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New here - have some questions on treatment for silent GERD

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Posted 2/4/2012 7:32 PM (GMT 0)
Hello all! I have had a "sensitive stomach" for most of my life. I discovered Prilosec when it first came out and have been taking one a day for years. When Costco began carrying the generic version, I changed to it. No heartburn as long as I took the purple pill.

about a year ago I began having symptoms like post nasal drip and a slight lump in my throat. My primary care physician sent me to an ENT who ran a tube down my nose and diagnosed silent reflux.

For what its worth, I also have obstructive sleep apnea and faithfully use a sophisticated CPAP.

The ENT sent me to a GI doc who examined me, did an endoscopy and did not find "anything serious." The GI doc seems very knowledgeable and has published over 80 articles on reflux, so I guess he knows what he is doing.

He upped the dose of Omeprazole to 40mg/day for three months. The lump went away, but the throat phlegm did not.

He ran a tube down my throat, into my stomach and had me wear this, with a little box for 24 hours. He said that the acid content in my stomach was high, but that was all. He suggested I go on Prevacid. I tried it for a couple of days, but the heartburn came back with a vengeance! So, with his guidance, I went back on the Prilosec, but he upped the does to 80mg/day.

I am now taking four times the recommended dosage.

This has been dragging out for about a year. In my last visit, yesterday. He showed me the results of the tube in the stomach (I don't remember what it is called). He said that there were two sensors. One low in the esophagus and one higher up, near the mouth.

He went on to say that my results were unusual. The chart showed mirror images of the acid peaks. He said that usually he would see a peak near the stomach and then the acid would rise to the upper throat. But my peaks were occurring at the same time.

He put me on Nexium, 40mg, but there is some glitch with my insurance, so I won't have it until Monday. The pharmacist told me that a month dosage costs about $400 if the insurance does not cover it.

After a year of having this and about nine months with this same GI Doc, I am growing impatient. He keeps telling me that I should be patient, that "these things take time and only get better very slowly.

Folks, I have no symptoms except the constant throat clearing. My GI Doc has ruled out cancer and does not think I have a hiatal hernia. He does not seem to understand my problem and keeps recommending I try new medicines for three or four months and then come back and see him again.

He has been practicing for 27 years, published 80 GI articles, with special emphasis on Esophageal Diseases, Small Bowel Capsule Endoscopy and Gastroenterology Motility.

Should I find another GI Doc and get another opinion? Any advice would be greatly appreciated!

Bill
Atlanta GA
Posted 2/4/2012 7:53 PM (GMT 0)
You don't mention what lifestyle changes you have made. Healing often requires more than just medication for this condition. The Koufman diet has helped me significantly. I,ve got a thread going here, with a lot of information on the first post.
Posted 2/4/2012 11:12 PM (GMT 0)
Sunbeam, thanks for the reply. This is another curiosity. My GI Doc has made very little change in my diet. Said to eat what I always have eaten. I asked about spicy food? He said it was ok, that if I ate something that gave me heartburn, don't eat that. But since my GERD is silent and there is no heartburn.....

I like food from India, particularly the Gujarati area (vegetarian and VERY spicy). Well it does not seem to make any difference. I just have this phlegm-tickle in my throat. If I eat bland or spicy.

Most curious.
Posted 2/4/2012 11:14 PM (GMT 0)
Sunbeam, I did look at the diet you posted. Looks good to me. Subscribed to the thread.
Posted 2/5/2012 12:43 AM (GMT 0)
DB,

Hello and welcome to HealingWell.  You posted " the heartburn came back with a vengeance!" - then you posted "But since my GERD is silent and there is no heartburn....."

I and a bit confused by this as I suspect you are having heartburn and looking at your diet is a wise decision.  You GI sounds like he knows what he is doing IMHO.

I wish you the best and hope a diet change increases your quality of lie.

