Constant Lump/question on endoscopy § 'balloon'

[notsogr8]

About 10 yrs. ago I had an endoscopy done.  I had no anesthesia or sedative except spray on my throat.  It went fine - they found some irritation and treated it.  A few months ago I was having problems with acid reflux so my family doc put me on Nexium for 4 weeks.  It worked great.  But I developed this lump in my throat.  Family doc did a serum h.pylori and it was.25 (fine).  Then he sent me for barium swallow CT scan of abdomen which was clear. So he sent me to a gastroenterologist for an endoscopy.  The GE wants to put me to sleep and do something involving a balloon and stretching.  My questions: 1. is it necessary to be put to sleep?  The first time, I was awake and did fine (different doctor)- this new GE says I have to be asleep so he doesn't poke a hole in my esophagus.  and 2.) How could he know before examining me that I need the balloon thing and is it safe and effective? I am not convinced that it is even my esophagus as my throat and nose burn all the time and my neck (adam's apple) is sore to touch. Any thoughts or suggestions would be welcome.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

Typically a gastroscopy alone is done only with conscious sedation - the technique varies according to the gastroenterologist.  If an esophageal dilation is necessary (you are suggesting that dilation is being considered), then you may need to be sedated for this procedure.  This is dependent on the gastroenterologist.  

Usually endoscopy or a barium swallow is needed to evaluate for any strictures.  It would depend on what is found during endoscopy to see whether you need the balloon dilatation.  Some complications of this procedure include esophageal perforation, bleeding, infection, and aspiration pneumonia.  Studies report the success rate of a dilatation to be between 60 and 90 percent, depending on the cause.  

Followup with your personal physician is essential and strongly suggested.

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.

[surgeon]

I'd assume he's considering the possibility that the balloon could be necessary and is preparing in advance. People who have reflux can sometimes develop scar tissue which causes narrowing of the esophagus at a point (stricture) which can be treated with balloon dilataion. He could also just scope you without sedation, etc, and plan a second procedure if necessary; but it makes sense to be ready to do the whole shootin' match at one session....

[ashpie3]

Hi, I too am having the same lump sensation and am getting an endoscope on wednesday..I had one done 4 yrs ago and was had the sedative and I think the doctor dilated my throat ..do you have problems swallowing certain things too? I feel like certain things like bread and dry things stick at the bottom of my throat..french fries too..I have been on nexium 2x a day and it's not doing anything for the lump..

[JackieG]

Hi Notsogr8:

I'm not sure if you got your $15 worth from the forum's MD.  It is difficult, as he says, to diagnose over the Internet.

Reflux should not be taken lightly, and difficulty swallowing should be taken very seriously. Your gastroenterologist should perform an endoscopy, and you should be sedated. I say this because the gastroenterologist should be able to see irritation, stricture, etc in the esophageal lining visually through the scope. She/he should be prepared to take biopsies of suspicious looking tissue, and that does hurt without sedation. Your gastroenterologist should NOT be preparing to dilate your esophagus on the first visit. The results of any required biopsies should be known first. It is important to be evaluated. You may have irritation, but you may also have Barrett's Esophagus, low, medium, or high grade dysplasia, or, heaven forbid, esophageal cancer. An accurate diagnosis should be made before a dilation is attempted. If you believe your current gastroenterologist is charging ahead to fast, get the endoscopy/biopsies, and then consider a second opinion.

As for the sedation, many people fear general aneasthesia. They are concerned that they will be put under and suffer a stroke/heart attack, etc.. and not wake up. The procedure your gastroenterologist will be doing is best done with a sedative, but you will not be out. You'll be in a "twilight state", although you may not remember much. They generally use IVs of some combination of valium/demerol/versed, and it is not a risky procedure.

Good luck, and don't fear the sedative. Also, insist on the endoscopy with possible biopsies before deciding on the dilation.

regards,
Chicken Soup

[surgeon]

As was said above, it's not possible to diagnose over the internet: nor is it possible to say what your doctor should or should not do on the first visit. It's going to depend on what is seen.

