Chronic Reflux

[silverstanger]

Since 2001 I started having reflux problems. I broke my leg and gained weight. I am 5' 8" and weigh 195lbs. Not too bad I guess.

Over the years my reflux has turned into many episodes of esophagitis and gastritis.. and one time duodenitis.

I have been scoped several times with the last time the following:

Erythema found in lower third of esophagus and in the gastroesophageal junction.

A less than one cm benign-appearing, intrinsic stenosis was found forty cm from the incisors and was traversed. They dilated it with a 46 Fr Maloney dilator with mild resistance.

Patchy Erythematous mucosa with no bleeding found in entire examined stomach.

Patchy Erythematous mucosa without active bleeding and no stigmata of bleeding found in duodenal bulb and in the 2nd part.

Impressions:

Benign-appearing esophageal stricture
Savary-Miller Grade I reflux esophagitis
Gastritis
Duodenitis

Nothing more found after biopsies were taken.

This procedure done on 1/24/2005.. And since I suffer with pain every day in my esophagus still and constant relentless reflux despite Nexium, Tums, Zantac 150, and eating right.

What I am doing wrong here..

I need suggestions PLEASE!!

Should I find another doctor?? I do not want to die of cancer but with this severe reflux.. eventually I think I will get barrett's and with my luck cancer.

Thanks

[Kevin Pho, MD]

With vigilence, Barrett's esophagus can be prevented.  There are several recommendations that you can use to ensure that Barrett's esophagus will not develop.  The American College of Gastroenterology recommends the following:

Patients with Barrett's esophagus should have regular surveillance endoscopy to obtain esophageal biopsy specimens. GERD should be treated prior to surveillance to minimize confusion caused by inflammation in the interpretation of dysplasia.

* For patients who have had two consecutive endoscopies that show no dysplasia, surveillance endoscopy is recommended at an interval of every three years.

* If dysplasia is noted, the finding should be verified by consultation with another expert pathologist.

* For patients with verified low-grade dysplasia after extensive biopsy sampling, yearly surveillance endoscopy is recommended.

* For patients with verified high-grade dysplasia, the risks of intervention (eg, esophagectomy) must be weighed against those of intensive endoscopic surveillance (eg, every three months) in which intervention is withheld until surveillance biopsy specimens show adenocarcinoma.

You can discuss this strategy with your personal 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.
Medical Weblog:
kevinmd_b

Bibliography:
Spechler.  Management of Barrett's esophagus.  UptoDate, 2005.

[JackieG]

Lifestyle changes sometimes prevent symptoms of GERD. Because fatty foods, mints, chocolates, alcohol, nicotine and caffeinated beverages such as coffee or colas relax the LES, you may be able to reduce the amount of acid reflux you experience by avoiding these foods. Carbonated drinks, citrus fruits and juices, and tomato sauce may irritate the lining of your esophagus and make the effects of GERD more severe. Cutting these foods from your diet will reduce the severity of the symptoms.

You may help reduce reflux by quitting smoking, wearing loose clothing, eating smaller meals, not lying down for at least three hours after you eat and losing weight if you are overweight. Some people are able to prevent symptoms at night by raising the head of their bed with six-inch blocks or by sleeping on a special wedge-shaped pillow that elevates the upper part of the body.

[yoshi]

certain kind of exercise called JARRING EXERCISE could loosen the LES.

[yoshi]

Try chewing gum,your own saliva contains bicarbonate and it will neutralise stomach acid.
For some reason,the motion of chewing is also good for your esophagus.

[Inanga]

I'd have thought if lifestyle changes and mediaction to moderate the acid don't work the next step is surgery. I was in that position with a hiatus hernia. nothing helped until I had a fundiplication. the lower esophagal sphinter was tightened up which made it very "one way" - ie acid could not come back up. It also made bloating a problem for a while as any air or gas had to go the long way out and it hurt a bit. but this went away after a while. I class myself as "normal" now - the reflux is still gone and the side affects have gone - i'm like a normal person.

[JackieG]

I did the Nissen Fundoplication also, in 1991, and it bought me an extra ten years. I did not develop esophageal cancer until 2001. Of course, everyone's experience is unique, but I would suggest periodic surviellance endoscopies for Barrett's patients even after fundoplication.

[JackieG]

The Doctor's response does not point out an important consideration once High Grade Dysplasia is detected and surviellance (endoscopies with biopsies every three months) rather than intervention (an esophagectomy) is decided upon.  Endoscopic biopsies do not always detect the presence of esophageal cancer. In fact, one prominent EC surgeon at the University of Pittsburgh Medical Center reports that roughly 50% of his patients that opt for intervention (an esophagectomy) for previously diagnosed high grade dysplasia are reclassified with esophageal cancer as a result of post-esophagectomy biopsies.

Having said that, an esophagectomy is MAJOR surgery, and carries with it a likely change in your quality of life. This must be weighed with the high morbidity and mortality rates associated with esophageal cancer when deciding on the proper treatment of high grade dysplasia.  NEITHER IS AN ATTRACTIVE CHOICE. That is why I recommended in my earlier response certian life-style changes that should be followed ardently in the case of Barrett's Esophagus. The relatively minor life-style changes they entail are much more preferable to the alternatives one faces once high-grade dysplasia is detected.

Best wishes,
Chicken Soup

[rcoker05]

I was beginning to get GERD, which is what it sounds like you have. I am completely over it now. I started taking Nexium and it seemed to help a little. Then I tried eating Tums. But, it kept coming back.

Now I know what completely fixes it. YOGURT !!! No kidding. Go to a health food store and get a real good yogurt or Kefir. It should be low in sugar and have L. Acidophulus. You can also eat refrigerated Acidophulus tablets. I buy and eat goat yogurt (Redwood Farms) every single day.

All the medications in the world will not help this problem. They will make you worse. You immune system is completely compromised with the wrong kind of bacteria. The friendly bacteria in yogurt will fix the problem in minutes, but you must keep it up (probably for life).

Also, it fixes all digestive disorders, ulcers, candida, anal itching, bloating, gas. Long term it will help against cancer, fibermyalgia (fibromyalgia), arthritis, etc.

Let me know how it goes.

[tunny]

A related discussion, esophageial was started.