Acid Reflux issues

[nikey2003]

Hi. I have had a redness and irritation in my throat for about a year. I have seen both a gastrologist and an ENT.  The gastrologist originally gave me an endoscope and he said I had esophageal erosions.  He had me go on a diet and nexium for three months which he said would cure the problem.  My heartburn went away and that is what I told my doctor, but the pain in my neck was still there.  So the gastrologist said that if the hearburn is gone then the erosions must be gone.  He said that the pain wouldn't be at my neck but below the breastbone. So he then said he didn't know what was wrong and sent me to an ENT. The ENT looks down my neck and sees a redness and irritation and he says he sees this in the area between the vocal cords. Sometimes when I cough or laugh I will feel pain. So the ENT assumed some acid might be hitting that area so he had me take Aciphex twice a day. I have been doin this for several months and still the pain is there.  The only thing is that there have been periods where I felt like it went away because the pain just disappeared for a short period.  But then it comes back again.  In the beginning the pain was very severe and I could even feel pain when eating. I would eat something and I could feel the pain as the food went down my esophagus.  This seems to have improved but the original source of the pain is there and it seems to be acting up again.  I have also had the few symptoms on and off of shortness of breath and food sticking in my throat and few occasions had trouble swallowing. But these were only a few times  So anyway, my ENT now thinks I should be further evaluated by the gastrologist since I am still not better. I called for an appointment to do that and they seemed to wonder why I was going back to them.  My main concern at this point is what the long term effects of this esophagus or throat stayin red in that area.  I was thinking about maybe cancer but the pain is not in the heartburn area where they say the barrets is supposed to originate.  The ENT says there has been talk about pain in my area causing cancer but it hasnt been proven. So maybe I shouldnt be concerned but I really don't know.  But the pain is still very disruptive and I would like it to go away.  I am a 30 year old white male and I have had this issue for a year now.  Is it possible that there is still some acid comin up to my throat and each time my throat tries to heal that the acid worsens it and I have to start from scratch? I just don't understand why no one really seems to know why the redness is there. Also is erosion the same as irritation or redness and is there such a thing as permanent damage to the esophagus.  I don't notice the usual symptoms of acid due to the pills I have been taking, but for some reason this redness and irritation just won't go away. What can I do to heal it?  What are the long term effects if it never goes away? And what are the long term effect of continuing to use a pill like Nexium.  Thanks

[Kevin Pho, MD]

Hello - thanks for asking your question.

You describe GERD like symptoms, irritation in your throat.  An endoscopy suggested esophageal erosions.  You have been evaluated by an ENT physician and gastroenterologist.  

To answer your questions:
1) It is certainly possible that uncontrolled reflux can continue to cause inflammation and discomfort in your throat if it is not controlled.  I am assuming the the ENT did a largyngoscopy to make sure that it is nothing more serious than GERD (i.e. a tumor).

2) If the inflammation is caused by GERD, then better control of GERD is needed to heal the erosions.  You have been on Nexium and Aciphex.  I would suggest a 24-hr pH study to document GERD, or a repeat gastroscopy to evaluate the erosions and the possibility of Barrett's esophagus.  

Another consideration would be a gastric tumor known as Zollinger Ellison Syndrome - which an endocrine tumor that characterized as excess acid.  A fasting gastrin test or secritin stimulation test is used to diagnose this.  

3) The long term effects of continued uncontrolled acid reflux is what is known as Barrett's esophagus.  It is a chronic change in the lining of the esophagus from the acid.  People with Barrett's esophagus are prone to develop esophageal cancer.

4) The long term effects of Omeprazole (a medicine in the same class as Nexium) has been studied.  There have been clinically significant long-term effects seen in Omeprazole during the 15 years studied.  

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.