[GI.PA]

It should be mentioned that some patients benifit from "emperic" dilitation.  Meaning that even though no ring,stricture or other abnormality is seen a dilator or ballon is used.  I have found this to successfully relieve the globus (or lump in the throat) sensation in about 30-40% of my globus patients.  This is most likely what your GI is wanting to do.  It doesnot make sense to do this in two steps.  Talk to your GI about the sedation.  An IV could be started and the procedure attempted awake.  If there are problems or you are uncomforable, sedation can be given and the procedure completed.  

Erin
GI.PA

[notsogr8]

Dear ashpie3 - yes, dry things do seem a little harder to swallow.  But it seems I feel fine when I get up in the morning and as the day progresses, the lump is more of an agravation.  Sometimes I wonder if stress has anything to do with it, too??  About the Nexium, I liked it but when I told my family doc about the lump, he told me to stop taking Nexium as it may cause some kind of esophagial lump??? Don't know how that could be.  Best wishes for your procedure Wednesday - I will remember you in my prayers.

[kykatfan]

I too, have the same lump, comes and goes but lately it seems to be there during all waking hours. I also feel extremely tired but I don't know if I just want to sleep because the feeling in my throat bothers me so much.
I had the Barium test, and then had the scope this week, My Dr. said there was nothing abnormal, just Gerd. I have been taking Priosec for about 10 years for Acid Reflux and it does keep the acid from coming up into my throat.
This throat lump started about a month ago when my Dr. switched me from Prilosec to Protonics, I had such a problem with Constipation with Protonics I had to go back to Priolsec.
I don't feel like doing anything, I haven't left the house in weeks except to go to the hospital for tests. Please if anyone has had a successful treatment, tell me.
Thanks, Kaye

[Jeani]

Has anybody out there been on Nexium for a long period of time?  I have been on Prilosec and now Nexium since 1997 and wondering if Nexium could be the cause of my liver enzymes ALT/AST being raised 60/66?  What else is good for GERD that is over the counter or another prescription strength drug that is as good as the PPI's??

[Concerned lady]

Check out these tips. This is a very lengthy posting, but if it helps, it will be worth reading & trying:

Some GASTRIC REFLUX TIPS (without acid blockers):

Please check with your doctor, first, before trying these tips to be sure they are safe, in your particular situation. And, ask child's doctor & pharmacist about adjusting dosages down (tiny fraction of adult dosage), for children.

GER=Gastro-Esophageal Reflux. (Gastro=stomach. Esophagus=food tube.)

LPR= Laryngeal-Pharyngeal Reflux. (Larynx=voice box, containing the 2 vocal cords. Pharynx=throat, above the larynx. The larynx is above the trachea/windpipe.)

Reflux=acidic or alkaline stomach material that backs up into the esophagus (food tube), causing any of these problems (at least): VCD/Vocal Cord Dysfunction/Laryngospasm attacks, cough, voice problems, asthma, globus (feeling of lump in throat), constant need to clear throat, much extra throat mucus, worsening of sinus condition, sore throat, laryngitis, voice problems, pre-cancerous conditions of throat &/or esophagus, etc.

SOME GER/LPR CONTROL THINGS WE DO, that we learned from the excellent book: STOMACH AILMENTS AND DIGESTIVE DISTURBANCES, by Michael T. Murray, N.D. See page 9, References, and, also see GER/LPR info on page 5, and on LINKS page, in this VCD website.

PLEASE READ THIS GREAT BOOK. It may possibly be bought on-line, from Michael T. Murray’s website.

Some of the following we learned from people &/or other books, &/or other good websites about voice, GER, etc.

(1) DGL (De-Glycyrrhizinated Licorice) CHEWABLE TABLETS. Each DGL tablet has 380 mg of DGL. (mg=milligrams). DGL is one of our main methods of controlling the GER/LPR. We use Enzymatic Therapy brand DGL, shortly (about 20 minutes) before ALL meals (breakfast, lunch, supper, and snacks). The DGL does NOT cause high blood pressure, and does NOT cause fluid retention/edema, because a bad (steroidal) part of whole/crude licorice has been removed, leaving the DGL. Chewable DGL tablets are available at most health food stores, and at good pharmacies. DGL capsules are said to not be effective:

The DGL tablet(s) must be chewed, to mix with saliva, to be effective. If a DGL tablet is too dry (which could cause a cough), put a few drops of water on the tablet, and then chew it up. Chew DGL tablet(s) for a few seconds, to mix with saliva, shortly before (about 20 minutes before) EVERY meal, and if necessary, between meals (Read label directions). Chewing the DGL tablets for TOO long a time,  may cause a burning sensation on the tongue & in the mouth. (I do not know if this is from the DGL, or another ingredient).

