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Gastroenterology (Expert Forum)
GERD???
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
GERD???
by amberhaws, Dec 29, 2004 12:00AM
CBC, CT Scan, Abdominal ultrasound, Gastric Emptying Nuclear Study, and Esophageal Manometry: Normal
EGD Impression: Incompetent LES
Upper GI Series: Minimal spontaneous GERD.
Small Bowel Follow Through: Negative small bowel follow through. Slightly rapid transit time.
24 Hour Esophageal Study: Significant GERD with 100% symptom correlation. In channel one a total of 140 episodes of reflux were recorded. Demeester score of 18.6. In channel two a total of 301 episodes of reflux were recorded during the waking hours. Demeester score of 45.9. Only 4 episodes of reflux recorded while asleep.
I am a 27 year old, 5’3”, 126lb female with no history of any mental or physical diseases/disorders. My health started declining in Sept. 03 when my period was absent. Since that time I have either an absent or very irregular (spotting every 2 weeks) cycle. My digestive problems began on Nov. 03 (following a day of overeating). Symptoms consisted of intermittent regurgitation and gas pressure. After suffering from regurgitation for over 10 days, I had to go to the ER due to dehydration. At that time I was given Reglan. While the regurgitation stopped after taking the Reglan, I still had serious gas pains and excessive belching (90+ times a day). The digestive symptoms that I have are with me every moment that I am awake and have been occurring every single day. These symptoms consist of: Severe reflux that occurs whenever I eat/drink anything. The best way to describe this is to say that it is like no matter what I eat/drink, my stomach gets irritated. Within a minute or two after eating/drinking, loud popping/gurgling bowel sounds can often be heard. I feel a tightness/extreme pressure in my upper abdomen and I will have either reflux, regurgitation, or belching occur in this time period. Walking or any type of physical activity makes the belching and reflux worse. Going from a lying or sitting position to a fully upright position will also cause these symptoms. The belching/reflux is extremely forceful occurring spontaneously throughout the day and it is like food/liquid are going up and down in my esophagus. In addition, I have a sense of fullness after eating, am rarely hungry, and oftentimes will have belching/reflux that tastes like food that was eaten 6-9 hours before the episode. My weight remains unchanged.
My doctor has told me “to be honest, I don’t know what is wrong with you”. He felt that my stomach was spasming and prescribed Dicyclomine 10 mg AC & HS. When this did not relieve my symptoms he referred me to a surgeon for a Nissen. However, he has told me that he is “unsure how helpful surgery will be” as he is unsure what is causing the reflux. The only med I am taking is Protonix 80mg bid.
Do I just have severe reflux or is there some underlying condition that is in fact causing this pressure/reflux?
Are there other tests that I should undergo before I have surgery (in order to get to the cause of this problem)?
Thank you
EGD Impression: Incompetent LES
Upper GI Series: Minimal spontaneous GERD.
Small Bowel Follow Through: Negative small bowel follow through. Slightly rapid transit time.
24 Hour Esophageal Study: Significant GERD with 100% symptom correlation. In channel one a total of 140 episodes of reflux were recorded. Demeester score of 18.6. In channel two a total of 301 episodes of reflux were recorded during the waking hours. Demeester score of 45.9. Only 4 episodes of reflux recorded while asleep.
I am a 27 year old, 5’3”, 126lb female with no history of any mental or physical diseases/disorders. My health started declining in Sept. 03 when my period was absent. Since that time I have either an absent or very irregular (spotting every 2 weeks) cycle. My digestive problems began on Nov. 03 (following a day of overeating). Symptoms consisted of intermittent regurgitation and gas pressure. After suffering from regurgitation for over 10 days, I had to go to the ER due to dehydration. At that time I was given Reglan. While the regurgitation stopped after taking the Reglan, I still had serious gas pains and excessive belching (90+ times a day). The digestive symptoms that I have are with me every moment that I am awake and have been occurring every single day. These symptoms consist of: Severe reflux that occurs whenever I eat/drink anything. The best way to describe this is to say that it is like no matter what I eat/drink, my stomach gets irritated. Within a minute or two after eating/drinking, loud popping/gurgling bowel sounds can often be heard. I feel a tightness/extreme pressure in my upper abdomen and I will have either reflux, regurgitation, or belching occur in this time period. Walking or any type of physical activity makes the belching and reflux worse. Going from a lying or sitting position to a fully upright position will also cause these symptoms. The belching/reflux is extremely forceful occurring spontaneously throughout the day and it is like food/liquid are going up and down in my esophagus. In addition, I have a sense of fullness after eating, am rarely hungry, and oftentimes will have belching/reflux that tastes like food that was eaten 6-9 hours before the episode. My weight remains unchanged.
My doctor has told me “to be honest, I don’t know what is wrong with you”. He felt that my stomach was spasming and prescribed Dicyclomine 10 mg AC & HS. When this did not relieve my symptoms he referred me to a surgeon for a Nissen. However, he has told me that he is “unsure how helpful surgery will be” as he is unsure what is causing the reflux. The only med I am taking is Protonix 80mg bid.
Do I just have severe reflux or is there some underlying condition that is in fact causing this pressure/reflux?
Are there other tests that I should undergo before I have surgery (in order to get to the cause of this problem)?
Thank you
Doctor's Answer
by Kevin Pho, MD, Dec 30, 2004 12:00AM
, Dec 30, 2004 12:00AM
You have had a pretty comprehensive GI evaluation already with the predominant finding being GERD. There probably isn't any further test that I would pursue.
One consideration would be to combine an H2 blocker with the Protonix to see if this can better control the acid.
If the symptoms continue despite maximal doses of medication, then surgery should certainly be considered.
I would discuss these options 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
One consideration would be to combine an H2 blocker with the Protonix to see if this can better control the acid.
If the symptoms continue despite maximal doses of medication, then surgery should certainly be considered.
I would discuss these options 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
did you study your stool,do you see undigested or half digested food in your feces??
try this-drink some cranberry juice or pineapple juice or apple vinegar before you eat and see if it helps.
All these above mentioned raised the acid level in your stomach.