Grade 4 Esophagitis/Positive FANA Test

[Monica__0__0]

  I am very frustrated to say the least.  I have grade 4 esophagitis and I tested positive for a FANA test(whatever that is). I was told it was markedly positive in two titers at 1:2560.  That this was possibly the reason that my ulcers were not healing and inflammation getting worse.  I am scheduled to see a Rheumotoid doctor, which took an act of congress to obtain.  My gasto doctor at Duke told me at first that I could not have fundoplication surgery because my motility study showed borderline esophageal contraction pressures and my amplitude at the 8cm lead was 42.2 and at the 3cm lead was 28.7. Now my doctor tells me I may not have a choice but to have the surgery even if I take a chance on not being able to swallow.  I am totally confused.  Could you tell me what this means.  I don't understand any of it and my doctor isn't real good at explaining.  I was referred to Duke by my gasto doctor who felt he couldn't help me.  Thank you.
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Dear Monica,
Some patients with connective tissue diseases ( conditions in which the body makes antibodies against itself) have an impairment of esophageal motilty.  Normally when you swallow there are contractions of the esophageal muscles that propel the food into the stomach.  These people with connective tissue disease do not have these contractions and therefore swallowed food passes down the esophagus solely by gravity.  If you do a fundoplication and thereby increase the pressure in the lower esophagus, a situation may result in which swallowed food is not propelled with sufficient force to enter the stomach and therefore accumuklates in the eophagus.  The fundoplication has to be tight to prevent reflux but if too tight will cause problems swallowing for these people.
IF the above wasn't confusing enough there is one more twist.  We know that severe esophagitis can itself interfere with esophageal muscle contraction and if the esophgeal inflammation is allowed to heal that these patients will have a return to normal swallowing.  This means that some people with esophagitis who have the surgery will see an improvement in swallowing.  The question that must be answered in your case is whether you will improve with surgery.
This information is presented for educational purposes only.  Always ask specific questions to your personal physician.  If you wih a second opinion, we would be happy to see you in the Division of Gastroenterology at henry Ford Health System in Detroit.  You can schedule an appoinment with Dr. Fogel, one of our experts in esophageal disease by calling our Physician referral Line at [phone]
HFHSM.D.-rf
*keywords: esophageal reflux, dysphagia, swallowing
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