The DGL seems to not only promote healing of throat, esophagus and stomach, but also seems to help prevent OUR reflux.(resulting in no more globus/lump in throat sensation, no more constant throat clearing, excess mucous, excess phlegm, no more NIGHT-TIME VCD/Vocal Cord Dysfunction/Laryngospams attacks, no more laryngitis, etc. for us)

We like the taste of the plain, fructose-free, DGL CHEWABLE tablets, but for those who hate the taste, try mixing a crushed DGL tablet with a tiny bit of mashed organic banana, and then chew, briefly, to mix with saliva. Avoid any DGL that contains mint. (Mint—in all forms, can cause gastric reflux episodes. AVOID MINT!!).

Deglycyrrhizinated Licorice is pronounced: Dee-gl-eye-sir-rise-in-eh-ted Licorice.

(2) We use Thayers brand of SLIPPERY ELM Throat Lozenges when we feel the need. (Soothing, coating, healing, nourishing). Slippery Elm (inner bark from certain elm trees) also comes in teabag form, or in bulk, etc. as an herbal supplement.

(3) We drink the occasional small glass of CARROT JUICE (organic, fresh) which soothes, coats, heals the digestive tract, is nourishing, and stimulates the immune system, with beta-carotene, soothing and coating PECTIN (a type of fiber), and other good nutrients. Carrot soup, cooked carrots are also good. Beta-carotene is heat resistant. Beta-carotene later is turned into Vitamin A inside us. Do not overdo on carrot juice. If your skin turns orange, drink less carrot juice. Avoid beta-carotene pills -- too potent (can harm the liver, if one has liver problems). Sometimes, carrot cake, using brown rice flour (gluten-free), instead of wheat flour, may be more accepted by children than carrot juice or carrot soup.

(4) We tried elevating the head of the bed a few inches, by putting 6 inch to 8 inch BLOCKS, ON THE FLOOR, under the head end of the bed. This creates an incline (slant/tilt), where the head is 6 to 8 inches higher than the feet. This helps some people, but not all people. (Check with a pediatric Gastro-enterologist, about raising the head end of a bed of a child, or a crib of an infant). Also, see (16) about a special GERD PILLOW, for adults.

(5) We try NOT TO BEND OVER too often, and we try to AVOID STRAINING (Valsalva maneuver). We AVOID LIFTING HEAVY objects. (No weight lifting!) (at least until after no more reflux symptoms for 3 months). Sit without any pressure on the abdomen or stomach (knees lower than hips). Avoid running (shakes up the stomach), temporarily. Avoid gymnastics, etc., temporarily. Walking is best, until fully recovered.

(a) If CONSTIPATION is causing any straining, see Ref.15,18,23,24,25 on page 9 for ideas about gently treating constipation, including eating whole grains, not white (de-natured ones), etc.  For us, exercise, increased water intake, acidophilus/bifidus, digestive enzymes, avoiding junk food, improved diet, chewing slowly (takes will power!), eating when not under stress or angry, etc., all are helpful.  

(6) NO MORE TIGHT pants, belt, corset,--AVOID TIGHT CLOTHING, around waist, like tight elastic around waist, etc. Undo the top buttons or zippers, and wear shirts outside of pants or skirts, instead of tucked into waist.

