A couple basic questions about LPR

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DontStealMyBacon
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Date Joined Jan 2013
Total Posts : 186
   Posted 5/3/2013 4:16 PM (GMT -6)   
I am not new to GERD or LPR, but I do have a couple questions that I have been wondering about for a while now.

First of all, is it common for people with LPR to have both LPR and GERD? I have been looking around on the forums for a while, but not very many other people talk about having symptoms of both heartburn and a constant cough. I have been diagnosed with GERD for more than four years and never treated for LPR, but I have both heartburn and the constant cough and post nasal drip.

This question might not be as relatable, but it is about LPR. For as long as I can remember, I have had this constant itch in my throat. It is not a pain, but it causes me to cough every couple seconds. As I remembered it a couple years ago, it used to be that if I resisted my need to cough or clear my throat, my brain would basically be convinced that I was choking. Choking is different from pain because pain is a suggestion to change what you're doing and choking is the brain's way of saying something has to change. I basically couldn't resist this urge for more than a couple seconds, causing me to cough or swallow roughly every 10 seconds.

I have not attempted to resist this urge for a long time because of the fact that it just brings on a worse feeling. Recently when I tried it though, I noticed that after a few seconds of not swallowing, my throat filled up with liquid. I tried resisting this for as long as I could, but basically I end up swallowing without consciously trying to swallow, because of the choking instinct. Does anyone else have this problem?

This last question is just about GERD, but it can still fit here. Of all the pains that come with heartburn, why does the most pain I experience feel like it is coming from the stomach and not the esophagus? From the tests that I have had, I know that I have a normal amount of gastric acid and that it is a normal pH. If both of these are normal, why should my stomach not be able to withstand acid? Am I just wrong and it is actually happening in the esophagus?
Right Temporal Lobectomy 4/5/12

Diagnosed with GERD, Eosinophilic Esophagitis, and Epilepsy.
Studying biomedical engineering to research a better fix to at least one of them.

DOGGBONES
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Date Joined Apr 2012
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   Posted 5/3/2013 5:08 PM (GMT -6)   
Bacon,
I suffer from gerd (17+yrs) and lpr (2yrs). I have typical (heartburn) and atypical (lump/soar throat) symptoms. I won't be much help on lpr, I have no answer as to why some days I have bad lpr symptoms and other days mild. What you feel in your stomach is probably inflammation, I can only assume you are getting acid in your esophagus but just may not feel it.

DontStealMyBacon
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Date Joined Jan 2013
Total Posts : 186
   Posted 5/3/2013 5:16 PM (GMT -6)   
To clarify, I feel many pains in my stomach and my esophagus. I understand why acid damages the esophagus (since the cells are not designed to withstand it). My question was why acid damages the stomach if the pH and quantity is average.

The biggest question Im trying to search for an answer for at this point is which liquid is constantly filling my mouth. I could test the pH in a couple days, but for now I am still wondering whether it is mostly from saliva, post nasal drip, or actual acid.
Right Temporal Lobectomy 4/5/12

Diagnosed with GERD, Eosinophilic Esophagitis, and Epilepsy.
Studying biomedical engineering to research a better fix to at least one of them.

DOGGBONES
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Date Joined Apr 2012
Total Posts : 707
   Posted 5/3/2013 5:22 PM (GMT -6)   
You might have a little bile inflaming your stomach. You might be getting "juicy mouth"/ water brash, which is extra saliva.

drtinsac
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Date Joined Apr 2012
Total Posts : 458
   Posted 5/3/2013 10:28 PM (GMT -6)   
Before my fundo, I was a firm believer that my "LPR" symptom (throat tightness) was caused by reflux making it up to the throat and irritating it, making me have the urge to swallow. I also had a nearly constant bitter taste, which I thought lent weight to the idea that reflux was making it up to my mouth. A PPI significantly reduced my throat tightness (maybe 80% decrease) but did nothing for the taste issue.

