Upper Endoscopy necessary for GERD?

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electracat
Regular Member


Date Joined Sep 2009
Total Posts : 89
   Posted Yesterday 8:57 PM (GMT -6)   
hi there,

i've had symptoms of GERD (mostly the 'silent' kind) for the past couple of months. The doc I saw suggested endoscopy to (I guess?) make sure esophagus, stomach look ok. And to check for H. Pylori.

Of course, after reading a lot about GERD and finding that it's due, usually to LOW stomach acid, not high, and also reading about how PPIs usually worsen that condition (and of course my doc recommended them), and also after reading articles by docs suggesting that upper endoscopies are overprescribed, I wonder--is an UE necessary if I don't have vomiting, bleeding, etc? As in, do docs just prescribe it because that's what they're used to doing? Apparently they don't find much more about GERD when they do, and also H. Pylori can be detected in other ways (I think).

I've been working on natural ways of increasing stomach acid, changing diet (no carbs, sugar, etc.), trying to encourage flora growth in gut and reduce bacteria...

I do have a history of stomach/colon cancer in my family.

Any advice is appreciated! Thanks so much.

TonyG
Regular Member


Date Joined Apr 2013
Total Posts : 254
   Posted Yesterday 9:56 PM (GMT -6)   
Hi electracat,

Sorry to hear you haven't been feeling well!

GERD stands for GastroEsophagealRefluxDisorder. As such, the name implies that you have acid moving into your esophagus from your stomach. I've never heard of the terms "high" or "low" acid however the diagnosis itself points to stomach acid traving up your esophagus.

In this case, an upper GI would definitely confirm that diagnosis. It would also see if the history of acid has caused any esophagitis and/or gastritis. A check for Barrett's Esophagus is also done and biopsies taken to confirm. If there is a concern that h.Pylori is the cause of your acid, samples of stomach acid and a biopsy of the stomach would confirm that.

PPI's would help control the reflux into your esophagus. Most also contain a compound to help relieve any h.pylori infections.

Be well and take care!
-TonyG-
-TonyG-
Nissen Fundoplication April 30, 2013
Pain-Free, Reflux-Free, Sleeping on my back!

electracat
Regular Member


Date Joined Sep 2009
Total Posts : 89
   Posted Today 3:56 PM (GMT -6)   
Thanks, Tony. Yeah, I suppose it's a good thing to have done. I'm just a little nervous about it!

If you google 'low stomach acid', you'll see lots of articles about it. Apparently it's responsible for 95% of reflux issues. PPIs (from what i read) can further lower the stomach acid, which is not beneficial to us (the lowering, not the actual acid--the actual acid is very necessary!).

Interesting, as most docs don't seem to subscribe to this fact.

I thought my reflux was better, but the 'silent' kind came back with a vengeance last night...:(

Thanks again!

Poppie
Veteran Member


Date Joined Feb 2014
Total Posts : 2152
   Posted Today 4:35 PM (GMT -6)   
I have GERD and haven't had the test done, to be honest I don't see the point, it is what it is and doctors are far to quick nowadays to do Endoscopy and Colonoscopys its a nice little earner for them..also I don't take any meds, I think they just make you worst in the long run. I have seen a chiropractor which helped me, and I watch what I eat...
Samantha, 45 yrs
Diagnosed. Left sided UC, 8th Feb 2014
Pentasa..2g daily
2 x Ultimate Flora 50 billion probotics, Vit D, and Multi vitamin tab daily.
Stopped smoking Jan 2013.

electracat
Regular Member


Date Joined Sep 2009
Total Posts : 89
   Posted Today 4:48 PM (GMT -6)   
Thanks, Poppie. Do you think the endoscopy has value in determining damage to esophagus, stomach, H.Pylori, etc?

I know there are other tests to determine H. Pylori...

Poppie
Veteran Member


Date Joined Feb 2014
Total Posts : 2152
   Posted Today 8:13 PM (GMT -6)   
I think so for some people. But I also think you have to go by your own symptoms, recognize, and pinpoint exactly where you are feeling discomfort, I just don't think its always necessary to do such invasive tests all the time....I think as you say there are other routes.
Samantha, 45 yrs
Diagnosed. Left sided UC, 8th Feb 2014
Pentasa..2g daily
2 x Ultimate Flora 50 billion probotics, Vit D, and Multi vitamin tab daily.
Stopped smoking Jan 2013.