(7) We try to not eat too much junk food. Some people avoid acidic  food, while others need to eat acidic food, if their stomach is not producing any (or enough) acid. (It is good to avoid acid, if one has an ulcer.) These gastric reflux tips methods often can help to heal ulcers. Some people need betaine hydrochloride supplements, which becomes HCl/hydrochloric acid, or, some use vinegar (acetic acid) in salads, or mixed with water, while others need to avoid eating excess acid. Each person is unique. We avoid all artificial sweeteners. Anyone with diabetes can read the excellent book Reversing Diabetes, by Dr. Julian Whittaker, M.D.

Diet soda pop contains the harmful artificial sweetener Aspartame (Equal/Nutrasweet), which can cause WEIGHT GAIN, HEADACHES, UPSET STOMACH, BLURRED VISION, BLINDNESS, TWITCHING, SEIZURES, BRAIN TUMORS, HYPERACTIVITY, MOOD SWINGS, ETC. Also, soda pop often has strong acids, plus other harmful artificial ingredients. Plain water, gentle herb teas, certain fruit juices (diluted with water, to prevent dehydration), brown-rice-milk, etc. are healthier substitutes for soda pops.

We try to avoid artificial ingredients, including fake fats (like Olean, Olestra, etc.), because these can greatly hurt the digestive system, and prevent absorption of vital nutrients, such as fat-soluble vitamins (A, D, E, K) from foods. These fake fats also prevent digestion and absorption of needed fats & oils, used to repair myelin nerve cell sheaths (made of fatty material, mostly cholesterol). Hormones are also made of mostly cholesterol.

Avoid no-fat, or extremely low fat diets. Fats & oils (organic olive oil, organic sesame oil, organic butter in small amounts, organic nuts, etc.) are needed to produce hormones, and to produce myelin sheaths for certain nerve cells. Diets too low in fats & oils, can cause neurological (nerve) damage, and hormonal imbalances. But, don't overdo on fats & oils. For example, if "fish oils" might aggravate your GERD, avoid them, and instead, eat fatty fish like salmon, etc.

(8)  We try to drink more water, to prevent chronic dehydration. We like hard (nicely mineralized) well or spring water.

We do not drink distilled water (soft water, no minerals), because it can leach minerals out of our bones, possibly contributing  to osteoporosis. We avoid water softeners (chemicals) because they can be toxic, and because good minerals help keep us healthy. People with KIDNEY PROBLEMS &/or GLAUCOMA, etc. should ask their docs how much water is safe to drink, since too much water can be dangerous for them! (But, dehydration can cause problems also.)  

We also avoid water filters that contain silver in the filters, because silver is a toxic heavy metal. When necessary, we use a solid carbon sink-top water filter, instead. Some reverse-osmosis water filters remove too many good minerals, making the water too much like distilled water. (See Ref.18,20,23, on page 9)

(9) We use ACIDOPHILUS/BIFIDUS (edible beneficial bacteria which keep bad YEASTS away, such as Candida Albicans, formerly called Monilia). ACIDOPHILUS/BIFIDUS also can eat or control some bad bacteria, and some viruses. The ACIDOPHILUS &/or BIFIDUS are also called PRO-BIOTICS and are beneficial intestinal flora (mainly for the large intestine). We keep the jars refrigerated, but not too cold. These are available at health food stores & pharmacies. (See Ref.14,15,23,24,25, on page 9).

The ETHICAL NUTRIENTS company makes a very gentle, yet very effective, pro-biotics formula, ("DAIRY-FREE, MAXI-BIFIDUS") that is a milk-free (called dairy-free) powder, made of Bifidus infantum, with only rice maltodextrin as an additive (said to be gluten-free). This can be used by infants, nursing mothers, children, & adults. Follow label directions. Keep refrigerated. This is the simplest (yet effective) probiotic formula I have seen. Good health food stores have many choices available, and usually can order whatever you ask for, if your choice is not immediately available.  

Acidophilus/bifidus can re-populate the large intestine, with good bacteria, after antibiotics &/or steroids, etc. have killed off these good bacteria! Some of us have to continue eating the acidophilus/bifidus (daily, or from time to time), but the results seem worth the effort to us.  

Yogurt and buttermilk contain similar beneficial bacteria, but are milk products, so see (11) below about milk products.