However post fundo, after months of recovery, my throat is much better but the sour taste remains. For the first few months (I am less than 4 months out), I had recurrent throat tightness, despite the fact that due to the surgery there was likely no reflux making it to my throat.

My case may be different because I had the sour taste and a tongue burning issue, but at least in my case I do not believe that direct contact of reflux is necessary to cause a globus sensation, which is a common LPR symptom. This is supported by literature indicating that irritation of the distal (near stomach) esophagus can trigger globus sensations in the throat. And LPR is usually described as damage due to proximally-reaching reflux, though, it isn't always.

As for why the stomach might be becoming inflamed (thus becoming sensitive to acid which it is designed to handle), it could be related to what you put into your stomach. It could be a food allergy or something else that doesn't agree with your stomach. Alcohol (I know you're young and probably don't drink, this is just an example) can also mess with people's stomachs. Taking antacid can help the gastritis feeling, and hopefully the person learns to not continually put what's irritating the stomach into it. I've also got direct experience with this. Before taking a PPI ever, I had these bad feelings in my stomach in the morning -- not an ache per se but more like I was scared of something. Only after I went to a Dr. complaining of throat tightness, was I prescribed a PPI, which much to my surprise, completely removed that feeling by the next morning.

I can only think that something I was eating or drinking was irritating my stomach lining, making it sensitive to acid. So taking the antacid gave me some relief. An endoscopy showed "chronic gastritis" even after 4 months of PPI though, and no effort was made at the time to determine what caused it.

drtinsac
Regular Member


Date Joined Apr 2012
Total Posts : 458
   Posted 5/3/2013 10:29 PM (GMT -6)   
BTW I see you have been diagnosed with eosinophils, which goes nicely with the theory that you are ingesting something that's irritating your system. I know you have tons of frustrating experience with GERD, but have you attempted strict elimination diets?

DontStealMyBacon
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Date Joined Jan 2013
Total Posts : 186
   Posted 5/3/2013 11:21 PM (GMT -6)   
drtinsac,

If you really like to read, heres a post I made a little while ago about all of the important details of what I have and haven't tried: http://www.healingwell.com/community/default.aspx?f=45&m=2706100

I have had problems with GERD, LPR, and EE, but currently they are not all active. After removing all milk, soy, and rice ingredients from my diet, my EE has gone away. This was confirmed in my 5th endoscopy two years ago and again in my 6th endoscopy two months ago. I have been prescribed with PPIs for as long as I've been seeing doctors, and they ultimately do not seem to help. Then again, during the two weeks that I had to be off them before and during the recent endoscopy and pH probe, I noticed just how much of a difference they make. Right now my pains are present, but without the PPIs they were about a 9 out of 10 on the pain scale, even after I waited a week for the rebound to lessen.

I have also tested how much pain I get without certain foods and without any food at all by doing a few 24 hour fasts and one 48 hour fast. Throughout the entire time that I was avoiding food, I continued to have stomach pains that felt like they were below the esophagus. Unless water has that much of an effect on my stomach's balance, I can say that most foods that are not major triggers do not make all that much of a difference to me.
Right Temporal Lobectomy 4/5/12

Diagnosed with GERD, Eosinophilic Esophagitis, and Epilepsy.
Studying biomedical engineering to research a better fix to at least one of them.

