GERD, Anxiety and Esophageal Hypersensitivity

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Andy1986
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   Posted 3/7/2013 5:46 AM (GMT -6)   
Hi

I was recently doing some research after I noticed something quite strange with my heartburn symptoms and have had increased anxiety since a negative ph test result.

My symptoms seem very linked to my emotions, if I am worried or down, or even if I just think about my symptoms they seem to get worse. An extreme example of this could be that I wake up in the morning, feeling pretty much fine, but I lie in bed for maybe 30 minutes thinking about my esophagus and whether it will be bad today and during that time the pain actually gets worse until its pretty bad.

I did some reading and found something called esophageal hypersensitivity.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950665/

It is a condition, apparently very common in people with anxiety and depression (e.g. me); the person is super sensitive to feelings in the esophagus. It is very common for these people to get sensations of heartburn and acid reflux symptoms from non-acid or weak acid reflux and GERD symptoms are only partially eased by PPI therapy. In some cases there is no reflux at all, and pain is caused by eosinophillic esophagitis or just hypersensitivity but no idea how common this is.

Treatment for this is apparently first to treat the actual cause of GERD itself (if it exists) like PPIs and NF surgery. Once the cause of GERD is removed the hypersensitivity can diminish by itself, or can still persist to some degree in which case further treatment for the hypersensitivity is needed. A common treatment is anti-depressents and therapy for any anxiety disorders.

Has anyone here been diagnosed with this? I think I might have this, as I have pretty much constant sensation in my esophagus.

I also thought about the numerous people that report GERD symptoms after NF surgery and the results come back negative. I guess a surgery is likely to make the esophagus hyper-sensitive anyway, but people that already had this beforehand I guess have a longer recovery period as the esophagus desensitises.

DOGGBONES
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   Posted 3/7/2013 6:23 AM (GMT -6)   
andy,
I suffer from hypersenstive esophagus, though I do suffer from gerd/lpr as well. The dr did give me some anti-d's but it's rare that I take them because they just make me feel like a zombie.

Andy1986
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   Posted 3/7/2013 6:49 AM (GMT -6)   
Hi Dogg

Do you find that it gets suddenly worse if you're worried about something, or if you focus on it more than usual? Like within a few minutes?

DOGGBONES
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   Posted 3/7/2013 7:01 AM (GMT -6)   
andy,
Yes, stress is a killer! Whether I worry or stress over just about anything makes it worst. Now having said that, eating poorly (I fall off the wagon from time to time) will make my gerd/lpr worst and then the throat issues kick in. It usually takes me several weeks to get it to ease up.

Gastricman
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   Posted 3/7/2013 9:49 AM (GMT -6)   
Hi folks,

I sometimes have a Globus in the back of my throat and I found out at different times that there are at least two factors which contribute to it. The first is Anxiety and the second is a bit of reflux which irritates my lower (distal) esopahgus and the nerve impulses present the Globus symptom in the throat, even though the reflux does not necessarily come near it.

Anti-anxiety agents help combined with better PPI/H2 coverage (or similar.) It is also possible that the reflux does indeed touch the upper part of the esophagus at times, causing an actual irritation from the reflux (im my case acid) that forms a Globus.

I wonder if Pepsin from LPR can also cause Globus - it would not surprise me.

Hope this information helps.

Regards,

GM :-)

Post Edited (Gastricman) : 3/7/2013 8:21:00 AM (GMT-7)


DOGGBONES
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   Posted 3/7/2013 10:11 AM (GMT -6)   
gastricman,
In most cases the lump in throat or globus is caused by non-acidic reflux which is pepsin or bile. Pepsin is usually the villian here.
 
Anit-d's do help some (if you like to feel like a zombie), and in some cases like mine some ppi's can make it worst (aciphex for me).

Gastricman
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Date Joined Jan 2013
Total Posts : 294
   Posted 3/7/2013 10:22 AM (GMT -6)   
Hi DB,

In my case, it is most definitely caused by acid reflux and anxiety.
My relfux symptoms strongly correlate to acid.
 
