Acid Reflux and Stool Color

[Katenyc]

Hello.

I am a 44 year old female.  Six weeks ago, I began suffering with burning in my chest, throat and tongue, as well as increase in bile and acid taste in my mouth.  I saw my doctor, who referred me to a GI doctor.  I was told that I have acid reflux and was given Nexium 40 mg twice/day.  After almost 3 weeks of taking it, and completely changing my diet to a gerd diet [eliminating coffee, fatty foods, chocolate, peppermint, etc. etc.], I was still burning up.  Was switched to Aciphex for 2 weeks, and that also did not help.  Just switched to Prevacid 3 days ago and so far that is not helping, either.  I am also taking Gaviscon, Tums, and I have just added Zantac 75 at nighttime.  In the meantime, I had an endoscopy done [showed esophagitis & normal stomach biopsies], a motility test [normal results] and a 24 hour ph test [normal results].  [Ironically, the day of the ph test was the best day I have had in 6 weeks.]

The doctor said that clearly I have gerd due to the esopagheal changes, but she is a bit perplexed that the PPI's are not working far for me.  At this point, she said to continue with Prevacid and everything else I am doing and see how it goes.

The other issue, which may or may not be a coincidence, is that my stool has changed to a green color.  [It is like an olive green color.]  This started about 5 weeks ago, and it has been consistent ever since.  I was not concerned about it because I thought it may be a reaction to the PPI drugs I was taking, but when I stopped taking the PPI's for 4 days before the ph test last week, the stools were still green.  In addition, I had severe diarrhea for 2 days last week, followed by 4 days of constipation.  This is not normal for me.  I am not taking any new supplements [I take a basic multivitamin and calcium every day], and I am not eating a lot of green vegetables.  I definitely don't believe the stool color is related to my diet.  

I have read some things here & there on the internet that the gallbladder could have something to do with green-colored stools.  I have also met a woman who had burning sensations in her chest, which were relieved when she had her gallbladder taken out.  Maybe I am grasping at straws here, but could there be a connection between this [so far] untreatable reflux and green stools?  One other comment:  I did have reflux once before two years ago when I was pregnant with my 1st child.  It was pretty severe on & off through the pregnancy, but went away as soon as I delivered the baby.

Thanks for your comments and any help on this.

Kate

[Kevin Pho, MD]

Erin, PA has kindly answered your question in her comments below and I agree with her comprehensive assessment.  

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.

Thanks,
Kevin, M.D.

[GI.PA]

At this point you and your GI need to consider a few things:

Perhaps you do have low grade acid refux disease which caused your esophogitis (seen on EGD) but perhaps acid reflux disease is NOT the cause of your symtoms.  This is supported by your normal 24 hour pH study, normal EMS, and most importantly, your lack of response to twice daily PPI's (multiple brands).

I would obtain a gallbladder ultrasound and perhaps a HIDA/CCK scan to look at the gallbladder which can mimick acid reflux symtoms.  The 24 pH probe can be repeated with the following modifications (do it while you are on PPI's..they ususally have them hold them for 7 days).  This would give an idea of if you are having inadequate acid suppression on high dose PPI's.  A motility study can be repeated with provacation (they put some acid at the probe to see if it replicates your symptoms, they use water as a control, they can also put a chemical in that causes your esophagus to spasm to see if this reproduces your pain..spasm can be unrelated to acid reflux).  A repeat EGD may be considered to "prove" that the esophogitis has healed, documenting acid reduction with PPI and taking esophogistis out of the mix.

Green stools are never a red flad in the GI world.  Although you alteration in bowel pattern may suggest more of a bowel component to your discomfort, or even on underlying irritable bowel/functional dyspepsia cause to your symptoms.  Stool studies (particularly a giardia antigen) can be obtained to rule out an infection with a paracite or bacteria and give clues to an underlying inflammations (stool for white blood cells).  A colonoscopy can be done to visualize the entire colon (particularly the loops in upper right and left quadrants.  This can exclude inflammation, cancer, polyps..ect.  Treatment with a non-bloating fiber supplement (fiber con 2 pills/day) may be helpful.  Your MD may consider other IBS medications.

Hope this helps.

Erin
GI.PA

[yoshi]

i was on prevacid for months and i was constipated.if you read the labels ,it said either diarhea (diarrhea) or constipation.
for me it was constipation,once i switch out of it,my bowel movement returns to normal.
hope this piece of information helps.

[TJV]

  One thing for sure, you obviously have gerd because there is esoghageal damage.  