inpinkagony
Regular Member


Date Joined Mar 2013
Total Posts : 274
   Posted 5/11/2013 12:16 AM (GMT -6)   
Hey bacon, how did you ever find out about your allergies? I am thinking about looking into this after my next ent visit, maybe see a PCP and have him do some type of intolerance/ allergy testing, I really think that our gastritis flares up from something we consume that our stomach does not like allowing the LES to malfunction by sending the food back up (reflux) explaining how I had gastritis and had developed GERD, I also read that once you have gastritis and after it heals the gut never is the same it becomes senestive and that's when GERD develops from the food sensitivities/allergies, I think this is what happened to me. But the thing with the LPR is tricky, why is the UES malfunctioning? cause I know LPR people have LPR is due to malfunctioning muscles, and when it malfunctions either acid or non-gasious refluxes happen such as bile pepsin destroying our airways, voice box, and etc. But it's interesting how GERD can be easily explained and I know LPR happens from pepsin (i got this part down) but why is the UES not working, this is where the nerves part comes into play that I came across with that many LPR people are throwing around, that it's (nerves) so I really believe there is underlying cause in all of us we just can not dissect properly. For me it could be from all the smokeless tobacco (hookah) I had done during my first years of college, I think my diet/smoking weakened my muscles over time and now I am suffering from it, so i really just wanted to write out this gibberish just to see if these odd ideas bouncing in my head make sense? :)

Sometimes I believe for me it can be nerve as well as damage I have done from smoking like for example I could have had nerve problems but smoking had made it worse you know? Cause smoking really affects our brain and stuff. I might see neurologist when all this is said and done, cause it could honestly been something i had all along, and damaged my nerves more without even knowing it.

Post Edited (inpinkagony) : 5/11/2013 12:27:39 AM (GMT-6)


DontStealMyBacon
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Date Joined Jan 2013
Total Posts : 186
   Posted 5/11/2013 1:04 AM (GMT -6)   
First of all, having dealt with epilepsy since I was born, I have seen many neurologists and neurosurgeons. In the years that I have been dealing with both epilepsy and GI problems, the neurologists tend to not show any interest in wanting to discuss or analyze any reflux related questions. Being specialists in neurology, they have knowledge of the nerves throughout the body, but they say that they don't want to say anything they are bot sure about since they know nothing about GERD.

In terms of allergies, I have been avoiding milk for a number of years since I found out I was allergic to lactose and casein. Beyond that, the allergy test that I got from an allergist said I was allergic to corn, beans, peas, shrimp, rice, milk, and nuts. After several months of toying with the esophagitis, my doctor took me off all milk and soy products, and then layer all gluten and egg products. So I have shown no reactions to any of these foods beyond developing eosinophils. I do not think that they are all even related to inducing reflux since they are only intolerances and do not actually trigger reactions (other than dairy).
Right Temporal Lobectomy 4/5/12

Diagnosed with GERD, Eosinophilic Esophagitis, and Epilepsy.
Studying biomedical engineering to research a better fix to at least one of them.

inpinkagony
Regular Member


Date Joined Mar 2013
Total Posts : 274
   Posted 5/11/2013 1:33 AM (GMT -6)   
That is really sad that these so called "specialist" don't want to do anything but collect checks from us? I just think sometimes as doctor you should really broaden your horizons and become well informed with other things, I mean 101 of anatomy is that the body is intertwined so if there is problem occurring in one part of our body it can be due to another thing. I am really sorry you have come across un-interesed/lazy doctors. But I can not say anything about anyone since I am not doctor myself, but hey at least we are the "coming up future" and maybe one of us will finally come up with solution you know? I hope how me and you are constantly challenging or digging through for an answer can land us somewhere to something called solution

For the allergies, thanks, I do not know if it's true but I am going to see a doctor about this and if I have some complications from foods I will cut them out just to see if it could be causing my symptoms or not.

Post Edited (inpinkagony) : 5/11/2013 12:37:26 AM (GMT-6)


Snowinsummer
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Date Joined Jan 2013
Total Posts : 40
   Posted 5/11/2013 8:40 AM (GMT -6)   
Bacon,

Before I went on PPIs I had terrible coughing/choking and water brash ( where you mouth fills with saliva); I never had heartburn. I read that the water brash in your body's response to acidic reflux in the esophagus..the saliva is acting as a buffer to reduce the pH of the reflux . And the extra saliva is the body's way to trigger the swallowing reflex to get rid of the reflux. The PPIs helped, and removing gluten and dairy from my diet helped even more.

