Silent GERD & medication

Echo wrote -

I thought they checked the throat too, during the endoscopy? At least they did the first time I had one in 2001. Not sure if they did this time.

Endoscopies do not usually check the throat. There are good links re: throat stuff in my post at -

viewtopic.php?f=1&t=51514&p=474810#p474810

echo wrote:
Mars -- the doctors that treated my dad said that even 10-yearly endoscopies are OK, but if it was someone in THEIR family they would recommend it every 5 years. The reasoning is that it takes a long time for the cells to become dysplastic and even longer to turn into cancer, so every 5 years is sufficient, in their opinion.

The recomended time period for checking about Barretts Esophagus in Australia is 2 years. I have it, so I chose a yearly check, and hopefully told there is no worsening of it. However. on the consideration that things might start going wrong the day after the check, I want to know as soon as possible if there is a change.

If the GERDS is treated soon enough, and the treatment is effective, I can understand someone who does not have Barretts being told 5 years. Doctors usually deal in the larger percentages. But what if you are in that small minority that is the exception - 5 years may be then too long.

When something is 100% guaranteed, I am fine. But when there are exception, my thought is that the exceptions are real people, and one of them could be me

So maybe I am overcautious, but what price peace of mind ? An endoscopy takes about 10 minutes. I do not have an anaesthetic, so I walk in, have it, and walk out.

cheers

Mars

frh wrote: As soon as I can get the money, I plan to order a Mediwedge http://www.mediwedge.com/index.html, but I can't quite decide between the 4" and 6" size.

Two tips from someone who has the head of the bed raised four inches.

1. You may find that six inches is a little uncomfortable and if you move around in your sleep often, there could be a tendency to slide toward the foot of the bed. Also, six inches is better for the GERD but I don't think there is a big marginal difference between four and six inches. Four inches gives me considerable help with preventing reflux.

2. But on the other hand, here is something much cheaper than the Mediwedge, http://www.walmart.com/ip/Adjustable-Be ... escription. These risers are sold in a set of four and of course you would only use two for the head of your bed. Besides the cost advantage, these risers are adjustable to three, five and eight inches. I have four-inch fixed risers, but if I had these I would use them at five inches and maybe experiment with eight inches.

If you cut out caffeine entirely, and are careful about spices (even things like cinammon and ginger can 'get' you later on in the day) plus take a Tums before bed, you might not need all the heavy meds you're afraid of (I speak from experience!).

Rooooster, thanks for the tip about the risers. I considered that. I came to the conclusion that I'm not willing to endure the domestic discontent that would be created if I tried to tilt the entire headboard / footboard. If I can get my sleep deprived brain to function well enough, I might try building a structure under the mattresses with wood slats. If it works I won't have to buy the expensive foam.

Thanks for the links and the good discussion. I might just have to go with a mediwedge type solution, but would have to try to find a local supplier. I can't imagine asking my mom to carry that on the plane over here! I also can't raise the whole bed either due to 'domestic discontent' that would ensue.

I have no idea if the medication starts working within the first day , 12 hours after taking it, but i did NOT wake up with a bad taste in my mouth this morning, and actually slept pretty well. yay! now time to replicate that, night after night, after night.

mars, i can understand your concern, esp if you already have the barretts esophagus.. i too would want to know about anything funny asap.

What about Aloe Vera juice? That is really supposed to help heal you "from the inside out" and may help your throat? It's supposed to help the immune system and has tons of benefits, supposedly. I had a friend that had fibroid-something growths and always swore that her pathology results were much better when she was taking aloe daily. My aunt was also drinking aloe after her chemo/radiation to help prevent breast cancer recurrence. I know those are just anecdotal stories, but it seems to be quite "popular" (of course not the same as "effective"). I've started drinking it in the mornings again, just in case

frh wrote:.... I'm not willing to endure the domestic discontent that would be created if I tried to tilt the entire headboard / footboard. ....

You mean there are two of them?!

Martha Stewart Rooster had a fit over the tilted bed clashing with the rest of the decor.

I may be further along with CPAP therapy than you are and I had the strength to put up a fierce fight and prevail with my risers.

roster wrote:Martha Stewart Rooster had a fit over the tilted bed clashing with the rest of the decor.

I may be further along with CPAP therapy than you are and I had the strength to put up a fierce fight and prevail with my risers.

In my case, it doesn't help that the primary cpap-er isn't really convinced that they want to do the tilting bid-ness in the first place! Sheesh if i was reading a poster posting like me, i'd whack em with a good strong 2x4. Do as i say not as i do

Clever words roster

Hi Echo,

Sounds like your GERD is not so silent. Actually, it doesn't sound like you have GERD--you have NERD, Nonerosive Reflux Disease (great acronym, huh?!)

