Alkaline reflux?

Question:

– Hide quoted text — Show quoted text -> I was diagnosed with LPR a few weeks ago. I know I’ve had it off and > on for years. Also have irritable bowel and hiatal hernia. But all has > been under control, through a lot of natural means, until the past few > months. So ENT put scope down my nose to throat and confirmed that it > was LPR (no heartburn, just pain, chronic throat clearing and > coughing). > He wanted me on Zantac. But my internist said no and I should use a > PPI. Well, I’ve tried Nexium, Prevacid, and finally Aciphex. And they > don’t help. In fact, tonight, after taking an Aciphex this morning and > last night, I have that drawing hungry gnawing in my gut. > I even tried DGL licorice for about three days, and no help as well. > Even though I’ve read that H2 blockers are not as good, I’m trying > that. > It’s so bizarre that the meds seem to increase the acidity instead of > decrease it. Same thing happens when I take natural enzymes. > Now, I have been reading and see there is an alkaline reflux. I’m > wondering if that’s what I have, so that’s why digestive enzymes and > PPIs make things worse. Anyone have any experience with this and can > suggest what someone with this can do to heal it?

The next step is a complete diagnostic workup. Technically, the ENT can’t diagnose LPR since reflux, its character and extent, hasn’t been diagnosed yet. There are other things that can cause such laryngitis/pharyngitis. I agree that given your symptoms, it’s a reasonable presumption, but you need to have your upper GI tract evaluated. You need to have EGD, ambulatory pH testing, esophageal manometry. Your internist should be quite willing to get a consultation from a surgeon or gastroenterologist. Acid reflux, if that is indeed what you have, that does not respond to PPIs will usually require anti-reflux surgery. The only other thing you might try is a prokinetic agent, metaclopromide (Reglan) in hopes that it will aid in esophageal clearing and gastric emptying enough to control your symptoms. In the meantime, diet, weight loss, eating habits etc as detailed by many previous poster here on this newsgroup. HMc

Response:

I was diagnosed with LPR a few weeks ago. I know I’ve had it off and on for years. Also have irritable bowel and hiatal hernia. But all has been under control, through a lot of natural means, until the past few months. So ENT put scope down my nose to throat and confirmed that it was LPR (no heartburn, just pain, chronic throat clearing and coughing). He wanted me on Zantac. But my internist said no and I should use a PPI. Well, I’ve tried Nexium, Prevacid, and finally Aciphex. And they don’t help. In fact, tonight, after taking an Aciphex this morning and last night, I have that drawing hungry gnawing in my gut. I even tried DGL licorice for about three days, and no help as well. Even though I’ve read that H2 blockers are not as good, I’m trying that. It’s so bizarre that the meds seem to increase the acidity instead of decrease it. Same thing happens when I take natural enzymes. Now, I have been reading and see there is an alkaline reflux. I’m wondering if that’s what I have, so that’s why digestive enzymes and PPIs make things worse. Anyone have any experience with this and can suggest what someone with this can do to heal it? Thanks, Susan

Response:

Alkaline reflux?

Aciphex is a medication used to treat gestational acid reflux disease (GERD) and ulcers. buy aciphex and feel better today!

Question:

– Hide quoted text — Show quoted text -> I was diagnosed with LPR a few weeks ago. I know I’ve had it off and > on for years. Also have irritable bowel and hiatal hernia. But all has > been under control, through a lot of natural means, until the past few > months. So ENT put scope down my nose to throat and confirmed that it > was LPR (no heartburn, just pain, chronic throat clearing and > coughing). > He wanted me on Zantac. But my internist said no and I should use a > PPI. Well, I’ve tried Nexium, Prevacid, and finally Aciphex. And they > don’t help. In fact, tonight, after taking an Aciphex this morning and > last night, I have that drawing hungry gnawing in my gut. > I even tried DGL licorice for about three days, and no help as well. > Even though I’ve read that H2 blockers are not as good, I’m trying > that. > It’s so bizarre that the meds seem to increase the acidity instead of > decrease it. Same thing happens when I take natural enzymes. > Now, I have been reading and see there is an alkaline reflux. I’m > wondering if that’s what I have, so that’s why digestive enzymes and > PPIs make things worse. Anyone have any experience with this and can > suggest what someone with this can do to heal it?

The next step is a complete diagnostic workup. Technically, the ENT can’t diagnose LPR since reflux, its character and extent, hasn’t been diagnosed yet. There are other things that can cause such laryngitis/pharyngitis. I agree that given your symptoms, it’s a reasonable presumption, but you need to have your upper GI tract evaluated. You need to have EGD, ambulatory pH testing, esophageal manometry. Your internist should be quite willing to get a consultation from a surgeon or gastroenterologist. Acid reflux, if that is indeed what you have, that does not respond to PPIs will usually require anti-reflux surgery. The only other thing you might try is a prokinetic agent, metaclopromide (Reglan) in hopes that it will aid in esophageal clearing and gastric emptying enough to control your symptoms. In the meantime, diet, weight loss, eating habits etc as detailed by many previous poster here on this newsgroup. HMc

Response:

I was diagnosed with LPR a few weeks ago. I know I’ve had it off and on for years. Also have irritable bowel and hiatal hernia. But all has been under control, through a lot of natural means, until the past few months. So ENT put scope down my nose to throat and confirmed that it was LPR (no heartburn, just pain, chronic throat clearing and coughing). He wanted me on Zantac. But my internist said no and I should use a PPI. Well, I’ve tried Nexium, Prevacid, and finally Aciphex. And they don’t help. In fact, tonight, after taking an Aciphex this morning and last night, I have that drawing hungry gnawing in my gut. I even tried DGL licorice for about three days, and no help as well. Even though I’ve read that H2 blockers are not as good, I’m trying that. It’s so bizarre that the meds seem to increase the acidity instead of decrease it. Same thing happens when I take natural enzymes. Now, I have been reading and see there is an alkaline reflux. I’m wondering if that’s what I have, so that’s why digestive enzymes and PPIs make things worse. Anyone have any experience with this and can suggest what someone with this can do to heal it? Thanks, Susan

Response:

Moderate Hiatal Hernia

Question:

Howard…. could you please explain what is meant by moderate? It’s been a month since my EGD and I’m not feeling much relief from the Nexium. How long should I wait for a return visit with my doctor? Any help would be greatly appreciated.

Response:

> Howard…. could you please explain what is meant by moderate? It’s been a > month since my EGD and I’m not feeling much relief from the Nexium. How long > should I wait for a return visit with my doctor? Any help would be greatly > appreciated.

A hiatus hernia is where the upper part of the stomach can slip or has slipped up into the chest. The part that slips includes the gastroesophageal junction and the lower esophageal sphincter. A "moderate" hiatus hernia is one where the gastroesophageal junction is displaced about 2-3 centimeters upward into the chest. It is a common misconception, even among doctors, that a hiatus hernia and acid reflux are the same thing. "Doctor, I have terrible heartburn"…."Yes, you must have a hiatus hernia."    Baloney. Many people with hiatus hernia have no acid reflux, and many people with acid reflux have no hiatus hernia. The causative factor in GERD is dysfunction of the lower esophageal sphincter. In about 40% of cases, the main reason for LES dysfunction is low resting pressure. In SOME of those cases, hiatus hernia contributes to that low resting pressure, therefore, hiatus hernia might contribute to GERD in some cases. The erroneous belief in the relationship of hiatus hernia severity to GERD severity is a holdover from the old days when doctors thought, erroneously, that low LES pressure was the cause of GERD. However, in over 60% of cases of acid reflux, the main cause is transient lower esophageal sphincter relaxation. The cause of these TLESR’s are primarily such things as nicotine, alcohol, caffiene, full stomach, and some foods such as tomatoes and other spices. It’s amazing to me how few doctors understand this concept. I guess it’s just easier to tell the patient "Oh, it’s just your hiatus hernia acting up…take these pills" So, whether or not someone has a hiatus hernia is pretty much irrelevant to GERD. The problem is the function of the LES, which is the root cause of GERD. If you have acid reflux, the place to start is lifestyle modification (diet, weight loss, smaller meals etc etc….these will help control your LES dysfunction. You can also take anti-secretory medication. These meds will not fix your LES dysfunction, nor will they do anything for your hiatus hernia, but they will decrease the amount of acid in the stuff that you reflux thereby moderating your symptoms. Maybe…unless the LES dysfunction is too severe. If these things don’t work, then the function of your Lower Esophageal Sphincter needs to be addressed surgically. Bottom line….don’t worry about your hiatus hernia, worry about controlling your acid reflux. Just because you have one doesn’t imply anything about the severity of your GERD. A high DeMeester score (>14.7) or refluxing more than about 3% of the time on 48 hour pH testing, that means something. A LES resting pressure less than 10 mmHg on manometry, that means something. An EGD that shows erosive esophagitis, stricture, or Barrett’s esophagus, that means something. All of these things allow us to draw real conclusions about your reflux disease. The presence or absence of a hiatus hernia tells us virtually nothing. If you haven’t had 48 hour ambulatory pH testing or esophageal manometry, and if all the doctor saw at EGD was a "moderate" hiatus hernia, then we still have virtually no objective information about whether or not you have GERD. HMc

Response:

med question? (neurontin)

Question:

I have read that you are not supposed to take an antacid within two hours of taking neurontin.  I take prilosec (for a hiatal hernia) which although it is not an antacid, it does deal with similar problems.  Does anyone know if you should also space two hours between neurontin and prilosec? Thanks, Bonnie

Response:

> I have read that you are not supposed to take an antacid within two hours of > taking neurontin.  I take prilosec (for a hiatal hernia) which although it > is not an antacid, it does deal with similar problems.  Does anyone know if > you should also space two hours between neurontin and prilosec? > Thanks, > Bonnie

As Lynda has suggested, you should discuss this with your pharmacist. It will be fully explained in his reference materials. The issue is really one of binding between the antacid (e.g. chalk, also known as calcium carbonate), and the gabapentin. Some of it just gets caught up in the antacid gorp, and doesn’t have a chance to get absorbed. Prilosec is a proton-pump inhibitor, which is a totally different sort of medication. Yes, they are similar in how they are perceived by the patient (less reflux-induced pain), but there should not be any similar interaction on the physical level, as with antacids. Larry

Response:

Hi Bonnie, > I have read that you are not supposed to take an antacid within two hours of > taking neurontin.  I take prilosec (for a hiatal hernia) which although it > is not an antacid, it does deal with similar problems.  Does anyone know if > you should also space two hours between neurontin and prilosec?