I'm following the Fast Tract diet -the theory here is that small intestine bacterial overgrowth causes inflammation, gas etc that results in acid reflux. Limiting certain types of carbohydrates and sugars reduces the growth of the bad bacterial, and rebalances the gut flora. If I follow the diet I rarely cough, but if I cheat I cough and my voice gets really weak. I had some lentil salad a few weeks ago (a no no on this diet), and I coughed for 2 days afterwards.

DontStealMyBacon
Regular Member


Date Joined Jan 2013
Total Posts : 186
   Posted 5/11/2013 11:47 AM (GMT -6)   
inpinkagony,
To my, it sounds like more of a legal thing than a lazy thing. Being a specialist in one part of the body, they could easily access and learn about another part, but to have the level of knowledge to diagnose and analyze a problem with an entire bodily system takes a lot more than just a little reading. I know this because the neurologist that I asked happened to be the nicest doctor I've seen. He genuinely cared about me as Mich as he did about a close friend or even family. He was even the one that signed me up for brain surgery, cured my epilepsy, and then continued to keep in touch with me after the surgery. No matter how much he cared, his response when I brought up any part of the body that wasn't the brain was that he was not qualified to give medical advice, so he didn't want to answer the question.

Snowinsummer, different things work for different people. I've understood that the large amount of saliva is designed to neutralize the acid for a while. I have not tried going off PPIs for very long, but when I was off them for just 2 weeks before my pH probe, I felt like I was dying. I might try that again in the future, but for now I am sure that I still need them for the heartburn. For the diet, I do not have a lot of confidence that there is any reflux diet that works for everyone. As I have explained above, I have been off many foods as an attempt to treat my esophagitis. One if those foods was gluten, so I know that avoiding gluten didn't work for me. Since there are so many foods that I have to avoid, I basically cannot consider any duets that make my list of foods smaller, but I might find one I can try someday.
Right Temporal Lobectomy 4/5/12

Diagnosed with GERD, Eosinophilic Esophagitis, and Epilepsy.
Studying biomedical engineering to research a better fix to at least one of them.

inpinkagony
Regular Member


Date Joined Mar 2013
Total Posts : 274
   Posted 5/11/2013 1:26 PM (GMT -6)   
Bacon: I am glad you came across good doctor and a legal thing that makes sense. You know I just try and blame things on others which is not nice of me to do, maybe it's all my frustration from being constantly consumed in worry about this whole thing. Anyways I rather just forget for this week and focus on getting ready for my "new doctors" appointment. How are you by the way when is your mamo again?
GERD 8 Months /LPR 3 months. College Student. Aspiring Dietitian/Registered Nurse.

"Where there is no struggle, there is no strength."

DontStealMyBacon
Regular Member


Date Joined Jan 2013
Total Posts : 186
   Posted 5/11/2013 2:00 PM (GMT -6)   
I just thought I should point that out since my neurologist is such a nice person. My manometry is on the last Friday of May, and I have a neurological evaluation scheduled the Friday before that. This doctor also helped me set up this neuological evaluation since I have been having some struggles in college with processing. When I hear a sentence, sometimes I have to ask someone what they mean, not because I didnt hear it, but because I couldnt process exactly what they meant by the series of words that they used. This isnt a major problem in conversations, but on written tests it is a giant problem. I hear the words "turn around on your right foot" and I hear two different things. On a written test, there is nothing I can do to understand it better and I do poorly no matter how much I study. Anyway, thats something else Im trying to get sorted out, because Im failing one of my classes all because of the tests.


Snowinsummer,
Looking back at my first post and your response, I see why you pointed out the excess saliva fact. I have known this for a little while, and I had forgotten that when I posted this topic I was wondering whether it was in fact saliva or acid building up in my mouth, but that was a dumb theory since I know it is saliva.
Right Temporal Lobectomy 4/5/12

Diagnosed with GERD, Eosinophilic Esophagitis, and Epilepsy.
Studying biomedical engineering to research a better fix to at least one of them.
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