strange heartburn problem

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Question:

I’ve had bad heartburn-like pain in my chest for the past 5 months at varying levels of intensity.  At its worst, I’ve gone to the emergency room.  Sometimes it is almost tolerable.  This started after 10 days on doxycycline, so the initial thought was that caused irritation to the esophagus or stomach.  Accordingly, my Prevacid dose was upped and the theory was that after a few weeks of extra acid suppression, I would heal, and could go back to the 15 mg every other day dose of Prevacid I was taking originally.  Well, 5 months later, and there is really no improvement in symptoms.  In fact, I’m now on 30 mg twice a day and it’s no better: I still get excrutiating attacks ever few weeks, and the pain is always present if sometimes almost tolerable. I even switched to Aciphex for 3 weeks, but it wasn’t better than Prevacid and made me feel "strange" so I went back to Prevacid.  Now, 4 months ago an endoscopy revealed that my esophagus was fine, but there was some "slight irritation" of the stomach lining itself.  I have yet to get another endoscopy to see if it looks worse, but probably will. So, my question is why the heck am I not healing? BTW, there seems to be almost no correspondence between the level of pain and what food I eat, but I eat cautiously anyway.  Also, I never drink alcohol, I don’t smoke, and I’m under weight if anything.  I would describe the pain as not so much burning as a tightness/fullness/achiness, mostly under the sternum, but often also under the right breast area.  The later pain is a poser because I didn’t think anything but lung was over there! Thanks for any insight. John.

Response:

– Hide quoted text — Show quoted text -> I’ve had bad heartburn-like pain in my chest for the past 5 months at > varying levels of intensity.  At its worst, I’ve gone to the emergency > room.  Sometimes it is almost tolerable.  This started after 10 days > on doxycycline, so the initial thought was that caused irritation to > the esophagus or stomach.  Accordingly, my Prevacid dose was upped and > the theory was that after a few weeks of extra acid suppression, I > would heal, and could go back to the 15 mg every other day dose of > Prevacid I was taking originally.  Well, 5 months later, and there is > really no improvement in symptoms.  In fact, I’m now on 30 mg twice a > day and it’s no better: I still get excrutiating attacks ever few > weeks, and the pain is always present if sometimes almost tolerable. > I even switched to Aciphex for 3 weeks, but it wasn’t better than > Prevacid and made me feel "strange" so I went back to Prevacid.  Now, > 4 months ago an endoscopy revealed that my esophagus was fine, but > there was some "slight irritation" of the stomach lining itself.  I > have yet to get another endoscopy to see if it looks worse, but > probably will. > So, my question is why the heck am I not healing? > BTW, there seems to be almost no correspondence between the level of > pain and what food I eat, but I eat cautiously anyway.  Also, I never > drink alcohol, I don’t smoke, and I’m under weight if anything.  I > would describe the pain as not so much burning as a > tightness/fullness/achiness, mostly under the sternum, but often also > under the right breast area.  The later pain is a poser because I > didn’t think anything but lung was over there!

Not enough info here to do anything but take a wild guess. You need another EGD, plus ambulatory pH testing and esophageal manometry. HMc

Response:

Just a couple of thoughts. Have you been checked for Heliobactor Pilori infection in your stomach?  The pain you describe sounds similar to that which I had when infected. Re the pain under the right breast, I think your gall bladder is on the RHS, in behind the lower ribs.  Gall stones can cause anything from a dull ache to sharp pains in this area. Andrew. – Hide quoted text — Show quoted text -> I’ve had bad heartburn-like pain in my chest for the past 5 months at > varying levels of intensity.  At its worst, I’ve gone to the emergency > room.  Sometimes it is almost tolerable.  This started after 10 days > on doxycycline, so the initial thought was that caused irritation to > the esophagus or stomach.  Accordingly, my Prevacid dose was upped and > the theory was that after a few weeks of extra acid suppression, I > would heal, and could go back to the 15 mg every other day dose of > Prevacid I was taking originally.  Well, 5 months later, and there is > really no improvement in symptoms.  In fact, I’m now on 30 mg twice a > day and it’s no better: I still get excrutiating attacks ever few > weeks, and the pain is always present if sometimes almost tolerable. > I even switched to Aciphex for 3 weeks, but it wasn’t better than > Prevacid and made me feel "strange" so I went back to Prevacid.  Now, > 4 months ago an endoscopy revealed that my esophagus was fine, but > there was some "slight irritation" of the stomach lining itself.  I > have yet to get another endoscopy to see if it looks worse, but > probably will. > So, my question is why the heck am I not healing? > BTW, there seems to be almost no correspondence between the level of > pain and what food I eat, but I eat cautiously anyway.  Also, I never > drink alcohol, I don’t smoke, and I’m under weight if anything.  I > would describe the pain as not so much burning as a > tightness/fullness/achiness, mostly under the sternum, but often also > under the right breast area.  The later pain is a poser because I > didn’t think anything but lung was over there! > Thanks for any insight. > John.

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Response:

Symptom help

Question:

A few months back I had tightness in my chest and what felt like heart palpitations. So I went to the doc and they run an ECG and find high voltage spikes or something to that effect. So they do an echocardiogram (sp?) to check for an enlarged heart, but find nothing. The problem has continued for months since then, mostly at night when I sleep on my back. I’ve also had back pain and what feels like swelling of the adams apple (difficulty swallowing) and when it’s real bad, then urge to throw up. I’ve also started to notice this during exercise. I’ve never had "classic heartburn" symptoms though. So I go back to the doc and they saddle me up with a 24 hr monitor to rule out heart problems. So now he prescribes an antacid, without doing any gastric tests. Everything is stress with this guy. From what little I’ve read in this group, this can be a complex problem, anything from Acid Reflux to GERD or spasms of the esophagus. Apart from finding a new doctor, what else can I do to narrow this down?

Response:

– Hide quoted text — Show quoted text -> A few months back I had tightness in my chest and what felt like heart > palpitations. So I went to the doc and they run an ECG and find high > voltage spikes or something to that effect. So they do an > echocardiogram (sp?) to check for an enlarged heart, but find nothing. > The problem has continued for months since then, mostly at night when I > sleep on my back. I’ve also had back pain and what feels like swelling > of the adams apple (difficulty swallowing) and when it’s real bad, then > urge to throw up. I’ve also started to notice this during exercise. > I’ve never had "classic heartburn" symptoms though. > So I go back to the doc and they saddle me up with a 24 hr monitor to > rule out heart problems. So now he prescribes an antacid, without doing > any gastric tests. Everything is stress with this guy. From what little > I’ve read in this group, this can be a complex problem, anything from > Acid Reflux to GERD or spasms of the esophagus. Apart from finding a > new doctor, what else can I do to narrow this down?

See a gastroenterologist or surgeon. You need an upper GI endoscopy (EGD) and 48-hours ambulatory pH testing to rule out GERD. HMc

Response:

Fundamental indigestion

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Question:

Would it seem reasonable for a consultant to diagnose (prior to future tests) fundamental indigestion for an elderly  patient (68) who last year had treatment for a duodenal ulcer and whose symptoms keep returning  after having had triple therapy and when PPI’s are reduced to a maintenance level for acid reflux. Grisby

Response:

> Would it seem reasonable for a consultant to diagnose (prior to future > tests) fundamental indigestion for an elderly  patient (68) who last year > had treatment for a duodenal ulcer and whose symptoms keep returning after > having had triple therapy and when PPI’s are reduced to a maintenance level > for acid reflux. > Grisby

I’m not sure what "fundamental indigestion" is. If one is working up dyspeptic symptoms, then I don’t think it’s reasonable to assume any diagnosis until the workup is complete. This would include EGD, gallbladder ultrasound, HIDA scan with ejection fraction of the gallbladder (if ultrasound is normal), esophageal pH testing, and esophageal manometry. If "fundamental indigestion" is what would be normally termed a "functional" diagnosis, then it’s a diagnosis of exclusion and by definition can’t be made until a complete workup is done. HMc – Hide quoted text — Show quoted text –

Response:

– Hide quoted text — Show quoted text -> Would it seem reasonable for a consultant to diagnose (prior to future > tests) fundamental indigestion for an elderly  patient (68) who last year > had treatment for a duodenal ulcer and whose symptoms keep returning > after > having had triple therapy and when PPI’s are reduced to a maintenance > level > for acid reflux. > Grisby > I’m not sure what "fundamental indigestion" is. > If one is working up dyspeptic symptoms, then I don’t think it’s reasonable > to assume any diagnosis until the workup is complete. This would include > EGD, gallbladder ultrasound, HIDA scan with ejection fraction of the > gallbladder (if ultrasound is normal), esophageal pH testing, and esophageal > manometry. > If "fundamental indigestion" is what would be normally termed a "functional" > diagnosis, then it’s a diagnosis of exclusion and by definition can’t be > made until a complete workup is done. > HMc

Sorry I got the wording wrong it should have been Functional Dyspepsia. Grisby Functional dyspepsia (FD) is defined as chronic upper, centered abdominal discomfort or pain excluding the predominant symptom, heartburn. Associated symptoms are early satiety, nausea, vomiting, abdominal distension, bloating, and anorexia. For many years motor (movement) abnormalities in the stomach have been investigated and thought to be the cause of FD. As usual, psychosomatic theories are popular and patients are often prescribed tranquilizers or antidepressants.  Stress and anxiety are linked to motility problems and with the blind of a blind eye; a bad theory of FD (and IBS) was formulated and has remained popular despite lack of any convincing evidence. FD suffers responds poorly to common drug therapies and the majority of sufferers have episodic symptoms that reduce the quality of life and result in increased use of healthcare resources. Since FD is a rather vague diagnosis, symptoms often overlap with peptic ulcers, esophagitis and irritable bowel syndrome. It is easy to confuse acid reflux into the esophagus (GERD) with FD. Most gastroenterologists will not classify heartburn as "dyspepsia", and if esophagitis is present, FD cannot be diagnosed. By strict definition, patients with FD have undergone upper intestinal endoscopy that has revealed no lesions that can explain their symptoms. Diagnosis should include testing and possibly treatment for Helicobacter pylori. If infection is present, antisecretory therapy with H2-receptor antagonists or proton-pump inhibitors can be tried but these therapies are often not effective. One has to recall that H Pylori is often found in asymptomatic patients and their presence does not automatically mean that they are the cause of disease.