FWIW,

GM

drtinsac
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Date Joined Apr 2012
Total Posts : 458
   Posted 3/7/2013 11:23 AM (GMT -6)   
I think the diagnosis can be mis-used, and applied to anyone where doctors think they should be fine from whatever tests have been run. Or if doctors just aren't familiar enough with symptom patterns in individuals. If it is a resonable diagnosis, then it should be able to be confirmed somehow.
 
To me, it only makes sense when there is no objective evidence of reflux (such as no inflammation in esophagus).
 
I have been diagnosed with it, and tried the treatment of two psych meds. Neither of which did anything except give me the drowsy side effects. That's why I don't think it's necessarily a reliable diagnosis, I don't think it fits in my case. If hypersensitivy was the issue, then decreasing sensitivity should help it, but how far does one take it? Yes, I can take a prescription painkiller and the sensations won't bother me as much. I don't think it's too far different from someone with pain from an injury.. you can numb the person to the point where the pain is less, but it doesn't follow that the injury is not sufficient to cause pain in the first place (therefore the body would be hypersentive to the injury).
 
From what I've read about it, sometimes it's written very broadly as "symptoms" related to nonacidic (weakly acidic) reflux. But there are truly so many symptoms of reflux, from pain, to bitter taste, to tightness, I don't think all of them can be lumped together to indicate hypersensitivity.
 
There is published evidence of people with normal DeMeester scores, objective evidence of reflux including hiatal hernia, who partially respond to PPIs, who have full resolution after surgery. I had surgery 7 weeks ago and I'm hoping to be one of them. All these people would have the label hypersensitive since their DeMeester is normal, yet removing the reflux has helped them (and I think is helping me, as my healing continues).
 
I don't know what a typical 24 hour PH study looks like for someone who is on maximum PPIs. But if acid is well controlled and the person still has symptoms, many of them get fundoplication, without ever getting tagged as having hypersensitive esophagus.
 
In case you can't tell, I don't like the widespread use of the diagnosis :)

DOGGBONES
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Date Joined Apr 2012
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   Posted 3/7/2013 12:05 PM (GMT -6)   
drtinsac,
Agreed! My reflux was considered "acceptable" on acid suppression from my ph test and therefore labeled hypersenstive. All this did was leave me frustated, confused and depressed. To me, it's what the dr's come up with when they can't fix you with max ppi's. It's wierd that on my test results it was noted that I had non-acidic reflux as well but the dr didn't seem concerned. Ugh

drtinsac
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Date Joined Apr 2012
Total Posts : 458
   Posted 3/7/2013 12:19 PM (GMT -6)   
dogbones. I was just this minute reading a journal article lending further evidence to the fact that weakly acidic reflux can be the cause of PPI-refractory GERD. My own 24 hour PH test was incorrectly read at first, it showed like 20 weakly acidic. Later it was re-analyzed and showed 46, which is outside the normal range.

Here is the abstract, see the last sentence. Their population included people with high numbers of weakly acidic refluxes, which are what decreased most after fundo and resulted in symptom remission.

If these people had normal DeMeester scores (which is about acid reflux, not weakly acidic reflux), they probably would not have been operated on and would have gotten the hypersensitive label.

http://www.ncbi.nlm.nih.gov/pubmed/23436097

drtinsac
Regular Member


Date Joined Apr 2012
Total Posts : 458
   Posted 3/7/2013 12:24 PM (GMT -6)   
also see

Weakly acidic refluxes have a major role in the pathogenesis of proton pump inhibitor-resistant reflux oesophagitis.


http://www.ncbi.nlm.nih.gov/pubmed/21198705

Gastricman
Regular Member


Date Joined Jan 2013
Total Posts : 294
   Posted 3/7/2013 12:25 PM (GMT -6)   
Hey DB and drtinsac,
 
I couldn't agree more on the "hypersensitive" issue.
 
One of my GI docs told me I had "functional hypersensitivity" with my esophagus on a max dose of Protonix (80mg/day). I looked him straight in the eye thinking that this guy has no clue.
 
