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sore throat for months??

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Posted 6/10/2011 4:22 PM (GMT 0)
hello out there,

my first time posting and wondering if anyone has had experience with long term sore throat. i have had this for months along with sensation of lump in my throat. yesterday i had the bravo capsule inserted for ph testing as they keep thinking its reflux, but i am not feeling its reflux. try reflux meds for a month and no difference. just keep having this darn sore throat and lump in throat feeling. any advice or others experiencing same thing??

thanks, nancy

Posted 6/10/2011 5:03 PM (GMT 0)
I have the same thing. Its probably LPR. I think the bravo capsule will tell you a lot. Docs arent well versed in LPR, so I hope you have a good one. You will probably have to do a lot of research on your own.
Posted 6/10/2011 5:50 PM (GMT 0)
It does sound like LPR or otherwise know as silent reflux.
The acid is able to travel all the way up the esophagus and get into the back of the throat and sometimes the lungs.
LPR is tricky to treat because the symptoms are atypical of GERD.
First the doctor will try medications (PPIs and H2s). He may do other more extensive testing in addition to the bravo capsule.
Barium swallow, EDG (endoscopy), stomach emptying, and manometry (motility study).
If the testing shows a weak LES you will possible have to have the surgery, but this could be awhile before this is determined.

I had LPR and after three years of constant coughing the doctor gave me the surgery option. I had a loose wrap (270 degrees) done 18 months ago and have been cough free.
Posted 6/12/2011 3:04 PM (GMT 0)
Joy,
I haven't spoken to any surgeons yet .. but according to neptunian808 (another user here), unless one has weak LES, they won't let you have the surgery. Is this true?

In my case, the LES pressure is normal .. only LPR symptoms (no coughing or asthma like symptoms yet .. but mostly achy throat and voice fatigue) - that get worse with the trigger foods. I guess the LES transient relaxations due to nerve related issues - is the root cause in my case.
Posted 6/12/2011 3:48 PM (GMT 0)
Hi PPI-LESS,

You may need to get your PCP or ENT on board to help advocate for you. I know what you're going through. Everything looks hunky-dory on tests, but you're still dealing with the symptoms.

Find another GI doc, who may be more well-versed in LPR.

I'm sure Joy will add to the comments, but thought I'd weigh in on the subject.
Good luck!
Denise
Posted 6/12/2011 6:37 PM (GMT 0)
What did the barium swallow say? How about the pH test?
These are other indicators.
Posted 6/13/2011 12:41 AM (GMT 0)
Barium swallow was normal (no HH etc.)
pH Test results were abnormal with LPR manifestations:
pH < 4 (Upright): 2
pH < 4 (Supine): 0
pH < 5 (Upright): 53
pH < 5 (Supine): 9
The pharyngeal reflux injury score (RIS), a summary of weighted time at each pH level, is high RIS = 143
Esophageal Reflux:
Total % time pH < 4 = 3.3%
Upright % time pH < 4 = 5.0%
Supine % time pH < 4 = 0.0%
Total Number of episodes = 51
Deemester Score: 9.6

So again - my reflux is not that bad yet .. but the problem really is that I am unable to take the PPIs since I get the side effects .. which is causing me quality of life issues.

I am going to switch my GI and see another one who someone has highly recommended I do. He is going to redo the tests and we will try to really get to the bottom to see if the surgery is something I should even contemplate or not.
Posted 6/13/2011 12:46 AM (GMT 0)
PPI-LESS,

I think it's an excellent idea to get another opinion. As I've said, I had a DeMeester of 4 the first time I was sent by my PCP and asthma docs to get tested. While the GI cheerfully sent me on my way, my asthma continued to be affected by the reflux for another four years. Don't take no for an answer. You know how you feel.

The GI's are worried that you'll come back to them after the Nissen and be extremely upset if the surgery doesn't solve your problem. They'll never recommend it without good cause. That good cause may end up being in the form of your other docs' recommendations.

Persevere!
Denise
Posted 6/13/2011 2:09 AM (GMT 0)
I'd go to a different doctor and get retested.
I did a second opinion when my GI told me that he didn't believe the surgery could help my LPR.
Posted 6/13/2011 10:25 AM (GMT 0)
My concern at this point is:
- Since I've had this only for 3-4 months, am I rushing into the surgery?
- Could this go away on its own in a few months.. in which case, I would've gone for the surgery a bit too soon?

On the other hand, I am concerned about the throat getting worse ..

My symptoms do create quality of life issues, but my anxiety does too. However, I am still functional and can go through the day ..
Posted 6/13/2011 1:57 PM (GMT 0)
@PPI-LESS i found some info that say that LES pressure before surgery doesn't affect the final result, meaning you can have a normal pressure and still benefit from surgery cause a Nissen doesn't just fix your LES but also decreases TLESRs

now with that said i havent been able to find a doctor in my country who's willing to operate on me because of my LES pressure, and i only found one person that had a nissen with a normal LES and she/he had to fight for it.

keep me updated on what your doctors say, i will too

here's the study http://www.ncbi.nlm.nih.gov/pubmed/17436051

so according to that we should be candidates for surgery
Posted 6/13/2011 3:52 PM (GMT 0)
I've been reading about this very subject.

I guess, one of the reasons the surgeons don't want to touch patients with normal LES pressures is because the possibility of post-operative swallowing problems (dysphagia) is much higher in such patients (us). Our main problem is the TLESRs and the fundoplication does reduce these relaxations - although the exact mechanism is not clearly understood, but it may also introduce / cause dysphagia.

www.ncbi.nlm.nih.gov/pubmed/11986014

Not good!

Post Edited (PPI-LESS) : 6/13/2011 10:11:32 AM (GMT-6)

Posted 6/13/2011 4:47 PM (GMT 0)
now read this http://www.ncbi.nlm.nih.gov/pubmed/19370381
Posted 6/13/2011 4:58 PM (GMT 0)
hmm .. this study is newer .. but may be the surgeons still use the one from 2002 ..

I've also heard from a person from my wife's family the same thing as what you are saying: that the surgeons are not going to touch me with 24mmHg LES resting pressure. I'll see what this new GI and how his tests work on me ..
Posted 6/13/2011 11:22 PM (GMT 0)
I had a sore throat for 2 years in New York. Finally saw a ENT surgeon and he looked at it...they were cysts (very small tumors). Got them taken care of and then since I had confidence in the surgeon, I got him to take care of my deviated septum and he also shrunk my turbines.
Posted 6/14/2011 12:34 AM (GMT 0)
So, is it so that for people with normal LES, "toupet" might be less risky with respect to dysphagia .. question is will it stop the acid flow upwards or not?

www.ncbi.nlm.nih.gov/pubmed/10594263
Posted 6/14/2011 2:23 AM (GMT 0)
I had a partial wrap simliar to the toupet mine was a 270 degree wrap. The doctor compared it to wrapping a pant's cuff (top of the stomach) around your leg (the esophagus).
It helped me a great deal.
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