(10) We use DIGESTIVE ENZYMES. My husband likes Acid-Ease by Prevail, which contains Slippery Elm (inner bark), Marshmallow Root, Gamma-Oryzanol (from Rice Bran Oil), and the plant enzymes Amylase (digests starch), Lipase II (digests fat), and Cellulase I (digests cellulose from plant cell walls). The Acid-Ease does not contain Protease, which can be very irritating to ulcer/GER folks.

The Acid-Ease is NOT an acid blocker. It is not an antacid. It soothes, coats, nourishes, and promotes healing. Its enzymes help with leaky gut syndrome.

   I use Total Enzymes (which does have Protease, a protein digesting enzyme) by Nutri-West, a company that sells only to health practitioners (Chiropracters, Physicians, and others), who can order, at cost, by calling 1-307-358-5066.

   Digestive enzymes are NOT FOR EVERYBODY, but are helpful for MANY people.

(11)  My husband has found that AVOIDING MILK PRODUCTS helps him feel less congested, with less mucus in throat. Milk and milk products (like cheese, including pizza, etc.) can cause gastric reflux episodes. Brown-Rice Milk (look for gluten-free) can substitute for milk (but not for babies!). Rice Dream (a brand of rice milk) has a small amount of gluten in it, from barley.  

Gluten is in wheat (includes spelt & kamut), rye, oats, barley, & buckwheat. Read labels to avoid hidden gluten, in some soy sauces, gravies, grain alcohols, beer (barley malt), etc. People with Celiac Disease need to avoid all foods containing gluten. BROWN RICE (organic) is gluten-free. Corn is gluten free, but is very allergenic (allergy causing), so avoid corn. Avoid millet, at first, because there is disagreement about whether millet is safe or not, for Celiac patients. Celiac Disease may be found in about 1 out of 125 people, and even more often, in those with ancestors from any of: Ireland, England, Wales, Scotland, Scandinavia. (See webpage 5).

MILK MAY CAUSE MORE ACID to be produced, IN THE STOMACH!  

I occasionally eat milk products, like yogurt, cheese, whipped cream, or my ACIDOPHILUS/BIFIDUS, which is mixed with goat milk powder. So, at these times, I take LACTASE ENZYMES, to digest (break down into easily absorbed small molecules) the milk-sugar called LACTOSE. Many people (due to heredity &/or disease) have Lactose intolerance, where the small intestine does not secrete the lactase enzyme. Result is that the milk-sugar (lactose) travels further down the small intestine than it should. Then, bad bacteria eat the lactose, giving off lots of gas (the gases are by-products of the bad bacteria’s own digestion process), and this causes folks to get bloated, gassy, have diarrhea, and cramping. I use Lactaid brand lactase enzymes, and it helps, for me. Ordering direct from them can save money.

Some people may be ALLERGIC to MILK PROTEINS (like casein, etc.). This is a separate problem, from a "lactose intolerance". FOOD ALLERGIES & FOOD SENSITIVITIES & FOOD INTOLERANCES can cause or worsen gastric reflux!

To find out whether you do have food allergies, etc., look at link "AA", at the bottom of the links page, at http://cantbreathesuspectvcd.com/links.html . This is a link to "EnteroLab", a laboratory that was created by Dr. Kenneth Fine, MD, and which does special analytical tests on stool samples. These non-invasive tests can very accurately tell you which foods you are allergic to, sensitive to, intolerant of, etc. (like eggs, milk, gluten, etc.).

In fact, these special stool tests often give more accurate results than intestinal biopisies do! Avoid eating any foods, herbs, etc. that you may be allergic, sensitive, or intolerant to.

ACID BLOCKERS CAN HAVE DANGEROUS SIDE EFFECTS: Some examples are:

Acid must be present in the stomach, in order for the stomach to make a substance called Intrinsic Factor. Intrinsic factor must be present with Vitamin B 12, in the stomach, for absorption of Vitamin B 12 to happen, in the ileum (last part of the small intestine), I believe.