  It is logical  a ph and manometry would be negative if there were absolutely no symptoms at all on the day of the test. --  a repeat ph should be done -- i don't see gallbladder in the equation, it could be an additional problem to gerd of course--,and should be checked out,  but certainly speculation of gallbladder disease should not be based primarily on the fact of a negative ph  There were no symptoms on the day of the ph
  
Green stool means nothing in medicene and isn't significant . However your change of bowel habits are.  You should have a stool test for bacteria etc. and colonoscopy-- particularly to view the splenic and hepatic flexures.  Perhaps a gastric emptying test as well.



  

[tessa0825]

Remember to ask about Bravo PH if you do need to have it repeated.....It might be better in the fact that it is a 48 hr. test rather than the normal PH probe at 24 hrs....Longer time frame to pick up symptoms.....That's the one I'm having at post-op evaluation in Dec.....Tessa

[GI.PA]

The question is:

Yes, you have esophogeal damage and therefore GERD, but is GERD and the damage what is CAUSING the pain or just an incidental finding?  If a repeat endo is done and the damage has been nicely healed but the pain remains, one would arguee that with a failure on twice daily PPI's and endoscopy proven healing, an acid related condition is very unlikely.

GI.PA

[TJV]

Ahhh But over have of people with gerd have negative endoscopy,ppis could have healed erosions, -- another ph test would be necessary to rule out gerd conclusively, since there were no symptoms on the first ph test. But of course an ultrasound is a good idea

[tessa0825]

Kate, with the throat and mouth burning I wonder if your GI mentioned LPR? It seems like it takes higher doses of medication for longer periods of time to get under control...I also think it requires a double probe during ph testing....Tessa

[Katenyc]

Tessa,

What exactly is LPR, and is this just another form of reflux?

Thanks, Kate

[Katenyc]

TJV,

Do you think the 48 hour bravo test would be better than the 24 hour ph test?  Is it common for gerd suffers to have a normal ph test?  Just my luck; I had two good days in the last 7 weeks and the ph test happened to fall on one of them.

Thanks,

Kate

[Katenyc]

Erin,

Thanks for your thoughts on this.  I'm going to look into everything you suggested.

Kate

[tessa0825]

My understanding of LPR (laryngopharyngeal reflux) is that it is a backflow of acid all the way into the throat, not just the esophagus. Causing many symptoms, such as hoarseness, sore throat, chronic cough, excessive throat clearing, throat mucus, voice break, etc......If you look on the "other" board under the topic of LPR you can read alot about it......When I had my 24 hr ph there was a pt. that was being testing for LPR and I know she had two probes inserted....One to specifically test reflux in that area.....Tessa

[Katenyc]

Hi Tessa,

How long did you have gerd?  You are doing better now after surgery, right?  I am beside myself.  Last week, when I had the ph probe, I was doing better.  I've since had another flareup and I am going out of my head right now.  What do I do?  Call my doctor "again" and demand a bravo test?  Find a new doctor?  I'm not getting better -- I am continuing to reflux even on Prevacid, H2 blockers, antacids ... all day long.  This is like the worst nightmare.  

Thanks,

Kate

[tessa0825]

I would definitely call your GI and ask him what you should do next...Tell him that your symptoms arent improving and describe them (in detail) to him.....Im not sure that all GIs even do bravo yet but you could ask him about it and see what he/she advises....They do an EGD to insert the capsule but you do not need a repeat EGD to remove it.....I had heartburn for over 30 yrs...Im 51 now but have had it since pregnant for my first child when I was 20...I was treated then with tagamet for several yrs. and then I got better so I stopped the tagamet, was only available through prescription at that time....When my symptoms returned I self treated with OTC meds and never even mentioned it to my Drs. for many yrs......I lived on alka-seltzer....When I finally saw a GI 15-18 months ago, I couldnt swallow without terrible pains.....Thats when I found out that I had ulcers, strictures, and barretts esophagus.....When I had a biopsy that was read at high-grade dysplasia, my local GI sent me to CCF to be evaluated there.....They did many tests and many biopsies and confirmed low-grade dysplasia, no high-grade seen......My hernia was lg. and I also needed to have my esophagus lengthened so I had open collis gastroplasty/ fundoplication 5 weeks ago....YES, I am so much better now........In the last yr I had went from 165 lbs to 115 lbs the day of surgery....Dont let my experience scare you, just know that it is important to find out what is causing all your symptoms....I don't know if it's important or not but during all this I also had to have my gallbladder removed this last March, there does, atleast to me, seem to be some connection between acid reflux and GB problems..However, having it removed didnot help my reflux........As for your normal PH test, you thought it was going to come back ok because you wernt symptomatic that day...I would stress that to him and if not bravo then atleast push to have the probe repeated.....BTW, if at any point, down the road, anyone ever mentions that you might need to have surgery for reflux, please consider going to a lg hosp. and having it done by a thoracic surgeon that does many of them......The head of thoracic surgery did mine and he is top notch.......kate, I hope you get some answers soon......Tessa

[Katenyc]

Tessa,

Thanks so much for all the great information.  I'm so glad that you are doing better and are on top of this now.