1039smooth
Veteran Member


Date Joined Sep 2013
Total Posts : 2114
   Posted Today 9:46 PM (GMT -6)   
I thought I was having heart issues, so when heart studies found nothing, we went with an endoscopy. It revealed GERD, a hiatal hernia, stage 4 esophigitis, and eventually Barrett's.
LapNissen Fundoplication, 8/9/13
GERD, Anxiety, Depression

1039smooth
Veteran Member


Date Joined Sep 2013
Total Posts : 2114
   Posted Today 9:46 PM (GMT -6)   
I thought I was having heart issues, so when heart studies found nothing, we went with an endoscopy. It revealed GERD, a hiatal hernia, stage 4 esophigitis, and eventually Barrett's.
LapNissen Fundoplication, 8/9/13
GERD, Anxiety, Depression

electracat
Regular Member


Date Joined Sep 2009
Total Posts : 89
   Posted Today 9:56 PM (GMT -6)   
'smooth', what treatment did your endoscopy lead to? I guess finding out that you have a severely damaged esophagus would be worth finding out...!

refluxmcgee
Regular Member


Date Joined Jul 2014
Total Posts : 20
   Posted Today 10:06 PM (GMT -6)   
I think a scope is good, in that it gives you peace of mind---it can rule out sinister pathologies i.e. Barrett's, cancer, severe esophagitis/gastritis, EE, h.pylori. In certain cases it can help diagnose the cause of your GERD, i.e. a hiatal hernia.

Unfortunately, for some of us (myself included)--a scope does little to help us find out the cause of our GERD/LPR. In my case, it showed a little redness and inflammation of the esophagus. Big whoop. I pretty much already knew this would be the case, since at the time I was experiencing bad heartburn. After having the scope done, combined with a bunch of other tests (barium swallow, mannometry), my GI/ENT docs reviewed the results and said--we have no idea why you're having the symptoms you're having. Really helpful.

I have read somewhere that 50% cases of GERD are idiopathic. Nobody knows why a person has GERD, and their tests are 'normal'. The cause of their symptoms go undiagnosed..and basically, people like myself just have to live with their symptoms---since our pathologies are not 'bad enough' to warrant surgery or even to be put on medications (PPIs).

Our symptoms does however seriously impact our quality of lives, which nobody in the medical community seems to care about--or worse, have any solutions for. Sorry to seem so bitter and negative, but it's the truth!

refluxmcgee
Regular Member


Date Joined Jul 2014
Total Posts : 20
   Posted Today 10:08 PM (GMT -6)   
It sounds awful, but sometimes deep down in my heart, I wish they had found something from that scope. Anything. A reason to explain why I have LPR. A tear in my sphincter. A weak sphincter. Gastritis. Something. But they found nothing.

That way, I would know there was a reason for my LPR. A reason why I've had such bad symptoms for 7 months, and will probably have them for the rest of my life. But they didn't find anything. And every day, I just wonder---why? I'm a young healthy person otherwise. WHY?!

electracat
Regular Member


Date Joined Sep 2009
Total Posts : 89
   Posted Today 10:09 PM (GMT -6)   
mcgee, thanks for sharing. I agree--the more I read forums online, the more i realize that so many people are dealing with these symptoms, and not finding relief. It's so scary!

I guess I'll start with the scope (ugh--scared), and then continue on my journey of food modification, acid management, etc.

Any reason to see an ENT instead of a Gastro, in the case of 'silent' reflux? Seems they'll just do the same tests and find out the same stuff...?

electracat
Regular Member


Date Joined Sep 2009
Total Posts : 89
   Posted Today 10:11 PM (GMT -6)   
I agree with the idea that you'd like them to find *something*; I've dealt with unrefreshing sleep/fatigue for most of my life, and I always wished it was less idiopathic, more concrete. But alas, it's not to be (not yet, anyway!). Really didn't want this disorder on top of it, though...

Interestingly, I've noticed that when my stomach is distended and bile/acid coming up into my mouth/nose (i.e. reflux), I feel a new fatigue/suckiness. When my stomach, a little later, feels better/normal, the fatigue goes away. What could this mean?

1039smooth
Veteran Member


Date Joined Sep 2013
Total Posts : 2114
   Posted Today 10:22 PM (GMT -6)   
electracat, we tried PPIs for a while and I avoided the trigger foods like chocolate,tomatoes, etc. I saw some improvement, but I guess not enough for my liking, so I had the Nissen. Recovery has been tough.
LapNissen Fundoplication, 8/9/13
GERD, Anxiety, Depression

electracat
Regular Member


Date Joined Sep 2009
Total Posts : 89
   Posted Today 10:31 PM (GMT -6)   
I've heard that surgery can be tough. I hope you find relief soon...Have you seen any improvement yet?

TonyG
Regular Member


Date Joined Apr 2013
Total Posts : 254
   Posted Today 11:25 PM (GMT -6)   
I don't know that i would want an ear, nose & throat doctor trying to diagnose and treat my digestive issues.