Response:

– Hide quoted text — Show quoted text -> > Would it seem reasonable for a consultant to diagnose (prior to future > > tests) fundamental indigestion for an elderly  patient (68) who last > year > > had treatment for a duodenal ulcer and whose symptoms keep returning > after > > having had triple therapy and when PPI’s are reduced to a maintenance > level > > for acid reflux. > > Grisby > I’m not sure what "fundamental indigestion" is. > If one is working up dyspeptic symptoms, then I don’t think it’s > reasonable > to assume any diagnosis until the workup is complete. This would include > EGD, gallbladder ultrasound, HIDA scan with ejection fraction of the > gallbladder (if ultrasound is normal), esophageal pH testing, and > esophageal > manometry. > If "fundamental indigestion" is what would be normally termed a > "functional" > diagnosis, then it’s a diagnosis of exclusion and by definition can’t be > made until a complete workup is done. > HMc > Sorry I got the wording wrong it should have been Functional Dyspepsia. > Grisby > Functional dyspepsia (FD) is defined as chronic upper, centered abdominal > discomfort or pain excluding the predominant symptom, heartburn. Associated > symptoms are early satiety, nausea, vomiting, abdominal distension, > bloating, and anorexia. For many years motor (movement) abnormalities in the > stomach have been investigated and thought to be the cause of FD. As usual, > psychosomatic theories are popular and patients are often prescribed > tranquilizers or antidepressants.  Stress and anxiety are linked to motility > problems and with the blind of a blind eye; a bad theory of FD (and IBS) was > formulated and has remained popular despite lack of any convincing evidence. > FD suffers responds poorly to common drug therapies and the majority of > sufferers have episodic symptoms that reduce the quality of life and result > in increased use of healthcare resources. > Since FD is a rather vague diagnosis, symptoms often overlap with peptic > ulcers, esophagitis and irritable bowel syndrome. It is easy to confuse acid > reflux into the esophagus (GERD) with FD. Most gastroenterologists will not > classify heartburn as "dyspepsia", and if esophagitis is present, FD cannot > be diagnosed. By strict definition, patients with FD have undergone upper > intestinal endoscopy that has revealed no lesions that can explain their > symptoms. Diagnosis should include testing and possibly treatment for > Helicobacter pylori. If infection is present, antisecretory therapy with > H2-receptor antagonists or proton-pump inhibitors can be tried but these > therapies are often not effective. One has to recall that H Pylori is often > found in asymptomatic patients and their presence does not automatically > mean that they are the cause of disease.

Yes, I understand the term "functional dyspepsia". It is typically a "wastebasket" diagnosis that is made after all other potential diagnoses are ruled out. Symptomatic gallbladder disease, peptic ulcer, gastritis, GERD, IBS, etc can all present with the same or similar patient complaints. As I said, a diagnosis of exclusion. EGD is commonly done as part of the workup, and GERD is one diagnosis that must be excluded. The problem is (and many physicians don’t understand this) that GERD cannot be ruled out on the basis of EGD alone since severe symptomatic reflux can most definitely be present even in the face of a completely normal EGD. EGD can only diagnose the *complications* of GERD (esophagitis, stricture, Barrett’s esophagus). A normal EGD does not rule out the GERD. Ambulatory pH testing is the only way to definitively diagnose GERD if the EGD does not demonstrate the above complications. HMc

Response:

Aetna wants me to try protonix?

Question:

I’ve been on nexium .40 mg for 1 1/2 yrs now and its amazing.but now a new plan wants me to try a cheaper alternetive-protonix. Does anyone have experience with this?How similar/disimilar are they? Aetne wants to spend less, but will step me up only if protonix doesnt do a good job….thanks in advance…ED

Response:

> I’ve been on nexium .40 mg for 1 1/2 yrs now and its amazing.but now a > new plan wants me to try a cheaper alternetive-protonix. Does anyone > have experience with this?How similar/disimilar are they? > Aetne wants to spend less, but will step me up only if protonix doesnt > do a good job….thanks in advance…ED

It’s a common insurance company maneuver. All insurance companies negotiate deals with drug companies, and it sounds like Aetna just negotiated a better deal with Wyeth Pharmaceuticals than they had with Astra Zeneca. Protonix is fine. Different people respond to different medications differently. For some people, Nexium doesn’t work worth a damn and Protonix is their salvation. And the opposite is true too. Give the Protonix a try, see if it works ok for you. If not, your doctor will write a strongly worded letter to Aetna certifying that Protonix doesn’t work for you and you’ll get Nexium.   Probably. HMc

Response:

> I’ve been on nexium .40 mg for 1 1/2 yrs now and its amazing.but now a > new plan wants me to try a cheaper alternetive-protonix. Does anyone > have experience with this?How similar/disimilar are they?

Ahh, welcome to modern prescription coverage.  Due to changing carriers I had to move from prevacid->prilosec->protonix->nexium. For the most part, they’re the same, although the latter three seemed to work a bit better than prevacid for me, but everyone is different. Chances are, Protonix will treat you similarly to Nexium, but if it doesn’t work out, like Howard says you can usually get your doctor to talk to the insurance company and okay Nexium (but be prepared for a larger copay). Note that it’s worth checking out the OTC availability, since sometimes the OTC stuff can be cheaper than the prescription copay, although this widely varies (for a while I was taking Zantac, and OTC generic Zantac (ranitidine) from Walmart was *way* cheaper than my $15 copay at the time), since at least one proton pump inhibitor is on the market now (Prilosec OTC).  But check with your doctor before doing any drastic changes… — Richard W Kaszeta http://www.kaszeta.org/rich

Response:

– Hide quoted text — Show quoted text -> I’ve been on nexium .40 mg for 1 1/2 yrs now and its amazing.but now a > new plan wants me to try a cheaper alternetive-protonix. Does anyone > have experience with this?How similar/disimilar are they? > Aetne wants to spend less, but will step me up only if protonix doesnt > do a good job….thanks in advance…ED > It’s a common insurance company maneuver. All insurance companies negotiate > deals with drug companies, and it sounds like Aetna just negotiated a better > deal with Wyeth Pharmaceuticals than they had with Astra Zeneca. > Protonix is fine. Different people respond to different medications > differently. For some people, Nexium doesn’t work worth a damn and Protonix > is their salvation. And the opposite is true too. > Give the Protonix a try, see if it works ok for you. If not, your doctor > will write a strongly worded letter to Aetna certifying that Protonix > doesn’t work for you and you’ll get Nexium.   Probably. > HMc

Howard, I know that nexium and protonix are needed for alot of people. Isnt it some potent stuff though?

Response:

My prilosec seems to work fine for my acid but I still have stomach pain. Can’t wait for the endeoscopy. OH JOY!

– Hide quoted text — Show quoted text -> I’ve been on nexium .40 mg for 1 1/2 yrs now and its amazing.but now a > new plan wants me to try a cheaper alternetive-protonix. Does anyone > have experience with this?How similar/disimilar are they? > Ahh, welcome to modern prescription coverage.  Due to changing > carriers I had to move from prevacid->prilosec->protonix->nexium. > For the most part, they’re the same, although the latter three seemed > to work a bit better than prevacid for me, but everyone is different. > Chances are, Protonix will treat you similarly to Nexium, but if it > doesn’t work out, like Howard says you can usually get your doctor to > talk to the insurance company and okay Nexium (but be prepared for a > larger copay). > Note that it’s worth checking out the OTC availability, since > sometimes the OTC stuff can be cheaper than the prescription copay, > although this widely varies (for a while I was taking Zantac, and OTC > generic Zantac (ranitidine) from Walmart was *way* cheaper than my $15 > copay at the time), since at least one proton pump inhibitor is on the > market now (Prilosec OTC).  But check with your doctor before doing > any drastic changes… > — > Richard W Kaszeta > http://www.kaszeta.org/rich

Response:

– Hide quoted text — Show quoted text -> > I’ve been on nexium .40 mg for 1 1/2 yrs now and its amazing.but now a > > new plan wants me to try a cheaper alternetive-protonix. Does anyone > > have experience with this?How similar/disimilar are they? > > Aetne wants to spend less, but will step me up only if protonix doesnt > > do a good job….thanks in advance…ED > It’s a common insurance company maneuver. All insurance companies > negotiate > deals with drug companies, and it sounds like Aetna just negotiated a > better > deal with Wyeth Pharmaceuticals than they had with Astra Zeneca. > Protonix is fine. Different people respond to different medications > differently. For some people, Nexium doesn’t work worth a damn and > Protonix > is their salvation. And the opposite is true too. > Give the Protonix a try, see if it works ok for you. If not, your doctor > will write a strongly worded letter to Aetna certifying that Protonix > doesn’t work for you and you’ll get Nexium.   Probably. > HMc > Howard, I know that nexium and protonix are needed for alot of people. Isnt > it some potent stuff though?

