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04/16/2012 10:12 AM

Another GERD attack: residual pain?

EdNerd
Posts: 41
Member

About a year and half ago, I woke up one night with horrid chest pains. I tried to just "tough it out", figuring it was a bit of heartburn that would "just go away". When it finally had be on my knees lying across my bed crying, I begged my wife to take me to the ER. They gave me some sort of "GI cocktail", it numbed my esophagus and let me vomit, and I felt great.

My PCP told me to take Prilosec - the two-week course evey four months. I felt some twinges, took the Prilosec, and all was fine for a bit. But the heartburn kept getting more frequent. A new PCP (whom I like much better) put me on Nexium (40mg x 1/day) and it seemed to work well. He wanted an upper GI endoscopy, byt my insurance wouldn't support it at the time.

Four months ago, that familiar feeling came back - the hot knife up under the sternum. Another ER visit, another GI cocktail with predictable results. But of course they won't let you go until they've all the other tests. So I get a CT scan and X-rays (and a $10,000 bill!!). Gall bladder looks suspect, and the ER doc wanted to wheel me into surgery right now! I begged off; later my PCP and the surgeon confirmed that the gall bladder was not an immediate issue.

Life was good. Had my scope procedures last Friday (both the "up" and the "down"Wink. Slight inflammation in the stomach, they said. Saturday was a busy day, so I stopped at the store for some beans and hot dogs for dinner.

Sure enough - 1 am Sunday - the GERD is back! (I blame the hot dogs and the yellow gunk they were swimming in!) And I went back to the ER. The GI cocktail didn't work this time - I might have been dehydrated still from all the 'scopy prep (they had a very hard time drawing blood). But I'm alive and back at work.

Now besides the Nexium, I've got one Pepcid twice a day and one Reglan at bed time for the next two weeks.

So I'm home, the acid is gone - and that spot in my esophagus (I'm going to assume right above the lower sphincter?) is stil tender and a bit painful. Is there anything to take that will mitigate the residual pain after the attack is gone?

Ed

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04/17/2012 01:13 AM
robichris
robichris  
Posts: 289
Group Leader

I think you are taking all the possible meds to control the acid reflux.

Nexium (esomeprazole - a Proton Pump Inhibitor) blocks the cells that produce acid. (Prilosec (omeprazole) is the original PPI.) Pepcid (famotidine - a Histamine H2 Reaction Antagonist) blocks signals to the proton pumps to lessen acid production. (Not as effective as PPI but cheaper with fewer side effects). Reglan (metoclopramide - an anti-emetic / prokinetic drug) to help peristalsis of food bolus to stomach and chyme through duodenaum.

Your acute heartburn attacks have been a warning. You must watch your diet. You have seen how eating a fatty processed meat product in haste has caused this.

There is much advice about diet and lifestyle to cope with GERD. This one is useful: http://heartburn.about.com/od/goodfoodsbadfoods/tp/Acid- Reflux-Diet.htm but we are all different and you will find some things work for you that don't for others. Keep a food diary to find out what are your trigger foods.

As far as lifestyle goes, see these tips: http://heartburn.about.com/od/dailylife/tp/10-Things-To- Stop-Doing-If-Have-Heartburn.htm

These tips you may also find useful: https://sites.google.com/site/barrettswessex/tips

BUT take this seriously. Be proactive to prevent the attacks rather than reactive to heal the attack.

Frequent acid reflux causes esophagitis. Frequent esophagitis causes Barrett's esophagus with an increased risk of developing esophageal cancer.


04/17/2012 07:10 AM
EdNerd
Posts: 41
Member

Great info - except I have no idea what this means:

"to help peristalsis of food bolus to stomach and chyme through duodenaum"

(Must be the British accent! :8>O )

I will definitely check out the links to diet and lifestyle changes. I don't want to have to keep a diary to see what triggers this, because I don't ever want to trigger this again!! Too painful, too expensive.

On top of all that, they want me to get 30 grams of fiber every day in my diet. Okay - can I have a little food with my medicines and suppliments?!?

Ed


04/17/2012 08:29 AM
EdNerd
Posts: 41
Member

Just read the "10 Things to Stop Doing" tips page, and I can peg three things from last Saturday night:

-- food (grease, chocolate, caffeine)

-- tight waistband

-- went soon to bed

And a releated article pings sleeping on my right side, which of course is my favorite.

Time to change things ....