I know that I have to keep looking for answers.  I'll talk to my doctor tomorrow and if she doesn't want to go forward with anything else, them I'm going to have to find someone else.  As far as the surgery, I live near New York City and I'm sure I can find someone there [thoracic] who is skilled.  For now, I'd like to get my gallbladder check and another acid test done.  I know that if I had been tested today, the #'s would have gone off the charts.  

Thanks for the support.  It's hard for my husband to understand what I am going through.  It's like this internal agony -- best way I can describe it.

Kate

[pris.]

i am in a similar boat. started having acid reflux, tried nexium, achiphex & protonix. when each med would not work the dosages were doulbled & still not working. ppi's are uneffective therefore i do NOT have acid reflux disease. H2blockers are not as effective as ppi's.  also having bouts of clay colored stools with dark black specs. abdominal utrasound showed all organs were functioning properly & no gallstones. was having a "gallbladder attack," stabbing & burning pains URQ, chest pains, severe gerd & spitting up food 10-12 x's daily & went to the hospital (admitted for 5 days) had a chest x-ray for hiatal hernia (normal/negative result), hida scan without contrast or contrtaction (normal result), abdominal & pelvis ct oral & iv contrast (normal/negative result), endoscopy (level 2 esophagitis erosion, no ulcers or cancer, biopsies were normal). i was diagnosed with ibs 12+ years ago & no flare up or trteatment for it in 7+ years... the dr's put ibs & anxiety disorder & depression as my hospital discharge diagnosis. 3 days later had another "gallbladder attack" & was admitted back to hospital for another 5 days. this time mri performed head to toe (normal/negative)& another hida scan (this time with contrast/ contraction) was done that showed that gallbladder had shut down completely & was a "dead organ" there was 0 % input & ouput. did lap suregry & gallbladder was removed. gallbladder was swollen 2x's normal size & was all & was nothing but scar tissue.  for the 1st 10 days after surgery no symptoms at all. on the 11th day all prior symptoms resumed. did colonoscopy showed superifical erosion & ineternal hemorroids (hemorrhoids) & was treated. also put back on protonix 40mg/bid with no sucess for gerd & spitting up food, dr's refused to give me pain meds. did small bowel follow thru (normal) gastric/stomach emptying scan (normal) & a 2nd abd & pelvic ct scan oral & iv contrast (normal). the gi blamed the surgeon saying he "nicked an organ or residual bile sludge remaining in biule ducts."  went to a different hospital last sunday with "gallbladder attack" got a different internist & gi & they diagnosed me with SPHINCTER OF ODDI DISORDER. it is a malfunction of the muscle that controls the flow of bile & enzymes from the panrease & liver into the duodeum (juncture point of small intestine & stomach) & have an ercp scheduled in 3 days will require surgery due to my severity level....
i have symptoms of liver & pancrease immflamation with it showing up on any of my numerous blood & urine workups.
you have to listen to your body & not always the dr's. i went to 11 different dr's that all said "take a valium & go to bed it is all in your head" they said, possibly blood disorder, tumors, cancer, gerd, thyroid disorder, gastristis, & all those dr's really do not have a clue.  my gi dr refused to do the ph test on me. but was ready to refer my to a 4th gi dr because i had great insurance. also had a suspicious resulting bone scan due to right hip bone. another symptom i had complained about for 4 months.
stay on those dr's & do your research. the symptoms that you have may be indications of something minor or serious.

[cranky53]

I am a 53 year old female and have acid reflux, hiatal hernia, ulcerated colitis, etc.  With the acid reflux and hernia, I was like you and none of the medications the doctor gave me helped. My dad (73) also has acid reflux and hiatal hernia, and his doctor has him on Prilosec 20mg 2x daily. I took the same dosage he was on and I have felt so so much better. My doctor prescribed the same for me. Then, 6 months later, he put me on Nexium because of the esphogus erosion, but it did nothing for me. I made him put be back on Prilosec and I will never get off of it. Now if I could just find something for my throat and esphogus.