[tessa0825]

Hi, Im anxious to read the answer you get from Dr. Kevin about this.....Barrett's doesnt have any symptoms, the symptoms that you experience with barrett's is acid-reflux symptoms....Most commonly is the one of heartburn, and some people have absolutely no symptoms at all.(silent acid-reflux)...If your GI did an EGD and didn't find any indication of it then you most likely don't have it...Did he take biopsies when he was in there?....Barretts does occur at the very bottom of the esophagus and it is caused from YEARS of uncontrolled acid-reflux..It quite obviously is a hard disease to get a proper diagnosis on because of several reasons..First, it ALWAYS has to be confirmed by biopsy...GIs can sometimes think they see the red area that indicates cell changes in that area only to biopsy and have the path. report come back negative..When a negative path report comes back then it means you DO NOT have barretts, as there are other reasons that can cause the Dr. to think it is barretts only to find out it is something else..Also, there must be goblet cells or there should be no Barretts diagnosis....The area where the biopsy was taken is most important, if it was taken lower(below the Z line)than it should have been then you could get a false positive for barretts because those cells are normal to have in the stomach......I have talked to many peole who were diagnosed with barretts, that have went to a lg hosp (such as John Hopkins) where they do many biopsies for it, for a second opinion, and found out that they did not have it......As for the painful swallowing...Im not even sure that is the right term to use to describe it, for me it isnt painful swallowing when it occurs, it is pain that inhibits swallowing...Cant be done when it happens...When that pain occurs there is no way you can swallow...You just have to wait until it relaxes and eases up and then swallow....My nexium was recently increased to 100mg daily so my symptoms have come back under contol....The food getting stuck right after swallowing is caused by strictures,(narrowing of the esophagus) that requires the Dr. to dilate and get your esophagus back open.......Im sure there are probably other reasons that can cause that so we will see what Dr. says when he answers you....Also, if you had erosions Im wondering why your GI doesnt want to do any follow-up....Doesnt sound right, especially since you still have so many symptoms, I would keep pushing to be re-scoped......Good luck..........Tessa

[nikey2003]

Hi Tess. The food sticking happenned a few times but it was before I got to swallowing not after.  My doctor did do biopsies so I know I dont have any barretts.  I am not sayin I have barrets. I have just had this redness and soreness for a year and it won't go away. So I really don't know what is wrong. I am just concerned.

[nikey2003]

I just noticed today that that pain seems to shift a little below the source of the pain right above or at the breastbone.  It has done this before. I just don't understand why I can't get better.  It is really getting sore now.

[kevinmd]

I just wanted to add that if medications cannot control your reflux symptoms, then a referral to a surgeon may be considered.

Thanks,
Kevin

[PAJ]

Nikey interesting Article from Paul Cheney explaining the connection between CFS & lack of acid

Dr. Cheney then suggested the supplement betaine. Most CFIDS patients don’t have enough stomach acid, and betaine HCL (hydrochloric acid) is stomach acid.


Stomach acid is a paradoxical substance: too little can actually make you think you have too much. Many people think they have acid reflux or GERD, and they take Prilosec or other antacids to reduce the amount of stomach acid. In actuality, they may not have enough acid in their stomach to trigger the opening of a valve at its base. When food begins to fill the stomach, acid is released to assist with digestion. When enough acid is detected, the valve opens, releasing the food into the small intestine. If there isn’t enough acid, the valve doesn’t open. The food, mixed with what little acid is present, is forced back up the esophagus, creating a burning sensation. Paradoxically, the answer to the burning sensation is more acid, not less. Antacids can create a vicious cycle in these cases.


http://www.immunesupport.com/library/showarticle.cfm/id/3171/searchtext/acid%20reflux/

[Concerned lady]

It's true that some people with GERD are not producing enough stomach acid. BUT, even a tiny bit of acid, doesn't belong in the esophagus.

And, if the stomach happens to be (abnormally) missing some of the protective mucus producing cells, then, a person can get a stomach ulcer from their own HCl (hydrochloric acid).

A stomach having an irritated or damaged lining (missing those protective mucus producing cells) seems to be more likely to "reflux", than a normal stomach.

So, it's important to HEAL THE STOMACH, as one (of many) methods of fighting GERD.

There are some non-drug methods to do this. You can check Appendix B (some GASTRIC REFLUX TIPS without acid blockers), on webpage 10 of <a href=http://cantbreathesuspectvcd.com>http://cantbreathesuspectvcd.com</a> in case you're interested.

Some other causes of GERD, addressed in the "tips" include food sensitivities, GERD-promoting exercises, etc.

It's more of a pain in the neck to work on getting rid of all the underlying causes of one's GERD, but in the long run, it seems to work better, and there are usually no adverse side effects.

I hope this helps!

Sincerely, Concerned lady