Normal LES Pressure and Refractory GERD: What Does It Mean?

[the-wombat]

I have failed my last pH study on QUADRUPLE Aciphex.  My DeMeester score was 21.  My gastro wants to do an anti-reflux procedure called the Stretta procedure.  So I get a second opinion: the doctor noted my motility study shows that my LES is working with normal pressure (30; well in normal).  The comment made about the Stretta was this: "WHAT IS HE TRYING TO DO, MAKE IT SO YOU CANNOT SWALLOW?"  That made me think.   So the question is this:



If the LES is functioning normally, what is the likely cause of my GERD?   And are procedures (Nissen, Stretta) useless in such cases?

[karie]

I hope other patients reply to your interesting question?

So you had this test as a diagnostic due to no relief by the PPI ?

Have you been able to eat without heartburn?

What other tests helped your doctor to your diagnosis ?

I have noticed a doctor will post here every once in a while.

I know when we had support meetings it is helpful to have educated input as well. I have left numerous messages and too hope to learn all I can.

[the-wombat]

Comment on the above:  my symptoms have been a low level of dysphagia and more importantly atypical chest pain.  A sense of gripping in the chest.  Virtually no heartburn.  I have had 3 pH studies: first, without treatment: Demeester = 64; second Aciphex 20mg 2X; DeMeester = 34 (note: with stress induction, which worsens my symptoms and high fat, which also worsened symptoms).  Third pH study Aciphex 40mg 2X; DeMeester = 21.  



Second doctor thinks I have 'esophageal hypersensitivity'.   I think he is right.  



PPIs have no effect on most atypical symptoms.  Am not sure where the acid is - I do not feel it!



frank

[karie]

Can you share how this test went for you?

Do you find the chest discomfort comes on with exercise,stress,eating?

Any meds help you ?

Did you need to make lifestyle changes?

[the-wombat]

The test (pH): I HATED it!  All three times.  Particularly, installation is uncomfortable.  Also, esophagus feels raw after a few hours.  I sometimes wonder if that probe sitting in my esophagus makes reflux worse than otherwise.  Actually, I think it does.



Chest discomfort: glad you asked.  Certain things seem to provoke it.  Fatty foods, high stress (especially anger episodes) and not eating (like when I wait for procedure).  Feeling is constant, not gradual or cyclic.   Eating will reduce symptoms, but they will flare up after eating.  Exercise often helps, as does any endorphin flow (i.e., excitement).   Oh, a good head cold helps - actually it does wonders with the chest discomfort.  My esophagus feels GREAT when I have a cold.



Oh, benign foods like bananas and pears make my esophagus feel strange, too!



Meds: I feel pretty much the same if I have at least 1 PPI a day; they give me quadruple therapy now, which is overkill, I think.  I bet my DeMeester for double would be the same as quad therapy if the test conditions were identical.



Lifestyle changes: most of the standard ones.  Elevated position when sleeping, don't eat late, etc.  



I think either (a) this is related to CCK metabolism (guess on my part) or (b) esophageal hypersensitivity.



COMMENTS???

[Kittee]

Hi Frank:



How is esophageal hypersensitivity described.  Does it include spasms?  Do you feel pain in your back as well?



Thanks.



Kittee

[the-wombat]

When my symptoms get very bad, I get shooting pains in the back of my neck.  Also, I sometimes get a muscle spasm or twitch at the front top of the neck.  But no doctor has said I have esophageal spasm as a treatable etiology.

[daw]

Wombat....has any doctor ever suggested an antidepressant like Paxil? I've heard that it may affect the nerves of the esophagus (in a positive way). Something to check into or ask your doctors about. Some people are taking Elavil for GERD and spasms but I've heard mixed reviews on that one.

[the-wombat]

Regular doctor put me on low dose of Zoloft which controls a certain 'layer' of symptoms, but not others.  Specifically, there were times when I felt as if I could not swallow at all (briefly); this produced low level panic (my spin).  Both went away almost completely on Zoloft.

[kajo]

not to sound stupid, but what is a demeester score?