Cranky53

[wammer]

I too am suffering and have bad LPR and GERD symptoms.  I have been through hell the last 7 months with the doctors just saying its "in my head".  I am on nexium 2x a day and have "green stools" also but don't know if it is the cause.  I finally convinced them to do a gallbladder scan with CCK and my gallbladder is not functioning.  I also have severe back pain and chest pain and the doctors think that it is all anxiety and stress.  I have an appointment with the surgeon this week to get the gallbladder removed but I am concerned that my symptoms of GERD and LPR will not go away afterward.  I will let you know if they do.

[lim2000]

Hi, I'm 23 yrs old and living in Australia. A week ago I suddenly felt there was something wrong with my throat. Straight after I took a pill I was so worried because I thought it was stucked inside my throat. The feeling of "something" stucked in my throat wouldn't go away. Somehow other symptoms just appeared. Breathlessness, chest pain, headaches, loss in appetite and soreness of the throat. I literally thought I was either going to die or in such paranoia. Out of no where the feeling that something was stucked there just dissappeared, and my throat felt so "airy" again. To be honest, I literally felt as if something just dropped from my throat down to my chest cause I felt this cold tingling sensation. Weird.
Anyway, the problem came back the next morning straight after I ate and this on/off cycle continued for one week. I had a "barium swallow" xray soon after and the result showed that I didn't have GERD but just a "spasm". Phew.
At the moment my GP advised me to take these reflux pills for the next three days (getting dairrohea) and improvement should appear. Not to mention watching what I eat and how I eat etc. Things haven't been better for me. Hopefully this so called spasm of the throat goes away so I can enjoy life and food again. I mean I have a hectic life consisting of 2 young kids and an asthmatic too. Argh!

[lim2000]

Hi, I'm 23 yrs old and living in Australia. A week ago I suddenly felt there was something wrong with my throat. Straight after I took a pill I was so worried because I thought it was stucked inside my throat. The feeling of "something" stucked in my throat wouldn't go away. Somehow other symptoms just appeared. Breathlessness, chest pain, headaches, loss in appetite and soreness of the throat. I literally thought I was either going to die or in such paranoia. Out of no where the feeling that something was stucked there just dissappeared, and my throat felt so "airy" again. To be honest, I literally felt as if something just dropped from my throat down to my chest cause I felt this cold tingling sensation. Weird.
Anyway, the problem came back the next morning straight after I ate and this on/off cycle continued for one week. I had a "barium swallow" xray soon after and the result showed that I didn't have GERD but just a "spasm". Phew.
At the moment my GP advised me to take these reflux pills for the next three days (getting dairrohea) and improvement should appear. Not to mention watching what I eat and how I eat etc. Things haven't been better for me. Hopefully this so called spasm of the throat goes away so I can enjoy life and food again. I mean I have a hectic life consisting of 2 young kids and an asthmatic too. Argh!

[thunderingdeuce]

About 2 years ago I passed something in my stool several times that looked like pieces of fatty chicken. Sometimes it was mixed in with my stool but mostly it came out without stool present just the pieces itself. It finally stopped after 2 weeks and hasn't returned. Since then I have been having problems where my stool is not really solid even after eating something that shoudn't cause it. Even after having a bowel movement I still feel like that I have to keep wiping or take a shower to clean up. The presents of bowel is still there in a mushy state. This is a really embarrasing problem for me because I feel like I am always dirty down there. If anyone knows what this might be please let me know.       Thanks

[thunderingdeuce]

About 2 years ago I passed something in my stool several times that looked like pieces of fatty chicken. Sometimes it was mixed in with my stool but mostly it came out without stool present just the pieces itself. It finally stopped after 2 weeks and hasn't returned. Since then I have been having problems where my stool is not really solid even after eating something that shoudn't cause it. Even after having a bowel movement I still feel like that I have to keep wiping or take a shower to clean up. The presents of bowel is still there in a mushy state. This is a really embarrasing problem for me because I feel like I am always dirty down there. If anyone knows what this might be please let me know.       Thanks

[duece321]

I too had acid reflux and some damage to my esophagus. I was prescribed medicine to slow production of acid in my stomach. I am scared of prescription medicines and decided to change my diet etc. to fix the problem. I cut way down on the size of the meals I eat and left out spicy stuff. Started eating dinner by 5:00 or 6:00 pm instead of 9:00 or 10:00 pm. Slept in my lazy boy rocker in a semi sitting/laying position until about 12:00, then got up and slept normally the rest of the night. after about 8 to 10 weeks later my problem was gone.

Praise the Lord.