Antacids may decrease the absorption of gabapentin and lover the blood level by 20% Gabapentin may increase the concentration of some oral contraceptives by 13%. This probably is not clinically significant. I suggest you talk with your pahmacist about this. take care. Yours, Lynda

Response:

heartburn

Question:

Carafate is sold under the brand name: Sucralfate. Information can be located on this drug at the following web site: http://www.rxlist.com/cgi/generic/sucral.htm Heartburn and Gastro Esophageal Reflux web page: http://members.aol.com/HawkTear/index.html

Response:

> Does anyone know anything about a drug called carafate??  I want to get > pregnant again someday and was told it is safe to use during pregnancy for > heartburn.  I presently take prilosec, which is not safe during pregnancy. > I have a hiatal hernia and have to take something to control this > heartburn.

I can’t answer your question, but I was wondering what a hiatal hernia feels like. When I was pregnant with my first, it felt like she was jamming her foot up under my ribs. I also had heartburn. Now I’ve been having pain under my ribs and last night I poked around trying to find out where the pain is originating. While sitting, I tried putting a little pressure below the sternum and bending over. It hurt so bad my eyes watered! I haven’t had trouble with swallowing or regurgitating acids. My Dr. put me on Prevacid for heartburn. It helps a little, but it still gets pretty tender in that spot. Especially if I slouch in front of the computer. Does it sound like hiatal herna? Regards, Mary

Response:

– Hide quoted text — Show quoted text – >  I was wondering what a hiatal hernia feels > like. > When I was pregnant with my first, it felt like she was jamming her foot up > under my ribs. I also had heartburn. Now I’ve been having pain under my ribs > and last night I poked around trying to find out where the pain is > originating. While sitting, I tried putting a little pressure below the > sternum and bending over. It hurt so bad my eyes watered! > I haven’t had trouble with swallowing or regurgitating acids. My Dr. put me on > Prevacid for heartburn. It helps a little, but it still gets pretty tender in > that spot. Especially if I slouch in front of the computer. Does it sound like > hiatal herna? > Regards, > Mary

What you described could be as a result of hiatal hernia…or not. The only way to know for sure is get either an upper GI barium xray or an endoscopy.  Both pressure from below the diaphragm and genetic predisposition contirbute to this very widespread condition. Chris C.

Response:

Does anyone know anything about a drug called carafate??  I want to get pregnant again someday and was told it is safe to use during pregnancy for heartburn.  I presently take prilosec, which is not safe during pregnancy. I have a hiatal hernia and have to take something to control this heartburn.

Response:

> Hi, I have been having  bad heartburn for about 6 wks. I just got the > report from my upper GI today.  Everything is normal. No evidence of > hiatal hernia or reflux. No masses or ulcers in lower esophagus, stomach > or duodenum.So what in the heck could be causing the buning ? I’ve been > on Prilosec & it only helps a little.

If you aren’t getting much help from the acid blocking drugs, the burning might be caused by a yeast infection instead.  You can test this easily: eliminate ALL sugars from your diet for 48 hours.  No sucrose, fructose (fruit), lactose (dairy), or any -ose.  If you then feel better, yeast is most likely the cause, and you then will know to investigate other remedies.

Response:

Thanks Steve for the comment. I was thinking this same thing this morning , wondering if I could have candida. I’ve been baking "healthy" breads & yesterday I made bagels. I use all fruit jelly on these.I felt very bad after eating this baked goods & indeed have many, many symptoms of a yeast problem.

Response:

Hi, I have been having  bad heartburn for about 6 wks. I just got the report from my upper GI today.  Everything is normal. No evidence of hiatal hernia or reflux. No masses or ulcers in lower esophagus, stomach or duodenum.So what in the heck could be causing the buning ? I’ve been on Prilosec & it only helps a little. Of course I’ll be talking to my doctor on Mon. He sent me a note with the report but didn’t  offer any explanation. Anyone have any thougts on this ?

Response:

Ginger

Question:

I have tried it.. It seem to help but it could very well have been a placebo effect. I have talked to many people that have used Ginger to relieve heartburn and have found that most seem to think it helps. A few found that it made their heartburn symptoms worse. To date, no one has been able to explain to me why it would reduce heartburn symptoms. The formula is posted on the www.heartburn-help.com web site under Herbs and Vitamins. I would recommend talking to your doctor before trying this and even then proceed with caution. If anyone has experience with Ginger, good or bad, please post here. Heartburn and Gastro Esophageal Reflux web page: http://www.heartburn-help.com

Response:

Eve, I started using Ginger Root Juice (GRJ) and found out about it on this newsgroup. The man who told me about it discovered it in a book ‘Saving Yourself From The Disease-Care Crisis’ by Dr. walt Stoll. Copies can be ordered at 1-800-464-7034. I have suffered from a hiatal hernia (HH) since 1975 and had gotten along pretty good by watching what I ate, raising the head of my bed frame *not just my head* and taking Zantac 150 mg. as needed and the occasional over-the-counter antacid. All this worked good until I took an early retirement in Feb. 1996 and within a year my condition had deteriorated to the point my esophagus was so tender I was having trouble swallowing anything. I was living on cold cereal and milk. I was on the verge of calling a surgeon to have the Nissen Fundoplication operation to try and help my situation. I thought it was my only choice. But, luckily I read about GRJ. The article in the cited book reads as follows: "  Hiatus hernia is an increasingly common condition in which gastric contents escape up into the esophagus, causing heartburn symptoms that tend to be worse when the person is lying down.  Hiatus hernia can be simply, cheaply and safely resolved. The conventional medical options for treatment are dangerous (surgery), expensive (special antacids [Gaviscon] to coat the esophagus, prescription antispasmotics and tranquilizers); a real bother (propping up the head of the bed eight inches, not eating for four hours before retiring, avoiding alcohol and losing weight); and not very effective.  Although the following simple treatment was originally described to me as a way to cure hiatus hernia, it is also nearly as effective for other symptoms of the upper intestinal tract that have not responded to conventional treatment.  Anyone with an established diagnosis of hiatus hernia should do the following if they would like to be rid of it. Go to the grocery store and buy about two pounds of fresh ginger root (you will find it in the fresh vegetable section). The heavier the root, the more juice there is in it. Buy about two pounds of the stuff. Extract the juice with a juicer. For some reason (the Chinese medical practitioners know why — something to do with the yin/yan), the shredding type of juicer works best. If you use a blender (that slices things up) this will not work as well. Collect all the juice and store it in the refrigerator. You will notice some settlings in the bottom which you can safely ignore.  Every morning, on arising, take a teaspoon of the juice straight. At  first, it will feel like you have swallowed two-hundred proof alcohol.  However, the sensation will cause you no harm and lasts only a few seconds. In a few days, you will become accustomed to the warming sensation and won’t notice it so much. Be sure to keep this up for a full three weeks or the problem may recur.  Within a few days you will begin to see some benefits. Your problem should be gone long before the three weeks are up. If the problem should ever start to come back, just do the procedure again. However, if you start as soon as the symptoms recur, you should only have to take the ginger root juice a few days. If you wait till it has been there for a few months, you may have to do the whole three weeks again." I quickly state that the GRJ *won’t* cure GERD or heartburn but it definitely will sooth and help heal your esophagus. My esophagus got better within three days so that I could eat food that I hadn’t been able to eat for months. Then with your esophagus soothed and somewhat healed you can make some lifestyle changes that will definitely help. Like what, when, how and the time of day you eat. There are many, many things you can do to help the situation. Like properly chewing all food, stopping all caffeine, spices, hot and cold liquids, ments, nicotine, etc. etc. Different foods will trigger reflux in different people. It will take some experimenting to discover your triggers. Other things like your posture during and after eating. Standing up straight and taking a small walk will help the food move out of your stomach and into your small intestine. The worse thing you can do is what most of us do is immediately after eating sit in a recliner and lean back or slouch down. This allow reflux to touch the LES and thereby weaken the LES. Now, you must remember it has taken you probably years for your condition to become painful so the suggestions I make won’t make a difference in a few days, months or possibly years. But you will improve over time. There is no quick remedy for this situation. And definitely the Nissen Fundoplication operation won’t work. The docs are trying to replace a muscle, the LES, with a flap of your stomach. It just won’t work. Read the posts of people who have had the operation and still have the acid reflux. Some other things you can do is Positive Thinking and Positive Imagine, Yoga, Meditation, exercise, etc. etc. Your stomach is the seat of your emotions and negative emotions plays havoc on your digestion. Anyway, I hope I’ve given you some things to think about. I will be glad to answer any questions you may have by email. Good luck. Bill

Response:

Copy of email to WWW list

Want to learn more? Find for more information about acid reflux esophagus at our partner site AcidRefluxDiseaseGERD.com

Question:

Hello all, I wanted to post a copy of an email I just sent to a WWW list. Look forward to any comments. To:                     Gastroenterology Highlights > i have had acid reflux disease for 8 years now and it has progressively > gotten worse >  even though i am on the prevacid , propulcid and galvescon. after many >  >  > tests my doctor has referred me to a surgeon for the nilssen >  fundolophain procedure to be > > done after my >  vacation in february. has anyone had this operation,  and how are you >