Kindly,

Kitt

Posted 2/5/2012 2:09 AM (GMT 0)
Kitt,

I really want to start off on the right foot here. I am looking for help.

I had heartburn before taking Prilosec.

After Prilosec, no heartburn, but throat phlegm.

Stopped taking Prilosec and the heartburn came back.

I am a bit confused myself. You say 'looking at your diet is a wise decision. Your GI sounds like he knows what he is doing".

Yet my GI says he thinks a diet is not important for me. Most advice I had toward diet from him was to eat anything I usually ate, unless it gave me heartburn. I eat anything I want and have no heartburn unless I quit the Prilosec.

I hope the GI can figure out how to cure me. Have spent a lot of time with him. I guess I am frustrated that he said it could take another 6 months to see any real change. I am here to see if anyone has alternatives I could explore?

Kind regards,
Bill
Atlanta GA
Posted 2/5/2012 5:22 AM (GMT 0)
Hey DB,

I echo the welcome to HealingWell :)

As others have suggested, changing your diet is really key when it comes to dealing with GERD (like me!) and silent GERD (like you).

It seems like you like the sound of the Koufman low acid diet, maybe try that? If it's too much for you (I only say this because I've heard that the "induction" phase is strict and someone who's not used to living on a restricted diet can struggle with it), a lot of us benefit from simply avoiding trigger foods, like:

-chocolate
-tomatoes
-spicy food (I feel you there, I miss sambal olek!!)
-coffee/tea/soda
-onions/garlic (these seem to be okay for some and not for others)

You could also try not laying down for 3-5 hours after eating, eating smaller meals at regular intervals, and getting down to a "normal" BMI (or simply losing 10% of your body weight).

All of these things above will help to prevent reflux, which is causing your throat clearing symptoms. When I changed my diet I noticed a difference right away, but maybe just make the changes for 7 days and see if it helps :)

I agree with Kitt in that your doctor seems to be ordering the right tests for your condition. I'm sorry if I missed it, but what is going to take time? Did he order more tests that you're waiting for, or is he having you try out the PPI for a few months?

Take care,
Ashley
Posted 2/5/2012 1:30 PM (GMT 0)
Ashley,

Thank you for your kind reply and suggestions. I am ok with diets. about four months ago I was diagnosed as pre-diabetic. I went on a diet, replacing fatty and starchy foods with veggies and non-citrus fruits. Intentionally losing 50 pounds. From 236 to 186. I have kept that weight off. It was not difficult, simply changing eating habits. I am 6'1" tall and large boned, so this is a good weight for me.

The diabetes test results dropped from an A1C of 5.6 to below 5. I did what the doctor told me. My primary care doc specializes in diabetes. Though he is monitoring the diabetes, he feels I am in good shape regarding this matter.

I am a very successful businessman. I feel that this success comes from finding experts in a particular field and following their advice. I do not do this blindly, but carefully integrate their advice into my goal(s).

My instincts tell me that though the GI I am seeing now IS an expert in his field, his advice seems to go contrary to the majority of advice that focuses on GERD treatment. He says that diet is basically not important. Yet almost everyone else says diet IS important. It makes sense to me that the latter statement IS correct! If I have an acid imbalance in my digestive system, logically I should not eat things that exacerbate this condition.

When I receive advice that goes contrary to most thought, I think the "expert" is either very, very innovative in a constructive way, or I need to find someone else. When some of his advice is thrown into question, I begin to question the rest.

I have had three tests, beginning with an Upper Endoscopy, then Esophageal Manometry and Esophageal Ph. After each test the GI has said he finds "nothing wrong" and prescribes increasing dosages of PPI(s).

Ashley, in "taking time" to see results my GI has recommended I go on Nexium for the next six months and get back to him after that period has expired. An additional quirk is that the Pharmacy where I went to have the prescription filled, called my insurance company and was told that Nexium could "conflict" with other medications I am taking. I had given, for the third time, a complete list of medications to my GI right before the last interview.

