Normal EGD with lots of regurgitation

Hey all,

My EGD was normal, leading me to believe that I may have NERD or some other invisible disease and may not benefit from the Nissen. However, I burp food into my mouth upwards of 10x per day. I burp sometimes and food comes up from my throat and into the back of my mouth. I swallow and that's the end of it until it happens again. The regurgitation is always painless, but I have begun coughing a lot after these episodes, especially when I am sleeping - I wake up choking. This just started just a few days ago. Woohoo, another new symptom!

Also, the GI doc who did my EGD (the only time I've seen a GI doc) told me that my LES was fine. How is this possible??

I am wondering (of course I will ask my doctor too, but I have come to really rely on the opinions from our wise members here) if anyone else had symptoms like these and still benefited from a Nissen? Or if in anyone's good opinion I would still be a good candidate? I worry that that the lack of throat pain will hold me back, but the regurgitation leads me to believe that the LES is blown. I mean, it has to be, right?

I'm just trying to get some solace here. A GI doc tells me my LES is fine, but there is always food in my mouth. I have no idea what to think.

I'm so confused!!

Thanks all,
Ashley

Hi Ashley,

Did you have a PH test or Manometry test done also?

These test can tell a lot of what's going on with your GI tract as well.

I had two EGDs done and both didn't show much evidence of damage to the esophogus but my throat always hurt.

It wasn't until I showed all my test results to my surgeon that he insisted he could help me.

I'm due for a Nissen next monday...I'll let you know how that goes.

Ashley-

I too am wondering if you have had a PH study and manometry? The manometry will tell the pressures in the esophagus and the PH study would show if acid or something else is coming up.

Sorry the GI didn't have any answers for you.

Take care,
Bill

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opnwhl4
Moderator: GERD/Heartburn
Nissen 6/06 and 5/09
#3 on 8/24/11

Hey guys,

I haven't had either of those, only EGD and ultrasound (which, to my doctor's credit, did find a 2-cm gallstone - it wasn't said if it was blocking the duct). It's been a very slow process with my doctor here. He will call me on Wednesday to tell me if he sends me to GI or not. If he doesn't, I'm going privately. It's been too long with him with new symptoms popping up.

I feel nervous to have the pH monitoring done because if THAT isn't showing reflux, I worry that this is a chronic condition which I will be stuck with for life and no doctor or diet change will be able to help me.

Hi Ashley --

I can't say what's likely in your case, but I have NERD, and that's what stalled my diagnosis for over a year. The first two ENTs didn't see anything when they scoped my throat, and the first GI didn't see anything of note during my first EGD. Also, LPR symptoms will frequently cause edema, or swelling, and not erythema, or redness -- further complicating a visual inspection. Redness and erosions don't usually appear until the reflux has been allowed to impact the tissues unchecked for a long time.

I've heard of doctors proclaiming the LES as "fine" with just a visual inspection, and it makes me angry to hear this. They say this because of the way the LES "grips" the endoscope when they turn it around and look upwards from inside the stomach. This diagnosis doesn't consider the other 23.75 hours in the day when it may be relaxing at inopportune moments, etc. At the very least, however, you can rest assured that his visual inspection didn't see anything obviously suspicious.

I wouldn't describe your LES as "blown", necessarily. A barium swallow might provide some helpful information at this point. Manometry = quantifiable pressure data, and barium swallow = real-time, visual observation of swallowing action, position of LES, and possible minor abnormalities.

I'm really surprised that your doctor didn't install the Bravo during your EGD...unless you had one of those new un-anesthetized endoscopies. Actually, in your case, and if it's available to you, I'd go with the impedence test instead of the Bravo. Cheaper and more information, but unfortunately uncomfortable.

If/when you have pH monitoring, remember that the values it provides may not have direct relevance to your symptoms. If you're experiencing LPR/respiratory reflux, even a small amount of "normal" reflux can cause symptoms.

Best wishes!

-Bruce

Hey Bruce,

Yeah my scope was done un-anesthetized - I just had the throat spray. It was pretty rough! I agree with your opinion on the LES - it really irritates me if I stop and think about it. I mean really, the EGD lasted about 3 minutes. It seems very silly to me now to think that a doctor would label it "perfectly fine" based on that small window of time.

Barium swallow is no longer performed here in Finland, as I was told by my (primary care) doctor. He also told me that EGD was the best way to determine if the LES is working. However, I do still plan on asking my GI (public or private, all depends on the Wednesday phone call) if he thinks I would benefit from it.

Either way, I will push for pH monitoring/impedance testing.

Hi Ashley,

Not sure I have much to add...... but I was thinking you must have fasted for the EGD, so how can they know if the LES functions safely when the stomach is holding food?

Have you been asked to try (or would you consider asking for) the drugs that help stomach emptying - one of them is called Metaclopramide? Sometimes they seem (over here in the UK) to use it in GERD, or just simply as a diagnostic tool - if it helps then that tells them more about what is going on.

If they don't do barium swallow do they do something else (other than endoscopy)? CT scan??

MMM

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New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma

AshleyRose

what Bruce said above is spot on

im sorry that you got inconclusive, (unfavorable ?) results (are those the right words...not sure

but im not surprised

i have LPR and after being scoped i was told that LES and the lower esophagus "looked just fine"

but the heartburn and the reflux all the way up into my airways continues on and off

yeah the LES can "look" great more than 90% of the time, but
its that 10% or less when the LES opens when it shoudnt, or opens too often ...thats the problem

i know my LES doesnt work right cause within 2 hours after eating if i bend over to pick up stuff or lie down stuff comes up more than ever

seems to me thats the "acid" test "pun intended"

i share your frustration as my doctors here wont even consider an operation for me. they claim im well managed by medicine (they dont seem to care about my loosing balance and hearing from some of the meds and the nausea thats aggravated by others)...no mater for me as im gettin on in my years

but you are young and i would encourage you to press on if you are convinced in your heart and head that reflux is the issue, and it sure sounds like it to me

second opinions are warranted

if you are convinced the people you just saw are wrong "make a nuisance of yourself" by keep complaining and seeing these people until they get so tired that they give in to your request for a procedure

im very sorry you did not get definitive information that points you in the direction you want to go...very sad, but hey! dont give up! you have come too far for that

i believe you will get better because i remember your endeavors with diet, weight loss and exercise...you are disciplined and determined and will prevail

sincerely
mock turtle

Hey Aeshley,

Sounds frustrating. I can tell you that I have also been given the NERD title, but I very rarely burp food into my throat. Maybe 1 time per month, tops. The only bad feeling I get is behind my sternum. I'd be more comfortable with a NERD diagnosis given my symptoms then yours...I'd have to intuitively think, like you, that it really is reflux.

Of course, to answer that question get a PH test. That will be fairly definitive...if it comes back relatively normal, maybe you are burping up only weakly acidic or non-acidic contents, not acid. At the end of the day, when I tend to over-analyze things, I just remind myself that the doctors job is GI stuff, so he knows it better than me. Sometimes things seem intuitively one way, but the dr. explains to me why that is not the case. I guess that is why he has the medical degree. So I'd say find a good dr. that you trust and get those questions (and the big question about your LES) answered.

I might have even read it on this forum, but remember the wise words "do you know what they call somebody who graduated at the bottom of medical school? Dr." So remember that, and find a dr. you trust and is well-known if you can.