The entire class of drugs, proton pump inhibitors, is VERY effective at controlling stomach acid output. HMc

Response:

– Hide quoted text — Show quoted text -> > > I’ve been on nexium .40 mg for 1 1/2 yrs now and its amazing.but now a > > > new plan wants me to try a cheaper alternetive-protonix. Does anyone > > > have experience with this?How similar/disimilar are they? > > > Aetne wants to spend less, but will step me up only if protonix doesnt > > > do a good job….thanks in advance…ED > > It’s a common insurance company maneuver. All insurance companies > negotiate > > deals with drug companies, and it sounds like Aetna just negotiated a > better > > deal with Wyeth Pharmaceuticals than they had with Astra Zeneca. > > Protonix is fine. Different people respond to different medications > > differently. For some people, Nexium doesn’t work worth a damn and > Protonix > > is their salvation. And the opposite is true too. > > Give the Protonix a try, see if it works ok for you. If not, your doctor > > will write a strongly worded letter to Aetna certifying that Protonix > > doesn’t work for you and you’ll get Nexium.   Probably. > > HMc > Howard, I know that nexium and protonix are needed for alot of people. > Isnt > it some potent stuff though? > The entire class of drugs, proton pump inhibitors, is VERY effective at > controlling stomach acid output. > HMc

I bet but can it be good for long term use? Can it damage the system ever if used to long?

Response:

> The entire class of drugs, proton pump inhibitors, is VERY effective at > controlling stomach acid output. > HMc > I bet but can it be good for long term use? Can it damage the system ever if > used to long?

When the class first came out (Losec — now Prilosec), it was only FDA approved for short term use as there was speculation (and no long term data) that it would increase the risk of stomach cancer. It has long been known that no stomach acid would result in higher levels of circulating gastrin because it’s acid that determines gastrin output via negative feedback. In other words, gastrin stimulates acid output and acid controls gastrin levels. So, if there is too much acid, there is no gastrin, and if there is too little acid, there is lots of gastrin. If you take these anti-acid drugs, you will have high circulating levels of gastrin. Gastrin is a trophic hormone — it stimulates the stomach lining and the speculation was that that constant stimulation would increase the risk of stomach cancer. This has not  been shown to be the case, and the FDA has approved PPIs for long term use. I have seen multiple polyps in the stomach many times in patients who have been on long term proton pump inhibitors, but biopsies always show little or no malignant potential, as far as we know. It IS speculated that the use of anti acid medications such as H2 receptor antagonists and PPIs increases the risk of esophageal cancer. The use of these medications alkalinizes the stomach, changing  the pH and allowing bile salts to come out of solution. These bile salts are highly irritating to the lining of the lower esphagus, but don’t cause the severe symptoms that acid causes. So even though a person’s heartburn symptoms go away, their risk of esophageal cancer actually increases. The point is that these medications don’t do anything to stop the reflux, they only change the character of the refluxate, and although there are fewer symptoms, the esophageal changes of Barrett’s esophagus (and it’s attendant cancer risk) actually progress more rapidly. The incidence of esophageal cancer has been increasing rapidly over the last 35 years, and the graphs coincide exactly with the discovery and increasing use of anti-secretory medications. The use of these medications only stops the SYMPTOMS of GERD, but doesn’t actually stop the reflux. Managing the symptoms might be appropriate if there is no evidence of Barrett’s esophagus on EGD, but ongoing surveillance is important because of the increased risk of esophageal cancer. HMc

Response:

Two questions. 1 Are polyps caused by propton pump inhibitors lessening the acid content of the stomach? 2 "Stomach Pain" is listed as one of the side effects of proton pump inhibitors, how does a patient know if his pain is caused by the drug instead of his ulcer or other problem? Derek.

– Hide quoted text — Show quoted text -> > The entire class of drugs, proton pump inhibitors, is VERY effective at > > controlling stomach acid output. > > HMc > I bet but can it be good for long term use? Can it damage the system ever > if > used to long? > When the class first came out (Losec — now Prilosec), it was only FDA > approved for short term use as there was speculation (and no long term data) > that it would increase the risk of stomach cancer. It has long been known > that no stomach acid would result in higher levels of circulating gastrin > because it’s acid that determines gastrin output via negative feedback. In > other words, gastrin stimulates acid output and acid controls gastrin > levels. So, if there is too much acid, there is no gastrin, and if there is > too little acid, there is lots of gastrin. If you take these anti-acid > drugs, you will have high circulating levels of gastrin. > Gastrin is a trophic hormone — it stimulates the stomach lining and the > speculation was that that constant stimulation would increase the risk of > stomach cancer. This has not  been shown to be the case, and the FDA has > approved PPIs for long term use. I have seen multiple polyps in the stomach > many times in patients who have been on long term proton pump inhibitors, > but biopsies always show little or no malignant potential, as far as we > know. > It IS speculated that the use of anti acid medications such as H2 receptor > antagonists and PPIs increases the risk of esophageal cancer. The use of > these medications alkalinizes the stomach, changing  the pH and allowing > bile salts to come out of solution. These bile salts are highly irritating > to the lining of the lower esphagus, but don’t cause the severe symptoms > that acid causes. So even though a person’s heartburn symptoms go away, > their risk of esophageal cancer actually increases. The point is that these > medications don’t do anything to stop the reflux, they only change the > character of the refluxate, and although there are fewer symptoms, the > esophageal changes of Barrett’s esophagus (and it’s attendant cancer risk) > actually progress more rapidly. The incidence of esophageal cancer has been > increasing rapidly over the last 35 years, and the graphs coincide exactly > with the discovery and increasing use of anti-secretory medications. > The use of these medications only stops the SYMPTOMS of GERD, but doesn’t > actually stop the reflux. Managing the symptoms might be appropriate if > there is no evidence of Barrett’s esophagus on EGD, but ongoing surveillance > is important because of the increased risk of esophageal cancer. > HMc

Response:

> Two questions. > 1 Are polyps caused by propton pump inhibitors lessening the acid content of > the stomach? > 2 "Stomach Pain" is listed as one of the side effects of proton pump > inhibitors, how does a patient know if his pain is caused by the drug > instead of his ulcer or other problem? > Derek.

1.  Yes. The decreased stomach acid results in higher circulating gastrin, which stimulates the polyp growth in stomach lining. 2.  It’s not classified as "stomach" pain, but as "abdominal" pain. Usually it is cramping in the small intestine or in the colon. One would sort it out by the nature of the pain, or ultimately by EGD if it could not be diagnosed clinically. HMc

Response:

> Two questions. > 1 Are polyps caused by propton pump inhibitors lessening the acid content > of > the stomach? > 2 "Stomach Pain" is listed as one of the side effects of proton pump > inhibitors, how does a patient know if his pain is caused by the drug > instead of his ulcer or other problem? > Derek. > 1.  Yes. The decreased stomach acid results in higher circulating gastrin, > which stimulates the polyp growth in stomach lining.

What is polyp growth? – Hide quoted text — Show quoted text -> 2.  It’s not classified as "stomach" pain, but as "abdominal" pain. Usually > it is cramping in the small intestine or in the colon. One would sort it out > by the nature of the pain, or ultimately by EGD if it could not be diagnosed > clinically. > HMc

Response:

– Hide quoted text — Show quoted text -> > Two questions. > > 1 Are polyps caused by propton pump inhibitors lessening the acid > content > of > > the stomach? > > 2 "Stomach Pain" is listed as one of the side effects of proton pump > > inhibitors, how does a patient know if his pain is caused by the drug > > instead of his ulcer or other problem? > > Derek. > 1.  Yes. The decreased stomach acid results in higher circulating gastrin, > which stimulates the polyp growth in stomach lining. > What is polyp growth?

Something that grows in dark, moist places and looks like a mushroom. Derek

Response:

> What is polyp growth?

