I am new here as I recently developed symptoms of GERD, which manifested mostly as breathing problems although I didn't experience much actual acid reflux.
After a month on Omeprazole, my doctor has decided to send me to a GI and an ENT. I didn't think to ask him at the time, but I'm wondering... why go see both? What benefit could be gained from going to an ENT AND a GI, rather than just going to one or the other (or neither, and sticking with the meds and diet changes)?
After about a month of meds and diet changes, I seem to be improving. Will I be wasting time and co-pays going to specialists?
It would be good to make sure that it's just the one thing and not two that have overlapping symptoms. It could be that you have mild cases of two things that are manifested in similar symptoms. You'll want to be sure.
Well I'm now glad I went to both, but a little confused. The ENT diagnosed me with LPR (he said there was evidence of reflux in my throat) and told me to take my Omeprazole twice a day instead of once... ok, fine. But now my GI tells me to only take it once a day since it's 40mg each and he thinks I might shut down my acid production altogether, especially since I'm very thin and my body might not need that much medication. According to my GI, "ENT's see reflux in everybody."
So he's skeptical that it's reflux because my main symptoms are breathing problems and I don't get heartburn. I happen to think my ENT is probably correct about the LPR, but I'll do the endoscopy anyway to see what happens. Anyway, it's all very mixed up. Who should I listen to? I am on the restricted diet (although I probably don't cut down enough with the fat, it's hard!) and Omeprazole and I'm still having symptoms. I don't want to stop acid production, but I do want to feel better!
At any rate, I HOPE the GI is wrong and that it is indeed GERD and LPR, because the alternative is probably worse.
I had reflux (LPR) that affected my breathing a lot. If it is truly LPR, then you really do need the twice per day of the PPI's. They helped me for years. Unfortunately it eventually stopped working and my breathing got worse. It was my Pulmonologist who got my GI doc to be more aggressive on my reflux treatments.
Many ENT's don't even really look for LPR. I wouldn't say they always see it in people. My ENT does a 24 hr pH test with probes in the throat to confirm the LPR.
Other testing I had done to confirm it was reflux affecting my breathing:
-Modified Barium Swallow & Esophagram (This is a barium x-ray that showed the acid coming up and irritating my lungs.)
-24 hr pH
-Endoscopy (Even with severe reflux, mine come back OK.)
-Lung Function Testing.
For any testing that one specialist did, I had results sent to the others.
So my endoscopy was normal, which confirms my GI's suspicion that it's NOT reflux and just makes me feel more frustrated. I AM responding to the PPI's, a little, but it's only been 1.5 months on the one pill a day and I am by no means cured. I think the 24 hour PH test is next. Meanwhile, I am spending all my money on co-pays, yay.
Right there with you on the co-pays. I ate up my share of my salary with visits and testing last year. My reflux was out of control, but it took a while to get that confirmed and try a variety of treatments.
I have SEVERE reflux. I have for years, but it got even worse about 1 1/2 years ago. I've had two Endoscopies that came back perfectly normal. Reflux doesn't always cause obvious damage. For me, the 24 hr pH and Barium Swallows were the tests that confirmed reflux was my problem. Also, my Pulmonologist diagnosed the problem just by taking an extensive history with me. The tests just confirmed what he knew and my other docs didn't.
My treatment plan included a combination of treatment for my reflux and the asthma it was aggrevating. Eventually I ended up going with the surgical approach. Most people do get it in control with typical medical treatment though.
The surgery was a "miracle" for me. My breathing was better from the instant I woke up after surgery and has remained that way for 10 months. My acid is so severe that I have to continue on the double dose PPI's indefinitely. Most who have surgery get to go off the meds immediately. I've had a few post-surgical issues, but I was warned about them and accept them because I can breathe. I have to chew and take small bites. I also have some issues with gas bloat. They aren't too horrible.
The breathing "symptom" of reflux is pretty rare. Most of the time, the other non-invasive treatments do work. For the times is doesn't, surgery is usually very successful in treating reflux which results in breathing problems. For some reason, the success rate percentages go up in these cases.
My primary reflux symptom was a chronic cough. When my reflux was at its worst, I would cough so much that I couldn't catch my breath. Some of the coughing was from throat irritation. I also had reflux irritating my lungs and flaring my asthma. Testing showed that I was also aspirating the acid a bit. A little acid can cause alot of irritation.
When my reflux was out of control, I even needed emergency treatment for my asthma because my asthma got so bad.
Often it just feels like I can't get a full breath in... but mostly through my nose. It's as though my nose just closes up. When I breath out during an "episode," I catch myself doing strange things like pushing the air out in spurts. Also, in the past I've had the feeling that (upon falling asleep) my windpipe constricts... that one was the worst because I'd wake up gasping (that's how this whole thing started actually, but that symptom seems to be happening much less since I started sleeping on a wedge). Only once did I have asthma-like symptoms while exercising - but it scared the crap out of me. I've been careful not to push myself too hard aerobically ever since then. Oh, and occasionally a dry cough.
So my GI decided that he would NOT send me for the 24-hour PH test and the Mamometry, and that I should see a Pulmunologist just in case I have asthma. I actually agree with him on this... it's either reflux or it's not, and if it is reflux then I will be treated the same way I'm being treated now, and if it's not, well, there's nothing the GI's can offer. No use spending time and money on extra tests at this point, especially since I seem to be responding to the meds.
It's been 2 months and I still have symptoms but they are not nearly as bad as they were in the beginning. This is encouraging. I've gone back on the twice-daily 40mg of Omeprazole, just for the month, just so I could report back to my ENT at the end of the month on my progress with that particular treatment.
I am still concerned about what the doc said, though, about the high dose of PPI's. Will it really shut down all acid production? Could it be harmful to me?
The pH test is a good one for your next step. It was very telling for me both times I had it. Pulmonologist is also a good next step.
I know it isn't good to be on the high dosages of PPI's long-term, but I've been on the double dosage for about 5 years now and don't see coming off of them in the forseeable future. For me the benefits have outweighed the risks. My reflux was extremely severe though so I'm not sure I am totally typical. Nexium was the only PPI that I had side-effects with. All others have been OK. I have had to go off of them at times before testing and I didn't notice the "rebound effect" that others have had problems with.
Last edited by MountainReader; 09-03-2009 at 07:10 PM.
I could have written your post. I was finally diagnosed after 3 years with LPR! I have been to GI Dr.'s at Mayo Clinic. They could not pinpoint anything. My reflux and mucous was so bad I could sometimes not eat solid food at all! Finally, I had an ENT diagnose me with LPR. I am now on 2 PPI's and Day and zantac 150 prescription at night (it is a liquid.). The ENT said that Zantac works better than PPI at night to supress acid. This is an important component that many doctors do not add. Also, he said it can take 3-5 months to see relief. I would definitely goto an ENT. My GI at Mayo said it best, " A GI only looks at the esophagus, DOWN." The ENT is from the top of the esophagus, up, which is where the mucous and difficult to swallow sensation is felt. " If you have been to a GI and had endoscopies, barium swallow, etc with no conclusive diagnosis, I would find an ENT that knows about LPR. I finally have hope!! I also wanted to add that I have always eatten well and been thin! That is what is so frustrating!!! I am 5'7 120. My ENT says he sees 5-10 people a week with LPR. Hopefully, there will be a better cure someday! Please keep us informed on how you are doing!! Katie