Here's one not-so-well-known piece of information: Prilosec (you are taking the generic) should be taken 30-60 minutes before a meal. Also, it does not always provide complete 24 hours coverage. If you need to, you can take it twice a day.

Did your father have Barrett's? Was he a smoker?

Actually, the guidelines are that if you have had one clean endoscopy and no Barrett's was found, you don't need another endoscopy; however, that said, if it were I, I would repeat it because I would worry about whether it was missed. PPIs (proton pump inhibitors) can help in surveillance -- it can make it easier to see the esophagus when an endoscopy is done.

Finally, there are no studies that show that PPIs protect against Barrett's. It's assumed they do because it makes good sense (Acid leads to Barrett's, Barrett's leads to cancer). The thinking is that even though a good enough study hasn't been done to prove it, PPIs are recommended in someone who has Barrett's. According to your doctor, you don't have Barrett's. So the question is whether your symptoms bother you, and if they do, you can take the medication to alleviate your symptoms.

I hope this helps.

P.S. I doubt if your gastroenterologist works out 2 hours a day! That's a ridiculous recommendation, and the chances his patients will exercise are probably decreased by giving them an unrealistic standard.

echo wrote:Well I'm getting the 5-yearly endoscopies now, but I'm still not comfortable with continuously reducing my stomach acid with meds (since I don't think that's the real cause of the reflux anyway).

You might want to consider insufficient stomach acid as part of the problem. Because of a genetic disease I have routine endoscopies at least once a year to check for and remove adenomas polyps in the stomach and duodenum before the polyps become cancerous. I also have only 6" of colon because of adenomas polyps and things tend to move faster than 'normal' through my digestive system.

A few years ago I had signs of mild acid damage at the bottom of the esophagus. Because my digestive system behavior shows some signs of insufficient stomach acid, I was very consistent with taking Betaine HCL acid at the start of meals for a few months. My next endoscopy showed no signs of acid damage.

While this is clearly anecdotal info, my naturopath wasn't surprised - both his training and experience support that SOME people with symptoms of too much stomach acid actually have too little. The theory is that response of valve at the bottom of the esophagus is at least partially related to stomach acid levels and may not close when ph is too high.

While I would consider insufficient stomach acid, I would also be cautious - particularly with your family history. The amount of acid damage I had wasn't enough to start an acid inhibitor so it was pretty safe to try adding the Betaine HCL. When I am consistent taking the supplement, my digestive system is much calmer and handles things better.

Prilosec works immediatlely on symptoms for me - within ond day. Actually, that immediate (symptomatic) response is one of the indications that it's the right medication. Symptom relief in this case however is not to be confused with healing: it's simply a response to the removal of the irritant (acid).

O.

NERD, eh?! That's great, I AM a nerd Never heard of that, will look it up.

I don't know if my dad had Barrett's, he had complained of reflux since his teenage years, his dad (a surgeon) told him to take antacids. Later his GP gave him Prilosec for years. No endoscopy was ever done. At the age of around 50 he started choking on food, went to his GP, got referred for an endoscopy, and immediately they found the esophagael cancer. Then chemo, surgery, removal of the esophagus, etc. If of course came back about 2/3 years later. He never smoked, drank moderately, was VERY good at watching what he ate (wheat allergy), but struggled with weight gain (he wasn't obese, just overweight now and then).

I was told not to take any OTC PPIs before the endo because they could cover up the damage and lead to a false negative diagnosis.

fiberfan, I have always wondered about the low stomach acid too. I was actually pretty convinced THAT was the real problem, but i don't have a naturopath to work with and I never found any publications on this topic (though I didn't look too hard), but lots of naturopathic websites that talk about it. I even though that perhaps the esophagael damage was related to overproduction of bile to compensate for the low stomach acid, and that's what's coming back up. I was too afraid to start taking HCl tablets on my own with no monitoring.

Ozij, that's right, and that's what worries me, especially in combination with my dad's history. Just because the acid and symptoms are reduced, we don't really know what's going on so the question is, what is the real cause of the symptoms (like insufficient acid instead of too much), or perhaps it's simply the LES dysfunction.

It's all very confusing sometimes, and I'm someone that likes to know the real cause of something before I try to fix it (a fan of Ms muffy, one would say). Just because symptoms go away doesn't mean the underlying problem has been solved... and if it's not really solved, what other complications may soon arise??

There is a test for stomach acid production called Heidelberg Capsule Test. It involves swallowing a ph meter capsule. After recording stomach ph the patient drinks a alkaline solution like baking soda in water and ph response is monitored. I don't know how many doctor's use it but it certainly sounds like a good way to know how well your body produces stomach acid.

There is a book written by an MD on low stomach acid. "Why Stomach Acid is Good for You: Natural Relief from Heartburn, Indigestion, Reflux and GERD". I read it 5+ years ago and don't remember much about it.