Google. Or, look at http://www.endoskopischer-atlas.de/m18e.htm and at  http://tinyurl.com/rgcx . In fact, look at this guy’s whole site, it’s pretty good http://tinyurl.com/rgd1 HMc

Response:

- Hide quoted text — Show quoted text -> > The entire class of drugs, proton pump inhibitors, is VERY effective at > > controlling stomach acid output. > > HMc > I bet but can it be good for long term use? Can it damage the system ever >  if > used to long? > When the class first came out (Losec — now Prilosec), it was only FDA > approved for short term use as there was speculation (and no long term data) > that it would increase the risk of stomach cancer. It has long been known > that no stomach acid would result in higher levels of circulating gastrin > because it’s acid that determines gastrin output via negative feedback. In > other words, gastrin stimulates acid output and acid controls gastrin > levels. So, if there is too much acid, there is no gastrin, and if there is > too little acid, there is lots of gastrin. If you take these anti-acid > drugs, you will have high circulating levels of gastrin. > Gastrin is a trophic hormone — it stimulates the stomach lining and the > speculation was that that constant stimulation would increase the risk of > stomach cancer. This has not  been shown to be the case, and the FDA has > approved PPIs for long term use. I have seen multiple polyps in the stomach > many times in patients who have been on long term proton pump inhibitors, > but biopsies always show little or no malignant potential, as far as we > know. > It IS speculated that the use of anti acid medications such as H2 receptor > antagonists and PPIs increases the risk of esophageal cancer. The use of > these medications alkalinizes the stomach, changing  the pH and allowing > bile salts to come out of solution. These bile salts are highly irritating > to the lining of the lower esphagus, but don’t cause the severe symptoms > that acid causes. So even though a person’s heartburn symptoms go away, > their risk of esophageal cancer actually increases. The point is that these > medications don’t do anything to stop the reflux, they only change the > character of the refluxate, and although there are fewer symptoms, the > esophageal changes of Barrett’s esophagus (and it’s attendant cancer risk) > actually progress more rapidly. The incidence of esophageal cancer has been > increasing rapidly over the last 35 years, and the graphs coincide exactly > with the discovery and increasing use of anti-secretory medications. > The use of these medications only stops the SYMPTOMS of GERD, but doesn’t > actually stop the reflux. Managing the symptoms might be appropriate if > there is no evidence of Barrett’s esophagus on EGD, but ongoing surveillance > is important because of the increased risk of esophageal cancer. > HMc

OH MY! OH MY!  WHAT TO DO!  I am so confused.  I am taking Protonix so I don’t have acid reflux so I don’t get esophegeal cancer and long term use will likely CAUSE the cancer.  What do you suggest people with this chronic problem do exactly?  This is really perplexing.  I’d rather take no meds if given a choice.  Please tell me what to do here as I have been on Protonix for several years and am only 47.  I love my life and want to keep on livin it!  ( :  Is there anything that will actually stop the reflux…diet, etc.?

Response:

– Hide quoted text — Show quoted text -> What is polyp growth? > Google. > Or, look at http://www.endoskopischer-atlas.de/m18e.htm > and at >  http://tinyurl.com/rgcx . In fact, look at this guy’s whole site, it’s > pretty good http://tinyurl.com/rgd1 > HMc

Yuck!

Response:

– Hide quoted text — Show quoted text -> > > The entire class of drugs, proton pump inhibitors, is VERY effective at > > > controlling stomach acid output. > > > HMc > > I bet but can it be good for long term use? Can it damage the system ever >  if > > used to long? > When the class first came out (Losec — now Prilosec), it was only FDA > approved for short term use as there was speculation (and no long term data) > that it would increase the risk of stomach cancer. It has long been known > that no stomach acid would result in higher levels of circulating gastrin > because it’s acid that determines gastrin output via negative feedback. In > other words, gastrin stimulates acid output and acid controls gastrin > levels. So, if there is too much acid, there is no gastrin, and if there is > too little acid, there is lots of gastrin. If you take these anti-acid > drugs, you will have high circulating levels of gastrin. > Gastrin is a trophic hormone — it stimulates the stomach lining and the > speculation was that that constant stimulation would increase the risk of > stomach cancer. This has not  been shown to be the case, and the FDA has > approved PPIs for long term use. I have seen multiple polyps in the stomach > many times in patients who have been on long term proton pump inhibitors, > but biopsies always show little or no malignant potential, as far as we > know. > It IS speculated that the use of anti acid medications such as H2 receptor > antagonists and PPIs increases the risk of esophageal cancer. The use of > these medications alkalinizes the stomach, changing  the pH and allowing > bile salts to come out of solution. These bile salts are highly irritating > to the lining of the lower esphagus, but don’t cause the severe symptoms > that acid causes. So even though a person’s heartburn symptoms go away, > their risk of esophageal cancer actually increases. The point is that these > medications don’t do anything to stop the reflux, they only change the > character of the refluxate, and although there are fewer symptoms, the > esophageal changes of Barrett’s esophagus (and it’s attendant cancer risk) > actually progress more rapidly. The incidence of esophageal cancer has been > increasing rapidly over the last 35 years, and the graphs coincide exactly > with the discovery and increasing use of anti-secretory medications. > The use of these medications only stops the SYMPTOMS of GERD, but doesn’t > actually stop the reflux. Managing the symptoms might be appropriate if > there is no evidence of Barrett’s esophagus on EGD, but ongoing surveillance > is important because of the increased risk of esophageal cancer. > HMc > OH MY! OH MY!  WHAT TO DO!  I am so confused.  I am taking Protonix so > I don’t have acid reflux so I don’t get esophegeal cancer and long > term use will likely CAUSE the cancer.  What do you suggest people > with this chronic problem do exactly?  This is really perplexing.  I’d > rather take no meds if given a choice.  Please tell me what to do here > as I have been on Protonix for several years and am only 47.  I love > my life and want to keep on livin it!  ( :  Is there anything that > will actually stop the reflux…diet, etc.?

I confess that the relationship of long term anti-secretory medication to esophageal cancer is a little controversial in the medical world, but the mounting evidence is compelling. The situation is not dissimilar to the relationship of smoking to lung cancer. Many physicians fought the concept that those two things might be related for many years. The base reasons are the same — chronic irritation of the bronchial tree and chronic irritation of the lower esophagus. Personally, I think the evidence supporting the relationship of anti-secretory medication to Barrett’s esophagus and esophageal cancer is compelling as do the majority of physicians that deal with these issues on a daily basis. You may remember an advertising campaign by RJ Reynolds Tobacco in the 50s that featured TV and print ads focused on doctors smoking cigarrettes while relaxing. You are unlikely to see those ads again anytime soon. If your symptoms are under good control ie. medication, lifestyle changes, and watching your diet are controlling your reflux symptoms to your satisfaction, then nothing needs to be done UNLESS your EGD shows evidence of esophageal damage from the reflux. If you have an EGD which shows inflammation, stricture, or Barrett’s esophagus, then it is time to consider surgical intervention. Chronic relux sufferers need to have periodic EGD to evaluate the lower esophagus. Every 2-4 years depending on findings. If you haven’t had one, you need one. Medication and lifestyle changes only control the SYMPTOMS of reflux. Those things do nothing to address the CAUSE of the relux, that being dysfunction of the lower esophageal sphincter. The only way reflux can be stopped is with surgery. State-of-the-art in that regard is either a Nissen laparoscopic gastric fundoplication (look at http://tinyurl.com/rkvi ) or the Stretta procedure (look at http://tinyurl.com/rkvn ). Both are, or can be, effective anti-reflux treatments that can CURE acid reflux, not just manage the symptoms. HMc

Response:

howard!  you are such a wealth of knowledge and so wonderful to give of your time so freely here.  i would love your take on this situation.  by the way i am waiting for my appointment with a gastro….can’t get in until nov. 25th.  i know it’s a long wait but my internist and i agree that there is no crisis here and he is the one i want to see.  i have been on protonix off and on for a couple of years and have never treated my reflux very seriously until recently. it seems that when my diet gets crazy i start thinking the protonix isn’t working and have twice tried other drugs.  i had the same result with nexium and prilosec.  after a couple days i was elated.  it seemed that i could have my margaritas and mexican food and get by with no acid reflux.  i felt like a criminal getting by with the crime.  well, within about 7-10 days i would feel like there was a big lump in my diaphram and that i couldn’t belch to save my life.  it was like there was no digestion going on whatsoever.  the feeling was worse to me than the actual acid reflux and pain/pressure i had experienced in the past.  once i would stop the new drug, that problem would resolve within a couple of days and i would get back on the protonix.  i am now diligently keeping a food diary and being very good about my diet.  i am losing weight because i am eating smaller portions.  i have also elevated my bed.  things are soooo much better now.  i am just curious if you have heard of others having that experience with those meds?  thanks again for sharing your time and knowledge with all of us here….guess we are all a mess!

Response:

– Hide quoted text — Show quoted text -> > > > The entire class of drugs, proton pump inhibitors, is VERY effective > at > > > > controlling stomach acid output. > > > > HMc > > > I bet but can it be good for long term use? Can it damage the system > ever > >  if > > > used to long? > > When the class first came out (Losec — now Prilosec), it was only FDA > > approved for short term use as there was speculation (and no long term > data) > > that it would increase the risk of stomach cancer. It has long been > known > > that no stomach acid would result in higher levels of circulating > gastrin > > because it’s acid that determines gastrin output via negative feedback. > In > > other words, gastrin stimulates acid output and acid controls gastrin > > levels. So, if there is too much acid, there is no gastrin, and if there > is > > too little acid, there is lots of gastrin. If you take these anti-acid > > drugs, you will have high circulating levels of gastrin. > > Gastrin is a trophic hormone — it stimulates the stomach lining and the > > speculation was that that constant stimulation would increase the risk > of > > stomach cancer. This has not  been shown to be the case, and the FDA has > > approved PPIs for long term use. I have seen multiple polyps in the > stomach > > many times in patients who have been on long term proton pump > inhibitors, > > but biopsies always show little or no malignant potential, as far as we > > know. > > It IS speculated that the use of anti acid medications such as H2 > receptor > > antagonists and PPIs increases the risk of esophageal cancer. The use of > > these medications alkalinizes the stomach, changing  the pH and allowing > > bile salts to come out of solution. These bile salts are highly > irritating > > to the lining of the lower esphagus, but don’t cause the severe symptoms > > that acid causes. So even though a person’s heartburn symptoms go away, > > their risk of esophageal cancer actually increases. The point is that > these > > medications don’t do anything to stop the reflux, they only change the > > character of the refluxate, and although there are fewer symptoms, the > > esophageal changes of Barrett’s esophagus (and it’s attendant cancer > risk) > > actually progress more rapidly. The incidence of esophageal cancer has > been > > increasing rapidly over the last 35 years, and the graphs coincide > exactly > > with the discovery and increasing use of anti-secretory medications. > > The use of these medications only stops the SYMPTOMS of GERD, but > doesn’t > > actually stop the reflux. Managing the symptoms might be appropriate if > > there is no evidence of Barrett’s esophagus on EGD, but ongoing > surveillance > > is important because of the increased risk of esophageal cancer. > > HMc > OH MY! OH MY!  WHAT TO DO!  I am so confused.  I am taking Protonix so > I don’t have acid reflux so I don’t get esophegeal cancer and long > term use will likely CAUSE the cancer.  What do you suggest people > with this chronic problem do exactly?  This is really perplexing.  I’d > rather take no meds if given a choice.  Please tell me what to do here > as I have been on Protonix for several years and am only 47.  I love > my life and want to keep on livin it!  ( :  Is there anything that > will actually stop the reflux…diet, etc.? > I confess that the relationship of long term anti-secretory medication to > esophageal cancer is a little controversial in the medical world, but the > mounting evidence is compelling. The situation is not dissimilar to the > relationship of smoking to lung cancer. Many physicians fought the concept > that those two things might be related for many years. The base reasons are > the same — chronic irritation of the bronchial tree and chronic irritation > of the lower esophagus. Personally, I think the evidence supporting the > relationship of anti-secretory medication to Barrett’s esophagus and > esophageal cancer is compelling as do the majority of physicians that deal > with these issues on a daily basis. You may remember an advertising campaign > by RJ Reynolds Tobacco in the 50s that featured TV and print ads focused on > doctors smoking cigarrettes while relaxing. You are unlikely to see those > ads again anytime soon. > If your symptoms are under good control ie. medication, lifestyle changes, > and watching your diet are controlling your reflux symptoms to your > satisfaction, then nothing needs to be done UNLESS your EGD shows evidence > of esophageal damage from the reflux. If you have an EGD which shows > inflammation, stricture, or Barrett’s esophagus, then it is time to consider > surgical intervention. > Chronic relux sufferers need to have periodic EGD to evaluate the lower > esophagus. Every 2-4 years depending on findings. If you haven’t had one, > you need one. > Medication and lifestyle changes only control the SYMPTOMS of reflux. Those > things do nothing to address the CAUSE of the relux, that being dysfunction > of the lower esophageal sphincter. The only way reflux can be stopped is > with surgery. State-of-the-art in that regard is either a Nissen > laparoscopic gastric fundoplication (look at http://tinyurl.com/rkvi ) or > the Stretta procedure (look at http://tinyurl.com/rkvn ). Both are, or can > be, effective anti-reflux treatments that can CURE acid reflux, not just > manage the symptoms. > HMc

I would like to add to this Howard with your aproval. A healthy diet itself can decrease chances of cancer with the right amount of antioxidents and greens as well correct?

Response:

– Hide quoted text — Show quoted text -> howard!  you are such a wealth of knowledge and so wonderful to give > of your time so freely here.  i would love your take on this > situation.  by the way i am waiting for my appointment with a > gastro….can’t get in until nov. 25th.  i know it’s a long wait but > my internist and i agree that there is no crisis here and he is the > one i want to see.  i have been on protonix off and on for a couple of > years and have never treated my reflux very seriously until recently. > it seems that when my diet gets crazy i start thinking the protonix > isn’t working and have twice tried other drugs.  i had the same result > with nexium and prilosec.  after a couple days i was elated.  it > seemed that i could have my margaritas and mexican food and get by > with no acid reflux.  i felt like a criminal getting by with the > crime.  well, within about 7-10 days i would feel like there was a big > lump in my diaphram and that i couldn’t belch to save my life.  it was > like there was no digestion going on whatsoever.  the feeling was > worse to me than the actual acid reflux and pain/pressure i had > experienced in the past.  once i would stop the new drug, that problem > would resolve within a couple of days and i would get back on the > protonix.  i am now diligently keeping a food diary and being very > good about my diet.  i am losing weight because i am eating smaller > portions.  i have also elevated my bed.  things are soooo much better > now.  i am just curious if you have heard of others having that > experience with those meds?  thanks again for sharing your time and > knowledge with all of us here….guess we are all a mess!

I have seen people respond and not respond to virtually all of the anti-secretory medications on the market. Some of those medications work great for some people and not for others. Some people who have had such meds work well for years stop responding. The reasons for this are variable and speculative. They appear to relate to changing function of the lower esophageal sphincter. As I said previously, anti-secretory medication doesn’t affect the LES, only the amount of acid available for reflux. And this can vary during the course of a day. Prilosec blood levels can change during the day and if you take it once in the morning as typically recommended, the blood levels may be low in the evening. Nexium is basically the same drug as Prilosec, but with different absorption and release so it supposedly maintains higher blood levels over a 24 hour period. I have seen this to be *generally* true, but certainly not *universally* for example. The key point is that medication and lifestyle changes are the way to go as long as they are controlling your symptoms to your satisfaction AND as long as their is no progression of damage to the lower esophagus (esophagitis, stricture, Barrett’s). If lifestyle changes and medications AREN’T controlling your symptoms to the point where you can live with it, or if there IS evidence on EGD of esophagitis, stricture, Barrett’s, then it’s time to consider surgery. Surgery for GERD is remarkably effective, but like all surgery should only be done if there is no other way to address the issue safely and effectively. I cannot emphasize enough that long term GERD patients need a screening EGD to evaluate for reflux damage because of the very well-defined relationship of esophageal cancer to reflux. Barrett’s esophagus is readily discernable on EGD. HMc

Response:

> I would like to add to this Howard with your aproval. A healthy diet itself > can decrease chances of cancer with the right amount of antioxidents and > greens as well correct?

Doug, there is no question that a healthy diet is an important aspect of long term health, but there are huge variations within that "healthy diet" label. The theory of anti-oxidants and free-radical scavenging relative to cancer and heart disease is very interesting and is borne of some interesting lab work. However, it has never been shown in practice in randomized double-blind studies to be significant. One problem is the bioavaliability of the various anti-oxidants. These things are not closely monitored by the FDA as prescription drugs and there is a huge variability in quality, ranging from good bioavailability to outright scam. I believe that the key to many human ailments lays in free-radical scavenging, but we aren’t there yet. So far, there has been nothing in the anti-oxidant arena that has been shown to be effective, even though the science behind the theory is interesting, and may hold some promise. Just my opinion…. HMc

Response:

speeding gastric emptying?

Question:

Does anyone know of ways to speed up gastic emptying without taking the prescription prokinetic agents (Reglan, etc.).  I’ve got GERD and while heartburn is pretty much under control with Prilosec and Gaviscon, I still seem to have a gastric emptying problem where I feel full for many hours, sometimes even up to a day, after a meal.  Its not serious enough that I would be willing to incur the side effects of the prescription drugs, but I think maybe the prilosec has made it worse (less stomach acid to help break down food).  Is there anything mild I can take or do to help this beyond avoiding the fats. I’ve heard walking after eating helps as does chewing gum.  I’ve been trying both and have noticed "mild" improvement.  

Response:

>Does anyone know of ways to speed up gastic emptying without taking the >prescription prokinetic agents (Reglan, etc.).

Quit milk. That’s all that improved my gastric emptying. But it will only work if it turns out you’re allergic to it. I can’t even eat a molecule of the stuff without it messing me up for days. Constipation, bloating, fullness, heartburn, loss of appetite, pain. And those are just the gastro symptoms… CW Healing from GERD http://www.volare.net/gerd Alternative Medicine & GERD Discussion Group http://groups.yahoo.com/group/altgerd

Response:

> Does anyone know of ways to speed up gastic emptying without taking the > prescription prokinetic agents (Reglan, etc.).  I’ve got GERD and while > heartburn is pretty much under control with Prilosec and Gaviscon, I still seem > to have a gastric emptying problem where I feel full for many hours, sometimes > even up to a day, after a meal.  Its not serious enough that I would be willing > to incur the side effects of the prescription drugs, but I think maybe the > prilosec has made it worse (less stomach acid to help break down food).

I wonder a lot about this, too, and have been unable to find any research on this issue directly.  I had a gastric emptying scan when I was first diagnosed with GERD, and it was normal.  I had one after eight months on twice-daily PPIs, and it was definitely slow.   A study published just this year found that in some patients, gastric emptying improves after surgery.  I can’t help but wondering if the fact that those with a successful fundoplication no longer take PPIs was the real issue.   Colleen Porter

Response:

FAT!!!

Question:

In today’s Washington Post, on the (bottom of the) front page: Human Fat May Provide Stem Cells "Scientists for the first time have transformed human fat into a variety of different tissue types, suggesting the much reviled substance may be an unexpected source of cells useful for the treatment of a wide range of ills." http://www.washingtonpost.com/wp-dyn/articles/A61404-2001Apr 9.html

Response:

<giggle> Well I have about 170 pounds of fat they can use for their product. I am a willing giver. Di

: In today’s Washington Post, on the (bottom of the) front : page: : : Human Fat May Provide Stem Cells : : "Scientists for the first time have transformed human fat : into a variety of different tissue types, suggesting the : much reviled substance may be an unexpected source of cells : useful for the treatment of a wide range of ills." : : http://www.washingtonpost.com/wp-dyn/articles/A61404-2001Apr : 9.html : : : : : :

Response:

><giggle> Well I have about 170 pounds of fat they can use for their >product. I am a willing giver.

