I'm at a loss.  Your thoughts are really appreciated here.

Sincerely,

Kate

[Kevin Pho, MD]

I would consider having another 24-hr procedure.  If it is negative again, it is extremely unlikely that GERD is present.  This is a pretty sensitive test.  

Gallbladder problems can certainly mask as upper GI symptoms.  If the ultrasound is normal, a HIDA scan with CCK stimulation can evaluated for gallbladder ejection fraction.  If low, then some say that removal of the gallbladder can relieve the symptoms.  

I would also consider an upper endoscopy to evaluate for inflammation or ulcers.

If the 24-hr pH study confirms GERD, it seems like a surgery referral would be the next step since your symptoms are not controlled by medications.  

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.
Medical Weblog:
kevinmd_b

[Katenyc]

Forgot to mention that I did have a colonoscopy 6 months ago and it was fine.

Thanks.

Kate

[amielbrock]

Have you tried adding a product called caracream to your protonix??  Check out www.chocobase.com and see what you think.  This compound, approved by the FDA and coming to the shelves in January was developed and researched by the University of Missouri.  I worked wonders on my son after everyone told me that it was impossible to GERD after a fundoplication.  You might want to give this a try as a last ditch effort before you consider a big step like surgery.  You're welcome to email me at ***@**** for more info.  Good luck
Amie Brock