doing afterwards? Dear Eileen, I can imagine I will get flamed and jumped on by some of the readers of this group but I feel I must make some comments to you about the operation you are contemplating. Please, I beg you to do some research into this operation before you agree to have it done. There are lots of sites that discuss the merits of this operation and I have seen many posts by people who have had to have the operation done again because it didn’t work and other people who still have the same or more reflux after the operation was done. May I give you and anyone else reading this a few things to think about concerning the operation which I believe is correctly named: "Laparoscopic Nissen Fundoplication" There are many, many web sites that discuss this operation. Try and find some where the patients who have undergone the operation tell their side of the story. There *are* such sites but you have to dig pretty deep to find them but isn’t your life and well being worth the effort? There are many, many actions you can do for yourself to help with your condition of acid reflux. I have no medical training but I speak from personal experience. I was diagnosed with a hiatal hernia (hh) in 1975. For 20 years I controlled the acid reflux by altering my lifestyle, being careful what and when I ate, taking over-the-counter antacids and Zantac 150 mg. as needed. I did pretty good until 1996 when I took early retirement. My lifestyle changed for the worse and my acid reflux rapidly got worse until my esophagus was so tender I couldn’t hardly eat anything. The food just wouldn’t go down the esophagus. I was down to eating cold cereal with milk only and was losing weight rapidly. I was right on the verge of calling a surgeon to make an appointment to have the Laparoscopic Nissen Fundoplication operation done. I honestly thought it was the only way to save my life. Just before I made the call to the surgeon, I decided to educate myself as much as possible about the acid reflux and see if there was anything I could do for myself by lifestyle changes and through alternative medicine. Luckily I discovered there were many lifestyle changes I could do very easily and some alternative medicine I could try. First, let me say that when it comes to the digestive system and in fact the whole body, mind and spirit there is *nothing* absolute. What may work for me may not work for you and vice versa. And what may work for me one day may not work the next day. Your health is a continually, changing, balancing act and lots of things you do everyday can have an adverse reaction on your health, especially acid reflux. For example, I’ll bet many people do exactly like I did for years and immediately after supper, normally the largest meal, head for the nearest recliner and sit back to watch TV for a while. It took me years to understand that that simple act can cause acid reflux to be much worse than if you went for a small walk after supper. It’s explained very simply. If you are walking, your esophagus is in a vertical position and gravity helps keep the acid down in your stomach where it should be but if you recline or lay back even a very small degree, the acid in your stomach splashes up and comes in contact with your lower esophagus spinchter muscle (LES). The acid coming in contact with your LES causes it, the LES, to become weakened and inturn allow the acid to reflux up into your esophagus. This weakening of the LES can take days, months and even years and happens so gradually that most people don’t notice the problem until your esophagus becomes tender, sore or even ulcerated. This is sometimes called esophagitis (spelling??). And of course as some people point out many times (which is good but as I read this list every day, it does get tiring after a while) acid reflux can become serious and life threatening since continuous reflux can cause the esophagus to change to Barretts Esophagus which can become cancerous. Even your posture while eating can affect acid reflux. If you slouch, the way most people do, when eating you will have more acid reflux. Slouching causes a pressure to be placed agains your LES and can cause the LES to fail to close properly. Sitting up straight can help. Now, since this condition (sore, tender or ulcerated esophagus) happened over many days, months or even years, it will probably take days, months or even a year or more to allow your LES to heal itself by keeping the acid reflux away from the LES by simply taking a walk after your meals rather than sitting in a recliner or slouching down in any chair. Surprisingly, just this one simple act can help a lot of people with acid reflux. Raising the head of your *bed frame* from ten to fifteen inches will also help tremendously. I have slept with the head of my bed frame raised ten inches for over ten years and it is the one thing that has helped with my reflux problem more than anything else. Some people say that just propping your head up with pillows or a foam wedge will work also but I strongly disagree with this. By just propping your head up, you do put your esophagus at a more vertical alignment but you also put more pressure on your stomach, LES and the diaphragm that separates your chest from your abdomen area. It’s my opinion that this added pressure in that area hinders your LES from closing as tightly as possible without the added pressure. Now, I remind you that what works for me may not work for you and vice versa but as you will see, trying to control acid reflux is a balancing act that a lot of seemingly small things can have an affect on. Raising the head of your bed seems a small price to pay to me to help control the acid reflux. I’m married and my wife and I sleep in the same bed. I really prefer the raised head of the bed to a flat bed now and raising the head of the bed doesn’t cause any major problems. We do slightly slide down the bed during the night as we toss and turn but it is real simple to slide back up and of course if you don’t toss and turn, you probably won’t slide down. When I first raised the head of my bed, I used books stacked on the floor. The books kept falling down occasionally so I finally had a metal frame made just for this purpose. Works great. Only cost about $78.00. Well worth every penny spent. But, before I go any further, let’s go back to the operation, the Laparoscopic Nissen Fundoplication,  you are considering and let me in layman’s terms try to explain what the surgeon is planning to do. Basically, he is going to wrap the upper part of your stomach ( the part of your stomach that has pooched up from your abdomen into your chest area) around the lower part of your esophagus in an effort to tighten the LES. A few points need to be explained. The esophagus is basically a tube that allows chewed food, both solid and liquid, to pass from your mouth to your stomach. The LES is suppose to be a one-way valve that is suppose to allow food and liquids to travel in one way only. Occasionally, the LES does open the opposite way (it really doesn’t open the ‘opposite’ way, this is just the easiest way to explain it to you) to allow gas to escape from your stomach. That is when you burp. And very importantly, if you ever eat bad food, poisoned or spoiled, or anything that needs to come backup, the LES opens to allow you to vomit. If a person has had the Laparoscopic Nissen Fundoplication performed almost everyone agrees that you cannot vomit. You have to dig real deep to get anyone to admit this. Further, if you can find an honest surgeon he/she will tell you that when they first started doing the Laparoscopic Nissen Fundoplication several years ago, the surgeons did a ‘full wrap’ meaning the stomach was wrapped fully around the esophagus. Later, experience showed the surgeons  that a full wrap didn’t work for some people, especially with anyone who had trouble swallowing. The full wrap caused more problems than it helped. Then the surgeons started to experiment with partial wraps. Some stomach wraps were wrapped around the stomach only 90%, 80%, 70%, 60% or whatever the surgeon thought was appropriate for the patient. And as many patients discovered, this is not an exact science. So some patients had problems because the wrap was too tight or it didn’t help because it was too loose. You might ask your prospective surgeon what percent wrap he/she plans to do on you and why. Might be interesting to hear what his/her reasoning was in making that decision. Another problem with the Laparoscopic Nissen Fundoplication operation is fairly easy to see if you stop and think about it. The surgeon is trying to replace a ‘muscle’, remember the lower esophagus spinchter muscle (it’s the same type spinchter muscle at your anus) or LES, with a piece of your stomach wrapped around your esophagus. Now, the ‘muscle’ instinctively knows when to open or close. There is no way a part of your stomach can know when to open or close.  Whatever position the surgeon sews your stomach wrap around your esophagus, will remain the same. There isn’t going to be any … read more »

Response:

Thanks.I’m just beginning to learn and accept this.I’m grieving my food,glass of afternoo n wine,and morning cup of coffee.

Response:

Ah, yes.  Understood. However, it is much better to grieve those things than to grieve for your life. Gentle as you go, Marny

– Hide quoted text — Show quoted text -> Thanks.I’m just beginning to learn and accept this.I’m grieving my food,glass > of afternoo > n wine,and morning cup of coffee.