Di, You beat me to the punch…..I was just about to offer to donate all they needed Bev Remove the "SpamFree" for email, please.  

Response:

Well you can help but the first 170 comes from me. LOL Besides you are not —that word—anyway. You are beautiful Love Di

: ><giggle> Well I have about 170 pounds of fat they can use for their : >product. I am a willing giver. : : Di, : : You beat me to the punch…..I was just about to offer to donate all they : needed : : Bev : : : Remove the "SpamFree" for email, please. :

Response:

Me, three!  Take it all! melodymom – Hide quoted text — Show quoted text -><giggle> Well I have about 170 pounds of fat they can use for their >product. I am a willing giver. > Di, > You beat me to the punch…..I was just about to offer to donate all they > needed > Bev > Remove the "SpamFree" for email, please.

Response:

Do you think they will do free liposuction as a means of harvesting the fat? Just wondering where I can make the appointment..starting with the 6 chins. – Hide quoted text — Show quoted text – > <giggle> Well I have about 170 pounds of fat they can use for their > product. I am a willing giver. > Di > : In today’s Washington Post, on the (bottom of the) front > : page: > : > : Human Fat May Provide Stem Cells > : > : "Scientists for the first time have transformed human fat > : into a variety of different tissue types, suggesting the > : much reviled substance may be an unexpected source of cells > : useful for the treatment of a wide range of ills." > : > : http://www.washingtonpost.com/wp-dyn/articles/A61404-2001Apr > : 9.html > : > : > : > : > : > :

Response:

<giggle> Hmmm. I hope so cause I have TB (two bellies) Di

: Do you think they will do free liposuction as a means of harvesting the : fat? : Just wondering where I can make the appointment..starting with the 6 : chins. :

: : > <giggle> Well I have about 170 pounds of fat they can use for their : > product. I am a willing giver. : > Di : > : In today’s Washington Post, on the (bottom of the) front : > : page: : > : : > : Human Fat May Provide Stem Cells : > : : > : "Scientists for the first time have transformed human fat : > : into a variety of different tissue types, suggesting the : > : much reviled substance may be an unexpected source of cells : > : useful for the treatment of a wide range of ills." : > : : > : http://www.washingtonpost.com/wp-dyn/articles/A61404-2001Apr : > : 9.html : > : : > : : > : : > : : > : : > : :

Response:

> Well you can help but the first 170 comes from me. LOL Besides you are > not —that word—anyway. You are beautiful

You are BOTH beautiful, how come you are both up so early though. – Hide quoted text — Show quoted text -> Love Di > : You beat me to the punch…..I was just about to offer to donate all > they > : needed

Response:

Hi sweetie Thanks so much. It is 4:45 p.m. here. going to bed in about 6 hours. What are you doing up so early. LOL Di

:

: > Well you can help but the first 170 comes from me. LOL Besides you : are : > not —that word—anyway. You are beautiful : : You are BOTH beautiful, how come you are both up so early though. : : > Love Di : > : You beat me to the punch…..I was just about to offer to donate : all : > they : > : needed : :

Response:

>In today’s Washington Post, on the (bottom of the) front >page: >Human Fat May Provide Stem Cells >"Scientists for the first time have transformed human fat >into a variety of different tissue types, suggesting the >much reviled substance may be an unexpected source of cells >useful for the treatment of a wide range of ills." >http://www.washingtonpost.com/wp-dyn/articles/A61404-2001Apr >9.html

oh this is SO cool! — dx as Type 1 in Mar 00, joyfully pumpin’ since October! "I’d rather be loved by only me,     than create a facade and be loved by no one." — wombn "Never give up", Winston Churchill www.mindspring.com/~wombn On ANY "advice" I give here: I expect you to research it and confirm it independently

Response:

> Hi sweetie > Thanks so much. It is 4:45 p.m. here. going to bed in about 6 > hours. What are you doing up so early. LOL

Sorry, get the times mixed up I am always up early, have kids – Hide quoted text — Show quoted text -> :

Response:

Me too got Jacob and he is enough to be considered kids. LOL Di

:

: > Hi sweetie : > Thanks so much. It is 4:45 p.m. here. going to bed in about 6 : > hours. What are you doing up so early. LOL : : Sorry, get the times mixed up I am always up early, have kids : > : : > : > :

Response:

Thanks Di and Jan I was up early because I had a followup with the gastroenterologist today.  I saw her about 3 months ago with a swallowing problem, and was unable at that time to do a test she wanted because of a work conflict (no coverage when you are a one-woman show). The swallowing problem has disappeared, however, I’m having discomfort in my chest  which goes straight thru to my back, which sometimes worsens after I eat.  It’s like a dull ache, and lasts off and on for days. She was very concerned that, as a diabetic, I had not had a cardiology workup in 7 years, especially since I take heart meds and still experience palpitations and occasional tachycardia.  She doesn’t believe in taking chances where diabetics and chest pain are concerned.  She insisted that I go back to my cardiologist for a complete exam. The Gastro Doc is also going to do an upper GI and Barium Swallowing test to rule out any problems with my esophagus, especially Barrett’s Esophagus, since I have experienced heartburn for many years.   All in all, I am very pleased with the care I received….. Now, if I can just get a referral to an endo Bev Remove the "SpamFree" for email, please.  

Response:

(((Bev))) You sure do have your share of pain and suffering. Keeping you in my prayers. Good to see you post. I don’t see too much of it. Dale had an EGD and the doctors thought he may have to have surgery but not yet. He has to avoid red meat, caffeine, chicken, any fried food because he had inflammation around the esophagus leading to the stomach. He is taking Aciphex for it right now. I hope you get better and it isn’t bad news after your tests. Love Di

: Thanks Di and Jan : : I was up early because I had a followup with the gastroenterologist today.  I : saw her about 3 months ago with a swallowing problem, and was unable at that : time to do a test she wanted because of a work conflict (no coverage when you : are a one-woman show). : : The swallowing problem has disappeared, however, I’m having discomfort in my : chest  which goes straight thru to my back, which sometimes worsens after I : eat.  It’s like a dull ache, and lasts off and on for days. She was very : concerned that, as a diabetic, I had not had a cardiology workup in 7 years, : especially since I take heart meds and still experience palpitations and : occasional tachycardia.  She doesn’t believe in taking chances where diabetics : and chest pain are concerned.  She insisted that I go back to my cardiologist : for a complete exam. : : The Gastro Doc is also going to do an upper GI and Barium Swallowing test to : rule out any problems with my esophagus, especially Barrett’s Esophagus, since : I have experienced heartburn for many years. : : All in all, I am very pleased with the care I received….. : : Now, if I can just get a referral to an endo : : Bev : : : Remove the "SpamFree" for email, please. :

Response:

Well they can have some of mine just for the asking!!! I figure that they can get about thirty pounds worth off of me for free!! — Paul Patron Saint of Lost Causes and Hopeless Endeavours – Hide quoted text — Show quoted text – > In today’s Washington Post, on the (bottom of the) front > page: > Human Fat May Provide Stem Cells > "Scientists for the first time have transformed human fat > into a variety of different tissue types, suggesting the > much reviled substance may be an unexpected source of cells > useful for the treatment of a wide range of ills." > http://www.washingtonpost.com/wp-dyn/articles/A61404-2001Apr > 9.html

Response:

>Hmm…You know how they give you cookies after you give blood?   What >would they give fat givers?  Baked potato…fried rice…?

I don’t know,  but I’d be first in line, Tru Bev Remove the "SpamFree" for email, please.  

Response:

you are one up on me. I was second this time. LOL Di

: >Hmm…You know how they give you cookies after you give blood? What : >would they give fat givers?  Baked potato…fried rice…? : > : : I don’t know,  but I’d be first in line, Tru : : Bev : : : Remove the "SpamFree" for email, please. :

Response:

I’ll take the baked tater.

.net…

: : > ><giggle> Well I have about 170 pounds of fat they can use for their : > >product. I am a willing giver. : > : > Di, : > : > You beat me to the punch…..I was just about to offer to donate all they : > needed : > : : Hmm…You know how they give you cookies after you give blood? What : would they give fat givers?  Baked potato…fried rice…?

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> I’ll take the baked tater.

plus burnt baked pumpkin and onion

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> plus burnt baked pumpkin and onion

Okay…now I’m curious…what’s this?  I mean I KNOW what pumpkin is, and onion too, but combined? and burnt? Carol P.