Acid blockers therefore prevent absorption of Vitamin B 12. Malabsorption (lack of absorption) of Vitamin B 12, causes NERVE DAMAGE (pain, numbness, pins & needles sensation, etc.) in the peripheral nerves (outside the brain & spinal cord). This is called PERIPHERAL NEUROPATHY. For details about this problem, see the Peripheral Neuropathy forum at http://www.braintalk.org

If Vitamin B 12 continues to NOT be absorbed, eventually there can be NERVE DAMAGE to the Central nervous system (brain & spinal cord).

ALSO, the minerals calcium, iron, zinc, other minerals, and important trace minerals, etc. cannot be properly absorbed, when there is no acid in the stomach (due to acid blockers, etc.).

AND, protein does not start to get properly digested (broken down--eventually into amino acids), in the stomach, when there is no acid in the stomach.

Doctors and pharmacists can advise about VERY gradual(slow) tapering down (weaning) schedules (when and if safe) for the acid blockers. Some acid blockers, when stopped too quickly, can cause rebound acid secretion in the stomach, resulting in excess hydrochloric acid secretion. The REBOUND ACID SECRETION often causes worse GERD symptoms!

ALSO, SOME FORMS OF REFLUX ARE NOT ACID REFLUX, but are ALKALINE REFLUX, (bile is alkaline). Besides refluxed stomach acid (HCl/hydrochloric acid), Pepsin (an acidic proteolytic/protein digesting, enzyme) &/or bile (alkaline) can irritate & damage: the esophagus, throat, vocal cords, & lungs. Acid blockers may not stop alkaline reflux!

(12) Do not drink ICY COLD DRINKS, and AVOID VERY HOT DRINKS. Use room temperature drinks, or slightly cool, or warm, but not ultra-hot. Extremely cold or hot liquids can irritate the stomach, which is bad for ulcers &/or gastric reflux.

(13) Ask physical therapists, chiropractors, osteopaths, etc. if they know any safe adjustments that might lessen GER/LPR, if you wish.

(14) Read (by Dr. James A. Koufman, M.D.--a great VOICE DOCTOR) PATIENT INFORMATION SHEET ON REFLUX by Center for Voice Disorders of Wake Forest University. Here’s a link:  http://www.bgsm.edu/voice/pt_info.html  Dr. Koufman was a pioneer in showing the connection between stomach reflux (can be acid reflux OR alkaline reflux) and breathing problems!

(15) Some have found a special (large) GERD pillow helpful for preventing GERD episodes while sleeping and while lying down. Here is a link to the Prop up pillow website:  http://www.propuppillow.com

(16) Avoid harmful chemical air pollution, which can aggravate gastric reflux. See page 5 of this VCD website for more information about this.

(17) Some patients have been greatly helped by holistic NUTRITIONISTS, who can give advice about improving the diet, taking nutritional supplements, and avoiding certain irritating or allergenic foods.  

(18) Using the above methods has almost completely freed my husband of needing to use Tums, and seems to be nicely controlling his and my GER/LPR. We have never used acid blockers.

(19) Using the above methods, in addition to the SINUS SURVIVAL tips, has helped us to prevent VCD attacks, and COUGHING problems, in us.

(20) Please check with your doctor, in advance, to be sure that it is OK for you to try these tips, in your particular case.  

a) Please get monitored by your doctor, to be sure that no more damage to the throat, esophagus, stomach, vocal cords, lungs, etc. is happening, from possible SILENT gastric reflux.

b) Pregnant or nursing ladies should check with their doctors, before trying any of these tips.

c) Check with your doctor and pharmacist, to be sure that there would be no harmful interactions between any of your medications, diet that you may be on, and any herbs, foods, etc. mentioned in these tips.

d) Check with your doctor, to be sure that these tips would not interact badly with any medical condition(s) you may have.

These tips help my husband and me (adults). Some of these tips may be OK for children, and others may not be OK for children. Check with your doctor! Babies with gastric reflux need DIFFERENT treatments (see Appendix C, below), not these tips (except for raising the head end of the crib, if your doctor says it is OK to do this, etc.). Check with your doctor!  

I mention brand names of some things that we have used and like, or that others have recommended to us. However, we get no money and no compensation from the companies mentioned.

I hope this helps.

Sincerely, Concerned lady
http://cantbreathesuspectvcd.com