Response:

Moses here: I hope you are on a better drug than Zantac, now! As certainly you… well almost…. are. A PPI drug is what an F-16 is to an early biplane. Examples of PPI drug brand names here in the States are Prilosec, Prevacid & Aciphex. It doesn’t look like you are getting flamed by anything other than stomach acid. Thank you for the nice posting. Visit us again. Best Wishes Moses Clarke * Sent from RemarQ http://www.remarq.com The Internet’s Discussion Network * The fastest and easiest way to search and participate in Usenet – Free!

Response:

got test results today…

Question:

went to the doctors today and he told me the results of my endoscopy that I had done 2 weeks ago. He says I have a hital hernia and possible stones in my pancreas ….so now they up’d my daily dosage of prilosec to 40mg a day and I will have a ultrasound done next week to rule out the stones……does anyone know about this hital hernia stuff?

Response:

>does anyone know about this hital hernia stuff?<

Go to www.heartburn-help.com and click on ‘Heartburn Web Sites’ then scroll down to: (All about Hialtal Hernia, Heartburn and Gerd.) Hiatal Hernia is caused by an opening in the diaphragm, a flat muscle that separates the lungs from the abdomen. When this occurs, the top of the stomach slips through the enlarged hiatal hernia or opening in the diaphragm and allows the stomach to bulge into the chest cavity. A lot people have this condition to some degree or another. Many suffer no symptoms at all. Heartburn and Gastro Esophageal Reflux web page: http://www.heartburn-help.com

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can you tell me what they do for a hital hernia? do they just treat it with prilosec or what? also I have heard some people talk about changing eating habits and elevating the head when sleeping….I have done all these things….but my problem is not what I eat it is when I don;t eat anything at all……I get heartburn really bad when I don;t eat anything at all or I go to long in between meals with nothing to eat. anyone have any idea;s about this? Lisa

– Hide quoted text — Show quoted text -> One thing I learned years ago is to ask for a copy of the written > report from any medical test.  The first time I did it I felt funny > (as if the doctor might think I didn’t trust him), but after that it > is like 2nd nature to me. > I’m amazed at how much more I learn from the written material than > from what the doctor tells me. > I’ve never been asked by the doctor or the assistants why I want the > copies, but if asked, I would just say I keep copies of everything as > a complete medical history. > Good luck. > Jer >went to the doctors today and he told me the results of my endoscopy that I >had done 2 weeks ago. He says I have a hital hernia and possible stones in >my pancreas ….so now they up’d my daily dosage of prilosec to 40mg a day >and I will have a ultrasound done next week to rule out the stones……does >anyone know about this hital hernia stuff?

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> can you tell me what they do for a hital hernia? do they just treat it with > prilosec or what? also I have heard some people talk about changing eating > habits and elevating the head when sleeping….I have done all these > things….but my problem is not what I eat it is when I don;t eat anything > at all……I get heartburn really bad when I don;t eat anything at all or I > go to long in between meals with nothing to eat. anyone have any idea;s > about this?

Lisa,      First wanted to say Hi.   I’ve been checking here periodically and was beginning to wonder what happened to you.   I’m really glad to see your posts.     Was really glad to hear that nothing "serious" was found from your tests.   I know that is easy for me to say.    But considering all of the possible things they could have found,  I think you got pretty good news.       As several people have already pointed out,  a hiatal hernia is a condition where a small portion of the stomach can work its way up through the diaphragm.    In doing so,  the sphincter muscle that normally keeps acid from refluxing can sometimes be stretched open, causing continued heartburn.     I went to the web site that Hawk has been promoting and there is a pretty good and thorough explanation of the condition there.        The good news is,  this is generally a benign condition, in terms of any harm being done to your body.  Of course, the downside of that is,  if the heartburn continues over a long time period because of it,   problems secondary to the acid can develop over time.   However no need to worry over that at this time.        As for treatment,  I am not an expert on hiatal hernias,  but I can give you a few generalities.    A lot of what happens with such a condition will depend on the exact reason for the hernia and also on the degree that the stomach protrudes through the diaphragm.         Sometimes,  this condition corrects itself.    Other times,  it will very in severity as the stomach will change position.   So you could find that over time,  things will just return to a more normal state, with some occasional flare ups.          In the mean time,  it is very wise to minimize as much stomach acid production (and reflux) as possible.  Raising the dosage of Prilosec will reduce the amount of acid so you definitely should follow through on that.    I also still stand by my previous recommendations of some OTC Gaviscon.  It has a component called Alginic Acid which helps form a "barrier" between the stomach and esophagus.   It can further reduce acidity of the stomach as well as help prevent more reflux.  It is a good, and very safe antacid, and Can be taken with Prilosec.          You will need to discuss this with your doctor but there are also a few medications that will increase the LES (Lower Esophageal Sphincter) pressure. In other words,  there are medications that can help "force" the sphincter muscle to close more forcefully.   Obviously by doing this,  there is less chance of acid refluxing upwards.         Finally,  there are also medications which can help increase the motility of the stomach.   By taking these medications,  it causes the stomach to empty more quickly which causes less internal  pressure and just leaves less materials and acid  in the stomach to "back up".        There have been many advances in this area of pharmacology recently.  Not having a hiatal hernia myself, I haven’t been following these drug developments too closely.   I’m sorry but I don’t know the names of any of these particular drugs.   You’ll have to ask your doctor about them.         –   Keeping the head of the bed up is good,  if you can stand it.  (I was always sliding down off the bed or something.  :->).   Also, you might want to simply watch the position you normally sleep in.  Because of normal anatomical issues,  it is known that the esophagus is more "open" when laying on the left side.  That is why,  they had you on your left side when you had your endo.  That wasn’t by chance.   Try lying on your right side.  See if that makes things different in the AM and during the day.        -  Depending on who you talk to,  some folks will recommend  surgery for this.   However,  I believe that is usually left as a last ditch effort. Sometimes it is necessary but I wouldn’t worry about that just yet.    There are a lot of other techniques to be tried first.   Make sure you discuss ALL the options with your doctor and don’t let yourself be pushed into something complex unless he/she can give you a VERY solid reason for it.      As for the heartburn between meals.    I’ve had it.   There is no one, simple good answer for it.   If you do get on higher doses of Prilosec and some of the other medications for a while you may very well find this will settle down as well.  The Gaviscon will help too.    Eating smaller meals, more often is the other simple solution.    Of course,  small snacks can help as well. (The only down side to that is potential weight gain.)       Also,  you still may want to watch what you eat to some extent.   High fat foods,  carbonated and caffeinated beverages, and spicy foods are still serious culprits.    Even if they don’t seem to bother you right after eating,  they still could cause some of the between meal reflux.  So,  do keep an eye on that.   See if you find any patterns.       Finally, hang in there until they finish evaluating the pancreas stuff. If you have some type of irritation or inflammation going on,  that could be feeding into your symptoms too.   I’m not really sure how they figured that out via an endoscopy but let them do the remainder of the tests,  then have a long, assertive chat with your doctor and ask about all your options.       I know most all of this is "old news".    I hope it helps a little.   Have patience a little longer and try the Gaviscon and other eating tricks until you see the doctor again.    In the mean time,    please don’t worry and please continue to keep us posted.    As I’ve said before,  my e-mail box is always open.   I hope you’ll keep in touch.  Take care. John

