Good morning everyone
I finally saw my GI doc yesterday after having had my scope 3 weeks ago. According to him on the pathology of the stomach biopsies,he tested for parasites, H. Pylori, chrones, etc etc he said all was negative and he found nothing. He said I have slight inflammation of the esophagus and stomach. Said it's Gastritis, and GERD and a hiatal hernia. He said to me that the GERD, heartburn etc etc is all being caused by the hiatal hernia. So I said to him is the hernia bad ? He said well you have a small sliding hernia but the scope doesn't tell me how bad it is..He said the hernia can cause the swallowing problems etc etc. So I asked him about fixing it.. He said it can be done but he's not so sure he wants to do that he said because there is a chance he could make me worse instead of better.
He talked about having a 24 hr Ph probe and a mamotry test. Both tests I do NOT want, but he says this will tell him exactly whats going on?.. Oddly though, I heard that about the scope.. ALl the doctors said the scope would tell them whats going on but I still don't have a lot of answers.
He also said I could be having esophageal spasms and mentioned Reglan or Procardia. So, I was honest with him and told him I was not too high on the idea of Reglan because of the side affects to which he kind of acted as if there were really no bad ones that he knew of. So I explained to him about all the good people online I speak too who know a lot about these medications and I would send him the information on Reglan side affects.
I then said to him so you want to put me on a heart medication for an esophagus problem? In my brain that doesn't make sense. He said well for some reason it seems to help with esophagus spasms.. I said ok so let me ask this. When the Procardia lowers my allready low blood pressure because that's one of the affects this med will have and I pass out cold from a barely there blood pressure then what? He didn't have much to say...
So we made a compromise. I am now on Protonix 40 mgs once a day, and he's added Liquid Zantac 10cc's per day and I suggested an Ativan a day which is the same kind of med as like Xanax to see if things would relax that way. I am to do this for 4 weeks. If this changes nothing then I may have no choice but to do the 24hr Ph probe and the mamotry. I am putting these off though because I've seen SO many people do these tests and still come up with no real answers.. so I am PRAYING this drug combination works.. Any thoughts?
Thanks

Robyn, I don't remember what your symptoms are but it's good that you are asking the doctor pointed questions....it sounds as if you need a different GI to get a second opinion about getting the hiatal fixed. When I went in with a small cough and wondering about h. pylori, the GI doc immediately wanted to do an endoscopy. I guess this is their main diagnostic tool, but I felt as if he too eager to do this, was trying to make some $$$ off of me, and said no. I am pretty sure that there are ways to test for h. pylori other than knocking a person out and sticking a tube down their throat. So then I went to an ENT who immediately diagnosed me with LPR (after looking with smallish probe that didn't hurt) and put me on Protonix 40 mg twice daily. The GI never even mentioned LPR. I have also read that a doc does not need a ph test to diagnose LPR or GERD...though it is required by some insurances before they will cover any corrective surgery. You may need more than one dose of protonix to see an improvement....even though they say 1 tablet lasts 24 hours, further studies have shown that the a.m. dose prohibits stomach acid for 11.5 hours and the p.m. dose for only 7.5. But if the cause is really the hernia, meds seem like a band-aid. Once they are "ripped off" again, the hernia will still be there, and your symptoms may return. Just a thought....

Hi Robyn,

The scope was an essential part of the diagnostic process for LPR. My endoscopy showed pylori and sliding hiatus hernia. Took the H clear for the plylori so hope that is gone. Following finding of hiatus hernia I underwent manometry and 24 hr Ph monitor both on the NHS in the UK. I can imagine the cost for non funded patients but they really are essential to confirm both the frequency and volume of reflux and the movement of the esophaegus. They are not painful and even the 24 hr monitor is really only irritating....and nothing like a non sedated endoscopy (Oh god even thinking about it). They will aid your clinician about the impact of the hernia and on the working of your Lower Esophaegal Sphincter which is the real villain in all of this. Incidents of frequent reflux and even slightly impaired motility of the esophaegus all point to a loose LES and the presence of the hernia is a negative influence. A poorly functioning LES renders PPI's and H2 blockers useless especially with LPR where it is the frequency of the reflux that causes the problem and not the PH level or volume. The only real option for you would be either hiatal hernia repair on its own or in conjunction with a Nissen fundoplication to tighten the LES.

Best wishes

The FDA has also approved the Stretta procedure and it was featured on nightline recently....I don't know how many GI docs are doing it yet though...maybe do a google....

Robin you should have the tests, its better to do the tests that you can do quickly first. Think about it this way, when you try a drug it is in effect a test...
but so ur doing a drug trial, that will take a month..to get the results from.
your best off doing the quick tests first, so you know which treatments to try more quickly. yes its true that you might not get much information from the tests, but its not like you will lose informaiton from the tests.