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> plus burnt baked pumpkin and onion > Okay…now I’m curious…what’s this?  I mean I KNOW what pumpkin is, > and onion too, but combined? and burnt?

no, separate, baked potato, baked pumpkin (slightly burnt) and baked whole onion

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I realize I’m bujtting in here, bujt I had similar symptoms (chest pain, dull and sstuffy feeling) a few years ago.  After several tests, it turned oiut to be arthritis in the rib cage and sternum!  The cardiologist siad I didn’t exhibity the classic cardio symptoms at all and he fiddled around for a while; then  he almost literally jumped onto my chest and then asked "Is that it?"  After a couiple more tries, the pain was localized and identified as osteoarthritis…Ibuprofen made it disappear.  I believe part of it was psychosomatic, as well…I pysched myself into believing it was cardio. Gene

– Hide quoted text — Show quoted text -> Thanks Di and Jan > I was up early because I had a followup with the gastroenterologist today. I > saw her about 3 months ago with a swallowing problem, and was unable at that > time to do a test she wanted because of a work conflict (no coverage when you > are a one-woman show). > The swallowing problem has disappeared, however, I’m having discomfort in my > chest  which goes straight thru to my back, which sometimes worsens after I > eat.  It’s like a dull ache, and lasts off and on for days. She was very > concerned that, as a diabetic, I had not had a cardiology workup in 7 years, > especially since I take heart meds and still experience palpitations and > occasional tachycardia.  She doesn’t believe in taking chances where diabetics > and chest pain are concerned.  She insisted that I go back to my cardiologist > for a complete exam. > The Gastro Doc is also going to do an upper GI and Barium Swallowing test to > rule out any problems with my esophagus, especially Barrett’s Esophagus, since > I have experienced heartburn for many years. > All in all, I am very pleased with the care I received….. > Now, if I can just get a referral to an endo > Bev > Remove the "SpamFree" for email, please.

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>I realize I’m bujtting in here,

bujt I had similar symptoms (chest pain, – Hide quoted text — Show quoted text ->dull and sstuffy feeling) a few years ago.  After several tests, it turned >oiut to be arthritis in the rib cage and sternum!  The cardiologist siad I >didn’t exhibity the classic cardio symptoms at all and he fiddled around for >a while; then  he almost literally jumped onto my chest and then asked "Is >that it?"  After a couiple more tries, the pain was localized and identified >as osteoarthritis…Ibuprofen made it disappear.  I believe part of it was >psychosomatic, as well…I pysched myself into believing it was cardio. >Gene > Thanks Di and Jan > I was up early because I had a followup with the gastroenterologist today. >I > saw her about 3 months ago with a swallowing problem, and was unable at >that > time to do a test she wanted because of a work conflict (no coverage when >you > are a one-woman show). > The swallowing problem has disappeared, however, I’m having discomfort in >my > chest  which goes straight thru to my back, which sometimes worsens after >I > eat.  It’s like a dull ache, and lasts off and on for days. She was very > concerned that, as a diabetic, I had not had a cardiology workup in 7 >years, > especially since I take heart meds and still experience palpitations and > occasional tachycardia.  She doesn’t believe in taking chances where >diabetics > and chest pain are concerned.  She insisted that I go back to my >cardiologist > for a complete exam. > The Gastro Doc is also going to do an upper GI and Barium Swallowing test >to > rule out any problems with my esophagus, especially Barrett’s Esophagus, >since > I have experienced heartburn for many years. > All in all, I am very pleased with the care I received….. > Now, if I can just get a referral to an endo > Bev > Remove the "SpamFree" for email, please.

ya know……  there is no such thing as butting into a public discussion.  :-) As far as I’m concerned, you can participate in ANY discussion that’s going on here with no apology and no worries about "butting in". IMO, of course. — dx as Type 1 in Mar 00, joyfully pumpin’ since October! "I’d rather be loved by only me,     than create a facade and be loved by no one." — wombn "Never give up", Winston Churchill www.mindspring.com/~wombn On ANY "advice" I give here: I expect you to research it and confirm it independently

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>I had similar symptoms (chest pain, >dull and sstuffy feeling) a few years ago.  After several tests, it turned >oiut to be arthritis in the rib cage and sternum!  The cardiologist siad I >didn’t exhibity the classic cardio symptoms at all

I really don’t expect a heart problem to be the culprit, but the gastro doc is concerned.   I have had cardio problems before, such as tachycardia and irregular heartbeat, but as far as heart disease I’ve been clear in the past.  I guess this will just provide a base line exam, since I haven’t had one in 7 years. Bev Remove the "SpamFree" for email, please.  

Response:

H. pylori

Question:

>>I mean, it’s not life threatening or anything but it can be so rotten.<<

Constant irritation to the esophageal lining by stomach acid can lead to a condition called Barretts Esophagus. This is a precursor to Esophageal Cancer. Only 10% with Barretts go on to actually get Esophageal Cancer but, I would not want to be one of the 10%. If you are having heartburn more than twice a week do not treat it lightly. Seek medical attention. Ginger juice is a pungent spice. Proceed with caution. It has made some people worse. Some have made the claim that it has helped them but no explanation is given as to why it seems to help. Is it merely numbing the esophageal lining while the acid continues its damage? If anyone has any official studies on the use of Ginger Juice for heartburn, I would be more than interested in seeing them. Heartburn and Gastro Esophageal Reflux web page: http://www.heartburn-help.com

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I did some research on ginger juice and wow! it sounds pretty good. So that’s what I am going to try. The more I think about the drugs I was given for my H.pylori the less I want to take them. For one thing they sound as if they will give my stomach a real battering. And for another thing, there seems to be very little certainty that my symptoms will be cured. My heartburn is worse at night, when it stops me sleeping. I tried raising the head of the bed around 8 inches. I found this amazingly uncomfortable, plus it made no difference. I have to confess I could only put up with it for 2 or 3 nights. It’s amazing that something like heartburn can make such a difference to your life. I mean, it’s not life threatening or anything but it can be so rotten. I’ve got a friend with a cancerous eye tumour and when I start to feel too sorry for myself, I think of her and remind myself whose shoes I’d rather be in.

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Haveing test done

Question:

Hi All I am having a motility study and PH test done in the next couple of weeks and would like to know what it is like. My GI has told me about the procedure but when I ask for more info he just says "you’ll be OK it’s a piece of cake". Is it a "piece of cake" or should I expect something more. Also I have heard that if I do in fact have a motility disorder there is nothing they can do about it except take Prepulsid which I cant because of a heart condition. Any help would be appreciated. KLC

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The motility study is where a thin tube is passed down into your esophagus by swallowing it. The tube which is quite small in diameter is then slowly advanced down your esophagus as you are asked to swallow small sips of water. The tip of the "catheter" has a small hole in it that connects to a manometer and allows the doctor to measure esophageal pressure as the water moves down your esophagus by peristalsis into your stomach. The hardest part is getting the catheter to go down your esophagus and not your trachea. This is best done by slightly putting your chin down. Tilting your chin back may make it difficult to get it in the right place. The whole procedure takes only a few minutes and is a little uncomfortable but not unbearable. The pH study is where a tiny (thin) catheter is advanced through you nose and into your esophagus just a few centimeters above your LES (lower esophageal sphincter) ( the opening to your stomach) and is left there for 24 hrs. The catheter is taped to your nose and you are asked to try and do your normal activities of the day and keep a diary of your symptoms of heartburn. The catheter is attached to a recording device much like a holter monitor they use for heart patients and records acid pH above your LES which is a positive indicator for reflux. The tests are used in diagnosing reflux and determining viability for nissan procedures.

– Hide quoted text — Show quoted text -> Hi All > I am having a motility study and PH test done in the next couple of weeks > and would like to know what it is like. > My GI has told me about the procedure but when I ask for more info he just > says "you’ll be OK it’s a piece of cake". > Is it a "piece of cake" or should I expect something more. > Also I have heard that if I do in fact have a motility disorder there is > nothing they can do about it except take Prepulsid which I cant because of a > heart condition. > Any help would be appreciated. > KLC

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The motility test takes a half-hour or more and is very uncomfortable. Why kind of gag reflex do you have? The PH test I didn’t take because I was supposed to stay off my medication for three days before, but by the second night my heartburn was so bad I couldn’t sleep. ==seckatary – Hide quoted text — Show quoted text -> Hi All > I am having a motility study and PH test done in the next couple of weeks > and would like to know what it is like. > My GI has told me about the procedure but when I ask for more info he just > says "you’ll be OK it’s a piece of cake". > Is it a "piece of cake" or should I expect something more. > Also I have heard that if I do in fact have a motility disorder there is > nothing they can do about it except take Prepulsid which I cant because of a > heart condition. > Any help would be appreciated. > KLC

–

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I had both the 30 min and 24 hour tests done (actually been through them 3 times now) They are uncomfortable but not paintful. I have also been diagnosed with a small motility problem. I had "open" i.e. conventional reflux surgery in April 1999 and this has not helped my symptoms although the repair of a hiatus hernia, which was previously present was successful. It has recently come to light that I have a gastric emptying problem with solid food and this may infact be the root cause of my problems (which started after I was hit on my right abdomen by a car). I would caution you on the success of surgery, given my experience but every case is obviously different. Bottom line is make sure you get an absolute definite prognosis as to what the underlying problem is. It is certainly worth going through the tests in order to try and achieve this. Good luck.

Response:

H.pylori

Question:

What do people think about H.pylori? I had a gastroscopy and tested negative but now my doctor wants me to get tested again. She says it can come and go. Is this really a possibility? How much of a problem is H.pylori? I’m getting sick of tests. I’m finally taking Losec (or Prilosec) and that seems to be working.

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Moses here: People who have and are treated, in a about a third of the cases go positive again. As I recall over the counter Bismuth preparations can cause one to go negative for a time….after all bismuth is used as part of a treatment regimen to cure the "bug". Question…..are you having heartburn or are you having ulcers? Remember H. pylori suppresses acid production, hence a cure can worsen GERD/heartburn/acid reflux symptoms. Though of course it will one more prone to stomach cancer….H. pylori… I mean. > What do people think about H.pylori? I had a gastroscopy and tested > negative but now my doctor wants me to get tested again. She says it can > come and go. Is this really a possibility? How much of a problem is > H.pylori? I’m getting sick of tests. I’m finally taking Losec (or > Prilosec) and that seems to be working.

