Endoscopy Results; Questions for Howard

[c***@intel.com]

Hi Howard,

I am participating in a clinical research study for reflux and have
just had an endoscopy done. I've been off my medication, Prevacid,
for about 2 1/2 weeks. Being off of meds wasn't really that bad for
me and here are the results:

"2 small ersonsions are present at the GE junction consistent with
L.A. class A ersovie esophagitis. A very small sliding hiatus hernia
was observed. The lower esophageal sphincter was observed to be
patulous (incompetent). All other findings normal".

I have some questions:
Do I really have to have a pH study to be considered a candidate for
surgery?
Since the results seem mild, would be alright to stay off of my
Prevacid and use only OTC meds such as Pepsic or Zantac?
What do you think of the new Esophyx procedures?

I really don't like taking PPI meds especially since I have
Osteopenia, so I'm just curious about what other options there are.
I'm 45 years old, so I don't really want to be on PPI meds for the
rest of my life.

Thank you,

Christine

[Tim J.]

Post by c***@intel.com
Do I really have to have a pH study to be considered a candidate for
surgery?

They told me I had to, but after they couldn't get even the tube to
measure for the sensor wire down my nose because of my constant
gagging and vomiting, they finally sent me to nuclear medicine to
drink some radioactive orange juice and watch the reflux on a
fluoroscope.

[c***@intel.com]

Tim,

Did you finally have surgery done? I tried the pH study and manometry
and had inconclusive results; I did not tolerate the procedures well
at all! My pH test was done on meds, so it didn't do me any good. I
don't want to go through them again. I feel like I can tolerate less
medications, but I don't want the erosions to get worse! Thanks for
the idea; I'll talk to my GI doc and see what he thinks. I was
thinking of having the Bravo test done, but my GI doc told me that
they are no longer using it because the results were unreliable. The
only thing they use here are the more traditional pH or impedence
tests.

Christine

[Tim J.]

Post by c***@intel.com
Tim,
Did you finally have surgery done? I tried the pH study and manometry
and had inconclusive results; I did not tolerate the procedures well
at all! My pH test was done on meds, so it didn't do me any good. I
don't want to go through them again. I feel like I can tolerate less
medications, but I don't want the erosions to get worse! Thanks for
the idea; I'll talk to my GI doc and see what he thinks. I was
thinking of having the Bravo test done, but my GI doc told me that
they are no longer using it because the results were unreliable. The
only thing they use here are the more traditional pH or impedence
tests.
Christine

Yes, I finally had a Nissen Fundoplication done in April, 1999. My
only regret is that I didn't have it sooner. I went from having
100-200 episodes per *day*, every day, to not having a single incident
of reflux for almost 10 years.

I had to fight with the GI doc I was seeing at the time (and whom I
subsequently fired for his continual lies and unprofessionalism) about
the position of the test. My case was quite atypical. No medication
helped at all. The *only* thing that stopped the reflux was to lie
flat on my back. I could be in the middle of a severe attack and lie
down, and the reflux would literally stop instantly. My doctor was
made aware of this on numerous occasions.

But the protocol for the nuclear medicine test called for me to be
lying down. I told the technician that would not be acceptable
because it was guaranteed to give a false negative. She called my
doctor who said to have it done lying down, and if it came back
negative, he would order the test be done again (at my expense, of
course), this time with me sitting up. After I balked at that notion,
the technician made a phone call and was told by someone in the
hospital if I had to be re-tested in a different position, then I
would only be billed once. As I predicted, the test done lying down
showed nothing. When I went back and did it sitting up, the same
technician stood there with her mouth agape. She said she had never
seen a case of reflux that bad, and never, ever seen anyone with GERD
be completely asymptomatic when lying down.

Of course, I was billed twice. I sent the first bill back to the
hospital outlining what I was told by the technicain, and told them if
they still wanted the money to send the bill to my then ex-doctor. I
never heard from them on the matter again.

I changed doctors and the new one was immediately ready to schedule
surgery, but I put it off for over a year trying additional cocktails
of medications. When I finally got to the surgeon, the nuclear
medicine test was completely acceptable to him, too. The only thing I
asked him to do differently from the normal surgical procedure was to
not put an NG tube in me, or if he did, to remove it before I came to.
He agreed without any argument.

Now, if I could only get the lower GI issues resolved...

[H McCollister]

In article

Post by c***@intel.com
Hi Howard,
I am participating in a clinical research study for reflux and have
just had an endoscopy done. I've been off my medication, Prevacid,
for about 2 1/2 weeks. Being off of meds wasn't really that bad for
"2 small ersonsions are present at the GE junction consistent with
L.A. class A ersovie esophagitis. A very small sliding hiatus hernia
was observed. The lower esophageal sphincter was observed to be
patulous (incompetent). All other findings normal".
Do I really have to have a pH study to be considered a candidate for
surgery?
Since the results seem mild, would be alright to stay off of my
Prevacid and use only OTC meds such as Pepsic or Zantac?
What do you think of the new Esophyx procedures?
I really don't like taking PPI meds especially since I have
Osteopenia, so I'm just curious about what other options there are.
I'm 45 years old, so I don't really want to be on PPI meds for the
rest of my life.
Thank you,
Christine

Clearly, the fact that you have erosive esophagitis means that you have
GERD. You should not have to undergo ambulatory pH testing. The
information from that test will tell your doctors nothing that they
don't already know - that you have acid reflux.

You DO need esophageal manometry. IMHO, an anti-reflux should never be
done without understanding the patient's lower esophageal sphincter, and
functionality of the esphageal mid-body.

Likely your erosive esophagitis was acid-mediated, so IMHO acid
suppression is an important component of your treatment. In that regard,
I would definitely prefer that you stay on a PPI (rather than an H2
antagonist) if you can tolerate it.

Esophyx is an intriguing concept. My partners and I are certified in it,
trained in it at Ohio State, and we have the equipment, but we haven't
done any yet (first one coming up next week). It's very hard to find
insurance companies that don't label it "investigational". The vast
majority of them refuse to pay for it. I like the technique. The hype is
all about the "no scar" aspect, but that's immaterial IMHO. The risks
are the same, it requires general anesthesia, take as much time as a
Nissen, and the patient is still hospitalized overnight. OTOH, Esophyx
creates a wrap that is potentially more effective than a Nissen (fewer
side effects, I suspect). It's a Belsey Mark IV fundoplication as
opposed to a Nissen fundoplication. I do remain skeptical of its
longevity, as the method of securing the fundoplication (polypropylene
"T" fasteners) seems to be a little tenuous, but time will tell.

HMc

[c***@intel.com]

Thank you Tim and Howard for your resonses,

There is a lot here to think about. I've had a manometry in the past,
and the results were not so great. Even if I don't have to repeat the
pH test, I may have to repeat the manometry to be sure I'd be a good
candidate for surgery. I'll stay on my meds for a while and talk with
my GI doc again soon. I'm very glad to hear that there is a new
technique which shows some real promise.

Tim,

I hope you have continued success with the surgery. You mentioned
lower GI issues; are these related to the surgery?

Christine

Christine

[Tim J.]

Post by c***@intel.com
Tim,
I hope you have continued success with the surgery. You mentioned
lower GI issues; are these related to the surgery?

Thank you. No, the lower GI issues were already there at the time. In
fact, I've had lower GI problems just about all of my life. The
reflux didn't start until I was in my late 20's.