In my interview on this past Friday, he suggested I have an Upper Endoscopy. I reminded him that he had already done one on me. He had my complete file in his hands and had spent about ten minutes looking at it before speaking. I am losing faith in him -- actually I HAVE lost faith in him. I will begin vetting other GI docs this Monday, tomorrow.

Anyone in Atlanta who has a GI doc they like? Please recommend.

In the meantime I see benefits in beginning the Koufman diet and will do this also.
Posted 2/5/2012 4:26 PM (GMT 0)
DB,

Wow! Great job on the weight loss and the glycated hemoglobin results! That is definitely impressive. Good for you for doing such a great thing for your body, and I mean that sincerely.

If you're not happy with your GI doc and your gut is telling you something isn't right, I would see another GI too. Nothing bad can come from seeking a second opinion. Worst case is that the other concurs with the first and you have lost nothing. My doctor also gave me Nexium for a six-month period but did tell me to come back if it didn't work.

Let us know how the Koufman diet works for you!

Take care,
Ashley
Posted 2/5/2012 5:39 PM (GMT 0)
Thank you again Ashley,

I will be researching GI docs today and call some friends tomorrow for their local recommendations.

My wife is downloading information on the Koufman diet. May as well get started.

A close friend who was a medic in Vietnam and has a lot of current medical knowledge, suggested to me that we have 'way too much acidity in our bodies anyway, so I'll run this by him as well. But, whatever, I will get on it and see what happens.

Will keep on this Forum. A lot of interesting information here!

For me, and my wife, losing weight was painless. She lost 25 pounds. We made a game of it. We did this in about three months. I went from an XL shirt to a Medium. I have normally been around 200 pounds, but the weight can creep up on you if you are not careful. I like being about 185 or so. Feels good to me.

Bill
Posted 2/6/2012 12:01 PM (GMT 0)
Glad to hear you are giving the Koufman diet a go. I will look forward to your posts on the Koufman thread to let us know how you are doing on it. I was attracted by the reasearch article posted here, where 19/20 participatants reduced their symptoms during the two-week induction diet.
Posted 2/12/2012 9:36 PM (GMT 0)
i know ive had lpr for 4 years. i was started on double ppis and ate crackers, bread, almonds, etc. had some improvement. then winter 09/10 i moved dinner time later and started getting worse symptoms. had surgery and ate a good diet a couple months post op the symptoms got somewhat better. but i was eating next to nothing and never stopped the 2 ppis. my problem is too much time lapsed before they diagnosed me the gi dr. said all the throat clearing and mucous was anxiety. 2 minutes into an ent appt. they said i had lpr the whole time i had been suffering the gi doc had no clue. went to another gi he said lpr is made up. then 2 more ents and they also said lpr 3rd gi doc asked me what lpr was..seriously. they dont understand the esophogus and larynx are different. the standard probes and demeester scale are worthless for atypical symptoms in my opinion. just a drop of acid in your larynx can cause problems, yet is fine for esophoghitis. you need a skilled ent and a surgeon that understands lpr. i have completely given up on the gi docs..my advice is eat bland, take ppis and dont eat late. u can elevate bed, but my reflux was 0 when laying down..but a ton during the day upright..that is lpr and gi docs again in my opinion do not understand it as most surgeons dont either..that is why no progress is being made in treatment. they need to fix our upper esophgheal sphincter. i had esophoghitis 2x in my life both times resolved after ppis, but my lpr will not heal. i believe if a proper diagnosis had been made more promptly i would be far better off. if you dont like the gi doc see another or have the ent refer u to the surgeon..get a fundo surgeon..i didnt and never felt he got it tight enough, post op it showed i still refluxed on barium. i saw another surgeon and he said based on my severely red throat and the barium those probes were a waste. it is like if you have barrets..what is the point of all those tests..its clear you are refluxing...duh.
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