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I just found out that to have the test for H.pylori I’m not allowed to take Losec (or Prilosec) for two weeks! Forget it, I reckon. I am enjoying too much getting a proper night’s sleep. My doctor wants me to take Losec for two months to clear up my heartburn. She thinks the walls of my intestine are bleeding, hence my symptoms, and that the drugs will allow everything to heal. Sounds great, I reckon. Maybe I’ll do the test at the end of the two months.

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Moses here again: I say get healed up and then worry about the "bug".

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Thanks for you advice, Moses. Getting healed up first and then worrying about the bug is exactly what I plan to do. And hey, isn’t Losec (or Prilosec) amazing stuff? I am getting a bit of heartburn in the mornings but that’s all. I just wonder why the various doctors I have been seeing took so long to prescribe it. Merry Christmas to everyone.

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> Moses here again: I say get healed up and then worry about the "bug".

I don’t understand why ones intestine walls would be bleeding if one doesn’t have, at minimum, the "bug". It just doesn’t add up for me.  My understanding of the treatment for H.pylori is that it takes antibiotics and Prilocec (Losec,Prevacid etc.) at the same time. I believe that is what my G.I. doctor said. I tested negative for H.pylori at my last upper-endo. and was delighted by that. One other thought from a person who doesn’t know everything: Ciliac (sp?) disease can cause similar belly problems.  It is a genetic problem in which there are miserable reactions to foods, especially wheat.  This can cause all sorts of bellyache misery and bleeding.

Response:

prevacid, how long before it works

Question:

Prilosec reaches peak effectiveness after taking it for a few days. It is a real powerful Proton Pump Inhibitor that stops most of the acid the stomach produces. Sometimes any minor side effects go away once your body adjusts to the drug. Some people find that they can take the drug for a couple of months and then stop without reoccurrence of the symptoms. Others have to be on the drug continually. Glad you were able to get some free samples. Don’t be afraid to ask for more the next time you visit your doctor. Heartburn and Gastro Esophageal Reflux web page: http://www.heartburn-help.com

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> Prilosec reaches peak effectiveness after taking it for a few days. It is a > real powerful Proton Pump Inhibitor that stops most of the acid the stomach > produces. Sometimes any minor side effects go away once your body adjusts to > the drug. Some people find that they can take the drug for a couple of months > and then stop without reoccurrence of the symptoms. Others have to be on the > drug continually. Glad you were able to get some free samples. Don’t be afraid > to ask for more the next time you visit your doctor. > Heartburn and Gastro Esophageal Reflux web page:

http://www.heartburn-help.com As far as I’m concerned, an in my particular case, it’s a miracle drug.  I had a chat with my Doc. as I was leaving his office and we discussed first (antacids), second (Zantac, et. al.) and third (Prilosec and Prevacid) generation acid reducers and how each worked, and how much acid they reduced and patents and when things go over the counter, and generics and such.  Very interesting to hear his knowledge on the subject.  He said that Prilosec (and, I assume Prevacid too..).. won’t go OTC for 15-20 years. Like the H2 blockers, Zantac, Pepcid, Axid, and so on, did a few years ago, and now there are even cheap generics available for those "..dine"s.   So it’s gonna stay expensive and Rx for a long time as long as only one company can make and sell it. Harv

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>He said that Prilosec (and, I assume Prevacid too..).. won’t go OTC for 15-20

years.>> The Prilosec people just made a pitch to the FDA to take Prilosec over the counter.  Members of the Food and Drug Administration (FDA) committee said they believed Prilosec could be safe and effective as a nonprescription product. But a majority of panelists said they needed more information on long-term use before recommending that Prilosec be made readily available on drugstore shelves. They were concerned about the labeling and how the consumer might use the drug. The Prilosec people put a positive spin on everything saying it is quite common for the FDA to want more information and they were quite encouraged. A generic version of Prilosec will be available in some countries outside the USA maybe as early as next year. I am glad that Prilosec is working well for you Harv. I have been taking it for over 3 years now and it has been a miracle drug for me as well. Heartburn and Gastro Esophageal Reflux web page: http://www.heartburn-help.com

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> Sounds like you are producing some extra stomach acid when you are under stress > and your lower esophageal sphincter is a little on the weak side. Chocolate is > a known trigger food. I have similar symptoms.

Ding! and also Ding!.. you got that right.  I was an idiot to eat all those leftover chocolate bars after Halloween.. plus stress piled upon stress as I explained.  But when you feel fine, it’s hard to remember what it’s like when the burn starts.. so you do dumb things thinking it’ll be okay.  Well, another hard lesson learned.. > When I get a little out of > control I back off to a bland diet for a while and try to reduce the

amount of I’m curious what your "bland diet" consists of.. could you detail what you switch to during your episodes? > stress I am under. (Not easy sometimes to do that) Some people respond better > to the compounds that make up one of the Proton Pump Inhibitors than the other. > If you find one does not work well then switch to another. Try to get some > samples of Prilosec for times like you are experiencing now. It is much better > to get things under control as soon as possible. The recovery time is much > shorter.

I went through a bout of this a year ago, and the year before that.  I put off calling the Doc but just made an appointment for tomorrow.  He’s seen me for this condition twice before.. it seems to be a yearly thing with me and I haven’t had the burn for a year, but with the combination of the stress and the chocolate, blammo, back it came.  Exactly the same symptoms. Prilosec did it for me the last time, so I’m going to ask him for it again, as I had success with it. Thanks, Harv

Response:

Try asking your doctor for some samples of Prilosec. Sometimes they will give you a handful. Bland diet. I stick with things that I know do not bother me. Pears in the can and the juice. Toast, Chicken, potatoes, lots of water but a little at a time if too much makes you reflux. Then once I am feeling better I start introducing the next level. Red meat etc. I found onions, nutmeg and tomatoes are a big trigger for me so I stay away from these even when I am feeling good. When the urge for pizza get real bad my wife makes some with just a little tomato sauce. I add some cheese and hamburger with a little Tummy Tamer to neutralize the acid and I can get away with it. Heartburn and Gastro Esophageal Reflux web page: http://www.heartburn-help.com

Response:

> Try asking your doctor for some samples of Prilosec. Sometimes they will give > you a handful.

I saw my Doc. two days ago.  He put me back on Prilosec, 40mg. caps this time instead of 20mg. that I had last year.  He handed me two sample boxes with seven caps each ($3.00 each cap, if filled from an Rx typically). I’ve taken three so far.  The burn is 3/4ths gone already.  It’s either a miracle drug (for me) or it’s utter coincidence.  Choose one.  Side effects?  None that I’ve noticed, except for some gas. He also gave me an Rx good for 2 months’ worth in case I need to stay on it after the 14 free caps are gone. Harv

Response:

Background – I am having a bout of hiatal hernia/ulcer right now and am about ready to call the doc again.. I had it last year (and have had it in previous years) and am 100% convinced it is brought on by stress  and trigger foods – a close friend recently passed away causing much stress and angst and emotion, then Halloween came and I bought 100 mini chocolate bars to give to kids who never came so over the course of a few days I ate them all myself.. I think the chocolate is an irritant that might have pushed my condition over the edge.. since then, financial woes, plus the election.. add it all up and I have a real good burn going under that bottom little lump of my breastbone, exactly as I had a year ago.  I can feel it when I press it hard with a couple fingers, just as the last time. Funny thing is, I can sleep fine.. it’s only after I get up and the day’s travails start to hit me that the burn comes back.  I’m trying to change my diet, trying different things, but it also kills my appetite when I’m in this condition.  Glugging down antacids and taking Axid which seems not to help at all. So.. to get back to your question, and realizing everyone is different.. Last year my Doc put me on Prevacid.. first with three or four sample packages, and then with one or two full Rx refills.. it didn’t do squat. Did not help one iota. Nothing.  So I asked him to switch me to Prilosec. With a few days I felt the burn going away, I took it for about two months (which at $3.00 per cap, 2 caps a day, cost me over $500.00 for the two drugs.. out of pocket!..).. but for me, and speaking only for myself, Prilosec worked, and Prevacid didn’t do diddley.  Either that or it was simply time that healed it, although I tend to believe the Prilosec is what did it. Harv — Founder of AmigaZone. Supporting Amiga owners since 1985! Go here for info or to join: http://www.amigazone.com

– Hide quoted text — Show quoted text -> supposed to start taking prevacid.  how long before it starts to work? > thnks, > M.

Response:

Sounds like you are producing some extra stomach acid when you are under stress and your lower esophageal sphincter is a little on the weak side. Chocolate is a known trigger food. I have similar symptoms. When I get a little out of control I back off to a bland diet for a while and try to reduce the amount of stress I am under. (Not easy sometimes to do that) Some people respond better to the compounds that make up one of the Proton Pump Inhibitors than the other. If you find one does not work well then switch to another. Try to get some samples of Prilosec for times like you are experiencing now. It is much better to get things under control as soon as possible. The recovery time is much shorter. Heartburn and Gastro Esophageal Reflux web page: http://www.heartburn-help.com

Response:

supposed to start taking prevacid.  how long before it starts to work? thnks, M.

Response:

>supposed to start taking prevacid.  how long before it starts to work? >thnks, >M.

   When I started taking it, it worked immediately – that same day! I felt wonderful. However, if I forget to take it – it stops working right on cue. It’s been a godsend for me. I hope it does the trick for you too. Debi

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