The endoscopy is the only way to diagnose anatomical issues caused by GERD/reflux. A CT scan will not show you problems at the surface level of your stomach and esophagus. I had 4 of them and never had any residual effects from them. It was a great 20 minute nap that eventually led to complete elimination of 20 years of crippling reflux. no amount of chiropractic visits, PPI's, diet changes, and alternative treatments helped. The gold standard for diagnosing and treating GERD/reflux is the endoscopy, a 24pH study, a barium swallow and a manometry study. One can make all the assumptions they want, but it's hard to refute the results of anatomical and physiological proof.
-TonyG-
Nissen Fundoplication April 30, 2013
Pain-Free, Reflux-Free, Sleeping on my back!

1039smooth
Veteran Member


Date Joined Sep 2013
Total Posts : 2114
   Posted 9/24/2014 5:57 AM (GMT -6)   
electracat, um, I'm at a healthy weight now. That was a plus. I do overeat at times like I did the other night. I had some heartburn from it, which poor TonyG had to hear about. Haha. It's a little frightening.

The important thing is you're here and receiving good advice from people like Tony beforehand.
LapNissen Fundoplication, 8/9/13
GERD, Anxiety, Depression

SharonZ
Veteran Member


Date Joined Mar 2014
Total Posts : 1462
   Posted 9/24/2014 10:27 AM (GMT -6)   
I agree with Tony G about having the proper diagnostic tests done. I did, ended up having HH repair and a full nissen wrap done in April. I'm feeling almost 100% better, no acid reflux, no PPIs, and all of my asthma issues have gone away, and I no longer need my inhaler.

electracat
Regular Member


Date Joined Sep 2009
Total Posts : 89
   Posted 9/30/2014 11:54 PM (GMT -6)   
Hi Tony,
I had the endoscopy! Preliminary results are negative, but haven't gotten biopsies back yet.

Just wanted you to see what the moderator posted a couple of years ago;

"With laryngopharyngeal reflux, you may not have the classic symptoms of GERD, such as a burning sensation in your lower chest (heartburn). That's why it can be hard to diagnose and is sometimes called silent reflux.
Dr. of choice - an ENT who may use the Laryngoscope to check out the vocal cords for reflux damage, nodules or lesions."

I have these symptoms of LPR, which is why I mentioned having an ENT check me out, not a gastro. I guess a gastro doc wouldn't check on the vocal cords, etc? But...it still all stems from the stomach, in the end, so I would imagine seeing a gastro--maybe in addition to an ENT?--is as necessary for LPR as it is for GERD..??

I've read a theory about GERD/LPR in that the stomach is bloating (due to low acidity, bacteria, etc.) and 'pressing' the acid up the esophagus. That's what it feels like for me. Even though I have the 'silent' kind, no real 'heartburn', my stomach is constantly funky, especially when the reflux is happening. Does that imply that it's more of an issue with my stomach than with my LES, or is it both? Also, if you read about low acidity (which is responsible for most reflux issues), it does cause poor digestion which, in turn, could cause the reflux. PPIs lower acidity even more, which is why they're not a good choice for long term solutions...

A little freaked out because, as I struggle to get this under control, I'm losing weight. And I'm already skinny!

Whew. sorry for the long-windedness. And all the acronyms. ;) I guess I'm thinking/questioning aloud, a bit..
Thanks for reading! sad

TonyG
Regular Member


Date Joined Apr 2013
Total Posts : 254
   Posted 10/1/2014 12:04 PM (GMT -6)   
Electracat!

Glad to hear things went well with your EGD. Biopsies will take a couple days, usually. If your symptoms are more LPR related than digestive, then it would be appropriate for an ENT to take a look for damage specific to the trachea and larynx. If your symptoms are more digestive in nature, then it would make sense for a GI to look at them.

The GI specialist will be able to give you more specific diagnoses as to the cause of the GERD/LPR as the acid and reflux all come from the stomach to begin with. At the source, the reason you're having these is because of a weak LES. The LES is built to stop reflux from happening to begin with, so if you're experiencing any of these symptoms (silent or not), the LES is usually not functioning appropriately to seal off the stomach and prevent acid from reaching your esophagus. A weak flap valve may or not be completely visible on the EGD as you're sedated so muscle structures are naturally more relaxed. From my surgeons perspective, the weakened LES is a direct result of being abused by a stomach acid bath for so long (as is with reflux of any kind).

Your issue specifically could be a combination of things. I'd wait to hear back the results of the biopsies to be sure.

Take care and be well,
-TonyG-

electracat
Regular Member


Date Joined Sep 2009
Total Posts : 89
   Posted 10/1/2014 1:53 PM (GMT -6)   
Thanks, Tony!
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