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Pancreatiz enzymes high (re-post)

Question:

I’m not sure what happened to the original of this post. It seems to have disappeared. (If I am off topic, my apologies….otherwise, I could use some help.) Hello, folks. I have been lurking on this group for quite a while, but a recent bout of trouble with…well, my doctor isn’t really sure what is wrong at this point, even though there has been a lot of blood drawn, a couple of CT scans and an endoscopy. "We’re" looking at the other end as soon as it can be scheduled. I’m so excited I could just…well…never mind. Here’s my situation: Starting in 1982 (I was nearly 26), I began having regular bouts of heartburn. For a few years, I could control it with Tums, Rolaids, etc. I was eventually diagnosed with a hiatal hernia (recently reported to be "small"). In the past couple of years, I have been taking prescription strength Tagamet. Last winter, my family doctor put me in Prevacid, initially at 60mg per day. It worked wonders. The reason I had been in to see the doctor was because of tenderness in my abdomen. We never did determine what that was all about before it went away, but it placed us on a diagnostic path that seems to lead nowhere. My pancreatic enzymes are high (I don’t know the actual score), but there is no evidence of any problems with my pancreas. Over the past ten years, I have monitored my diet and weight in order to understand what triggers my heartburn episodes. While there are things I can point to that cause problems more than others (garlic, chocolate, alcohol), I can never predict when I am going to have real trouble until it hits. Unless, of course, I drink the least bit of brandy or eat it in foods. That will do it every time. Haven’t had it in years because of that. Oh, yeah, almost forgot. I belch a lot. Pretty melodic sometimes. It doesn’t matter if I have had anything to eat or drink in a while. In fact, one just snuck up on me and I haven’t ingested anything (except a few ounces of water with my Prevacid 2 hours ago) in 10 1/2 hours. Half the time I don’t even notice any more. I am taking 30mg of Prevacid per day and my gastroenterologist (did I get that right?) tells me "no one should have heartburn at that dose…" He, my family physician and I are equally puzzled. I am writing because I woke up at 3am with a stomach ache and couldn’t get back to sleep. Ticks me off when that happens. I have watched a number of thoughtful comments and conversations on this group. Any thoughts, observations or ideas on my situation? Anything I’ve left out of my story? TIA — Steven Kopischke Green Bay, WI

Response:

Moses here: First the disclaimer, I am not a Doc ( if you have lurked you know this) so I have my limits.  My comments mixed in below with yours. – Hide quoted text — Show quoted text -> I’m not sure what happened to the original of this post. It seems to have > disappeared. (If I am off topic, my apologies….otherwise, I could use some > help.) > Hello, folks. > I have been lurking on this group for quite a while, but a recent bout of > trouble with…well, my doctor isn’t really sure what is wrong at this > point, even though there has been a lot of blood drawn, a couple of CT scans > and an endoscopy. "We’re" looking at the other end as soon as it can be > scheduled. I’m so excited I could just…well…never mind. > Here’s my situation: > Starting in 1982 (I was nearly 26), I began having regular bouts of > heartburn. For a few years, I could control it with Tums, Rolaids, etc. I > was eventually diagnosed with a hiatal hernia (recently reported to be > "small").