When I asked (for "fun") if this might eventually lead to esophageal cancer, he said flat out, "no."
IMO, every instance of reflux is like throwing a teeny pebble at a glass window. In time, the window will show a crack (barrett's) and then eventually it will break (EC.)
 
I feel that hypersensitivity is the MD's way of saying that we have no idea why and how to cure it with the exception (maybe) of surgery.
 
Just my rant!
 
GM idea

Andy1986
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Date Joined Dec 2012
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   Posted 3/7/2013 1:20 PM (GMT -6)   
Interesting thoughts. Luckily my GI really believed in my symptoms and has referred me to a surgeon, my heartbyrn has got much worse over the last couple of days the only thing that could have caused that is stress and anxiety which is why i thought about the hypersensitivty.

I also have some prescription painkillers which i take occasionally, and have been on anti depressents for months but thats for actual depression, havent noticed any improvement in my esophagus from them. Painkillers only half work, best thing i can do at the moment is just distract myself from it, i know it will settle down again if i stay relaxed and dont dwell on ut too much.

mudmagnetmum
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Date Joined Apr 2011
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   Posted 3/7/2013 4:18 PM (GMT -6)   
Hi there,

My surgeon told me it's the level of symptoms that matter, not just the scores on the tests. I've had symptoms that fluctuate for the last 3 years, though overall I'm better than during the first 18 months or so. My symptoms can vary hugely, which makes me unconvinced of any structural cause (I had all the symptoms I had now at the time of my first gastroscopy which was entirely normal with no hernia). So I've also wondered if I feel more than I actually have any actual pathology for, if you know what I mean.

I've found in the last 6 months that acupuncture has helped me a lot and so has the herb milk thistle. The milk thistle has been a huge benefit for the sensation of reflux. I don't know if I have less actual reflux when I take it, or just less feeling of reflux though!

It's very hard to keep your head out of this illness - I'm just coming out of a huge flare up and although my body is getting back to how it was before (before a trip away from home), psychologically I'm finding it very hard to bounce back. I think you have to address it from all angles!

Distraction also works for me too - the GERD gets much less of a look in on the days I work!

MMM
GERD (over 2 years)
Lifelong stuff: Food allergies/intolerance, eczema, asthma

shrtcak81
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Date Joined Jan 2013
Total Posts : 165
   Posted 3/8/2013 1:03 AM (GMT -6)   
I just wanted to chime in. I've also been recommended for surgery, thankfully. I'm looking into the Linx.

Just recently I went through another horrible period of reflux. For the last 5 years, PPIs have stopped being as effective and some work better than others. However, I exhausted all of them a few months ago and was trying to switch them around to see if I could get one to work all the way. Unfortunately, most of them were hardly working and I was suffering from the worst rebound gerd for months. I decided to try Aciphex, which I had tried in the past for a month without great success. This time around it seemed to take a while for it to start working better and even though I still get breakthrough heartburn everyday, it's not as bad as it was.

I'm think that the gerd was worse than ever too because of the anxiety that I was experiencing at that time. I was off my antidepressant and it came back in full force. It was out of control and I was just miserable. After a couple months of getting back on an antidepressant, I felt better. But, I still want surgery because my tests showed that I have weakly acidic reflux despite max dose of ppi's. I'm going at the end of the month to USC to consult with a surgeon. I've had gerd for 14 years and have taken ppi's for all that time, so I need to get off of them.

Andy1986
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   Posted 3/8/2013 5:24 AM (GMT -6)   
MMM, I know exactly what you mean about when you can't stop thinking about it. My pain levels can be quite low but at times I just cant stop thinking about it which makes it seem all the more worse. All you can do really is keep living out your life and keep busy doing things you enjoy and eventually it gets easier and easier to take my mind off it, but as soon as I get anxious or something then the pain comes and you get the vicious cycle again.

Glad Im not the only one that suffers with this problem although I'm sorry you're all suffering like me. It's a horrible combination of conditions to have lets hope we all find a resolution one day.

