Contradictory test results!

Dear Sir,

Last month (November 2008) I requested a Gastroscopy because of severe epigastric fullness, early satiety, waterbrash, pain, vomiting and mild oesophageal burning.

The result of the Gastroscopy was that I had a moderately large paraoesophageal hernia (rolling) and a moderate sized sliding hiatus hernia. I commenced PPI's on the same day following Gastroscopy, with some alleviation of symptoms such as burning, waterbrash and vomiting but NOT the epigastric fullness, early satiety, palpitations or nausea.

I was referred three weeks ago to an upper GI surgeon to follow through on the Gastroscopy results. He immediately commenced me on an all liquid diet until the surgery date schduled for 9th January.

He also ordered a Barium meal which I had done earlier this week for him to have 'pictures' prior to the surgery to work from.

However it was quite a shock to be told following the Barium meal that they could see no abnormalities -  a normal looking stomach! The surgeon said it would now be necessary for him to do his own repeat Gastroscopy which is scheduled for January 16th, plus he has ordered a nuclear gastric emptying study (scintigraphy) prior to the Gastrocopy to exclude Gastroparesis.

Under what circumstance would this happen? Why would the paraoesophageal hernia disappear? Did the Gastroenterologist who did the Gastroscopy get it wrong - he is very experienced? Can these hernias slip in and out of the thoracic cavity? Does it mean that there is a large enough opening or breach in the diaphragmatic opening for this to happen? How will a Gastroscopy determine the size of the diaphragmatic hiatal opening if all is in its correct position during gastroscopy ie. will they be able to tell if the stomach has been rolling upward?

I'm confused about all this to say the least! Can you cast any light on the why's and wherefores of this occurence?

[Kevin Pho, MD]

I cannot give a definitive answer without being more familiar with the case.

I agree with all the tests that have been done and ordered.  I do not know why the hernias no longer appear on the studies.  Perhaps there was artifact, or a confounding finding that confused the results.  

That being said, the barium swallow is not as sensitive test as the upper endoscopy, so it's possible that the repeat test was in error.

In any case, I would agree with repeating the gastroscopy for a more definitive answer.  

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 Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd

[tipper11]

Have the doctor do a biopsy of your stomach.  There is a gastric cancer called lintis plastica its hard to diagnos mainly because doctors consider it rare and rarely look for it. your symptoms sound similar to my mothers and her physicians missed it and the end result was not good.  Do your own research and don't let them schedule your follow up appointments 4-6 weeks later.  Thats my advice.  You can't rely on the doctor to search for conditions that are not obvious.

[Megan1710]

Thankyou for your comment and concern.

When I had my Gastroscopy done in early November they did quite a number of biopsies and all thankfully came back negative. So I don't think I have this awful Linitus Plastica which you mentioned.

I am so sorry to hear about your mother's diagnosis.