Yeah, small ones seem to be enough to help the LES to fail, my wife had a "small one". In the past couple of years, I have been taking prescription > strength Tagamet. Last winter, my family doctor put me in Prevacid, > initially at 60mg per day. It worked wonders. The reason I had been in > to

 Well that tells you there is some dose that works. I’d say 40 milligrams of Prilosec would be more effective the 30 milligrams Prevacid, and yes 40 milligrams of Prevacid would be more likely to help also. It’s just I am not aware of the Prevacid capsule makers producing a 40 mg capsule. The comparison studies that I’ve seen the abstracts to on medline are a little stupid; in that, they compare different size doses of the drugs. Yes, I know the drug companies would say that each drug has a somewhat different activity, but the two different drug molecules are rather similiar IMHO. The 40 milligram capsule of Prilosec, the Merck company drug is about another 50 dollars a month than the 30 milligram Prevacid and the 20 milligram Prilosec. > see the doctor was because of tenderness in my abdomen. We never did > determine what that was all about before it went away, but it placed us on a > diagnostic path that seems to > lead nowhere. > My pancreatic enzymes are high (I don’t know the actual score), but there is > no evidence of any problems with my pancreas.

By this I assume you mean, the serum levels of the enzymes. This is quite worrisome. The two enzymes that my books mention are amylase and lipase. Both exist in the blood and are also excreted by the kidneys. They also are secreted in the the duodenum to digest starch and fats, respectively. Elevated levels of these enzymes can point to a number of ills. If it lasts a week or ten days, it may mean the patient has acute pancreatitis. According to the diagnostic algorithm chart, this condition is likely also marked with abdominal pain. A gall stone can be the cause of this problem. For persistent elevation of serum amylase, the chart lists three conditions, pancreatic pseudocyst, pancreatic abcess, and pancreatic ascites on this branch of the chart. On another related branch of the algorithm that includes abdominal pain, there is a  chance of malignancy of the pancreas, ovary, and colon. On the "no abdominal pain branch of the algorithm chart there is listed under the "chronic elevation" is the following macroamylasemia, S-type hyperamylasemia, renal failure, and prostate disease. > Over the past ten years, I have monitored my diet and weight in order to > understand what triggers my heartburn episodes. While there are things I can > point to that cause problems more than others (garlic, chocolate, alcohol), > I can never predict when I am going to have real trouble until it hits. > Unless, of course, I drink the least bit of brandy or eat it in foods. That > will do it every time. Haven’t had it in years because of that. > Oh, yeah, almost forgot. I belch a lot. Pretty melodic sometimes. It

doesn’t Yes, the belch goes with the failed LES (lower esophageal sphinter). If you get your acid completely suppressed, you won’t notice it much. Or so I am told by a workmate with the condition. He take 40 mgs of Prilosec per day. – Hide quoted text — Show quoted text -> matter if I have had anything to eat or drink in a while. In fact, one just > snuck up on me and I haven’t ingested anything (except a few ounces of water > with my Prevacid 2 hours ago) in 10 1/2 hours. Half the time I don’t even > notice any more. > I am taking 30mg of Prevacid per day and my gastroenterologist (did I get > that right?) tells me "no one should have heartburn at that dose…" He, my > family physician and I are equally puzzled. > I am writing because I woke up at 3am with a stomach ache and couldn’t get > back to sleep. Ticks me off when that happens.

The other thing to be aware of when taking acid suppressors is that one is more vulnerable to bacteria like the toxic form of E. coli. Small children are more vulnerable to E. coli at least in part from the fact that their stomachs make less acid than an adult. Eating out is thus a bit more risky for you now. Best Wishes Moses Clarke > I have watched a number of thoughtful comments and conversations on this > group. Any thoughts, observations or ideas on my situation? Anything I’ve > left out of my story? > TIA > — > Steven Kopischke > Green Bay, WI

Share what you know. Learn what you don’t.

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   Well dont believe a doctor when he speaks in absolutes,, I had Heartburn at 30 mg prevacid 2 times daily. And my doctor said, he could give me as high a dose as worked, its all about finding the dosage that works for you.    So ask your doctor to knock you up a notch,, maybe 45mg 2 times daily. I personally take a 30 and a 15  two times daily..   Also get checked for gastric emptying speed, maybe food sits in your stomach for a long period of time.. Ask your doctor if you might need a Motility drug in conjunction with the Proton pump inhibiting Prevacid…

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Esophagitis after fundoplication

Question:

Hi, I done fundo surgery in january this year, this time I had mild esophagitis + hiatal hernia. Now I done a gastroscopy because I was felling so much nausea, the result was mild esophagitis and possible reflux ? Is this common, like I done the fundoplication to cure the esophagitis? Thanx Liane

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>I done fundo surgery in january this year, this time I had >mild esophagitis + hiatal hernia. >Now I done a gastroscopy because I was felling so much nausea, >the result was mild esophagitis and possible reflux ? >Is this common, like I done the fundoplication to cure the>esophagitis?

I am a board-certified gastroenterologist and this information is intended to be general in nature. It is not uncommon to suffer from reflux symptoms following a fundoplication surgical procedure. Many patients still require their anti-reflux medication even after surgery for reflux.  That is one major reason that if your symptoms are well controlled on Prilosec or Prevacid, even taken twice daily, you’d be better avoiding surgery.

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>I am a board-certified gastroenterologist and this information is intended to >be general in nature. It is not uncommon to suffer from reflux symptoms >following a fundoplication surgical procedure. Many patients still require >their anti-reflux medication even after surgery for reflux.  That is one >major >reason that if your symptoms are well controlled on Prilosec or Prevacid, >even >taken twice daily, you’d be better avoiding surgery.

     As someone who had the Nissen two years ago, (reflux was not under control by any means) I wholeheartedly agree with this. If you are under control with meds, I would pass on the fundo.

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