I've always been the most relaxed and laid back person before all this, nothing ever phased me, it's been tough to learn how to deal with high levels of anxiety but I think I'm much better at it now than I was a few months ago.

DOGGBONES
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Date Joined Apr 2012
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   Posted 3/8/2013 6:16 AM (GMT -6)   
Somedays it's just so hard not to get consumed by this curse. I try not to let it get me down and just go on with my day but the truth is this is our every day. Ugh.....to be normal again :(

ericapeace2000
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Date Joined Mar 2012
Total Posts : 1110
   Posted 3/8/2013 9:04 AM (GMT -6)   
I feel the same way. I know things could be worse but this still is rough.
GERD Moderator; Diagnosed GERD, no other medical conditions (this one is enough)

Gastricman
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Date Joined Jan 2013
Total Posts : 294
   Posted 3/8/2013 9:26 AM (GMT -6)   
One thought...

Not many people realize (except here) how sensitive and delicate the GI tract is.
Even my wife cannot crawl indide my body and really understand.

GM

Andy1986
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Date Joined Dec 2012
Total Posts : 1178
   Posted 3/9/2013 4:39 AM (GMT -6)   
Indeed, i think ive become mentally tougher going through all this, you have to be, but sometimes it gets a bit too much and it really gets to you.
GERD - Hiatus Hernia, Anxiety and Depression

mudmagnetmum
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Date Joined Apr 2011
Total Posts : 1604
   Posted 3/9/2013 11:41 AM (GMT -6)   
For 2 years I had a painful bladder condition (post infection was the official cause). However, deep down I know I turned a corner when I was finally able to stop my head adding to the condition. If only I could pull off the same trick with my stomach! Perhaps I just moved things around........!!

MMM
GERD (over 2 years)
Lifelong stuff: Food allergies/intolerance, eczema, asthma

TheSiXness
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Date Joined May 2012
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   Posted 3/14/2013 9:32 PM (GMT -6)   
I've been called Hypersensitive by 4 doctors also. I'm just starting a round of therapy using nortriptyline hcl. This condition is a curse, nobody understands the mental fortitude it takes to endure day in and out except the people who live it. I've gone through the police academy and had to get sprayed by pepper spray. I remember getting sprayed and barely being effected by it. There were guys in our class basically crying because it hurt so much. I just thought to myself, hey! this feels kinda good! it takes my mind off my throat and chest!

drtinsac
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Date Joined Apr 2012
Total Posts : 458
   Posted 3/14/2013 10:31 PM (GMT -6)   
Couldn't agree more. The constant nature of the symptoms is what gets me.

I found an interesting abstract/paper on hypersensitivity treatment using Pregabalin (Lyrica). The authors say it may be of use to people who continue to have symptoms after PPIs.

I'm 8 weeks post fundo now and still having symptoms, and I'm seeing if my surgeon will let me try Lyrica. If not I might try going back on Elavil for a while. Lyrica is supposed to have a better side effect profile compared to Elavil, what that means specifically I don't know.

http://www.ncbi.nlm.nih.gov/pubmed/22211824

see #933:

http://download.journals.elsevierhealth.com/pdfs/journals/0016-5085/PIIS0016508510606178.pdf

DOGGBONES
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   Posted 3/15/2013 5:53 AM (GMT -6)   
I've tried Elavil and it didn't help much, I still seem to have the issues its just your glazed over so you "accept" whats happening. I've have tried nortriptyline as well with the same result but instead of turning into a zombie, it was like being in a coma. My guess is lyrica would be the same for me....ugh.

drtinsac
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Date Joined Apr 2012
Total Posts : 458
   Posted 3/15/2013 7:32 AM (GMT -6)   
Funny, Doggbones. I thought that might have been the only effect of those drugs for me too.. general numbness.

Another option for true hypersensitivity is Stretta procedure. I read that it deadens or otherwise desensitizes the nerves down there. I don't have the paper I read handy, but there was some evidence for this like.. the symptoms decreased despite the same number of refluxes. So it decreased symptom perception through physical means, no zombie effect.
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