Ed


04/17/2012 11:45 PM
robichris
robichris  
Posts: 289
Group Leader

Sorry, lapsed into medical terminology. Peristalsis is the action of moving material through the digestive system. Bolus is the term for the ball of chewed food and saliva that leaves the mouth and passes down the esophagus. Chyme is the mixture of food, acid and enzymes in the stomach that then passes into the duodenum which is the tube leading to the intestines.

04/25/2012 08:23 AM
Jacob777
Posts: 2
New Member

Jacob777

I spent most of my adult life in clinical reserach and am well aware of the problems associated with GERD. Many people assume that they are over producing Hydrochloric acid (HCL)when they have reflux. In many cases this is not true. Gastric juices with or without the presence of HCL is very bitter to the taste. Reflux can occur if you are over producing or under producing acid. The over production of HCL is called Hyperchlorhydria. The under production of acid is call Hypochlorhydria.

Many doctors make the assumption that patients with reflux are over producing acid, in many cases the opposite is true. The symptons associated with Hyperchlorhydria and Hypochlorhydria are virtually identical. Both conditions will cause gas, belching, reflux, abdominal pain, nausea, diarrhea and or constipation, burning in the esophagus, etc. Unfortunately many doctors are prescribing acid reducing medications or Proton Pump inhibitors to people who are not producting enough acid, without the benefit of a pH diagnostic test. When this occurs the patient will become Achlorhydric. Achlorhydria is the complete lack of HCL in the digestive process.

A little information about Hydrochloric acid (HCL): HCL is absolutely necessary for the digestive process. HCL maintains a sterile environment in the stomach to prevent the growth of bacteria and fungus.

When nutrients enter the stomach they is mixed with HCL to form a thick liquidy mass called Chyme. This starts the sterilization process. Proteins are broken down by the Peptic enzymes. The Peptic enzymes are most active in the conversion of proteins when the pH of the HCL fluid is at 1.0.to 2.0 pH. When the pH of the fluid moves toward the neutral side the Peptic enzymes become less active in the conversion process. At 5.0 pH the Peptic enzymes are completely inactive in converting proteins. The Peptic enzymes break down the proteins into Proteoses and Peptones, which are the building blocks for the amino acids. The amino acids are necessary for sustaining life. Many proteins are allergens and will cause allergies and many other serious complications, if they are not converted and destroyed in the digestive process. Another factor involved in the digestive process is the Pyloric Sphincter. The Pyloric Sphincter is located at the base of the stomach. It keeps solid from passing through into the small bowel before sterilization and conversion is complete. The sphincter does not completely close, it has an opening which measures from three to five centemeters. This allows excess fluids to dump out of the stomach. This is one reason many beer and coffee drinkers will pass fluids quickly. The tone of the sphincter in maintained by the harmone Gastrin. Gastrin production is affected by the prsence of HCL and fats and fatty acids sensed in the upper small bowel. The pyloric sphincter starts to relx, on average, at 4.0 to 4.5 pH allowing the content of the stomach to dump into the small bowel.

When you are not producing the proper stength HCL the nutrients consumed will be dumped out of the stomach without the benefit of sterilization and conversion. The sphincter is now open because of the reduced strength of the HCL, and every time a peralstaltic squeeze occurs fluids from the duodenum will flush back into the stomach (Pyloric insufficiency)and in some cases into the esophagus. The esophageal sphincters tone is also maintianed by the harmone Gastrin.

Many people over the age of 45 but not limited to these groups suffer from reduced acid production in the gut. Many of these people will develop allergies and reflux that they never had at an earlier age.

Statics indicate that only 12% or the total population suffer from the over production of HCL, compared to 42% that have low acid production.

I would highly recommend that anyone with reflux or other digestive issues have a pH diagnostic test done before taking any type of acid reducing medication or Proton Pump Inhibitor. This way you will know exactly why GERD is occuring and be able treat the condition with a natural supplement.

There is a lot of information available on GERD, Allergies,Diabetes, Cancer, Osteoporosis, Gastritis on the net. If you search the net under pH diagnostic test, Gastrogram, pH capsule test, you will find a lot of information.


05/02/2012 04:22 PM
EdNerd
Posts: 41
Member

Wow! That's a lot of great information.

I think I need that pH test.


05/17/2012 07:45 PM
mem6197

Jacob and Robichris,

Thank you so much for taking the time to give us so much information, it's so very helpful. Much of it I didn't know and am glad to have the information.

I've been on every PPI med there is and the next step is surgery, according to my GI doc. I'm not sure what type of surgery, I have to call him and make an appt to see him soon because the med isn't working as well as it was. So I need to see what's going on.

Thanks again for the great info. Smile

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