Do I have GERD?

DaveT. said...
Everything you are describing, except for the upper back issue, sounds like LPR to me. For me, it started out as a salty/sticky throat, then occasional trouble swallowing both food, and sometimes even water. I also had the coughs you mention, although never, until recently, connected that to be related to the throat problem. With GERD, you feel the stomach acid. With LPR, you don't necessarily feel the acid, as was the case for me (note that, for this reason, LPR is also called "Silent Reflux"). Eventually, that substance in the throat went all the way up to the roof of the mouth, and lately has been burning my tongue. All of this started 4 years ago, and it was not diagnosed by two ENTs. So, I never knew what it was until last month when I went to a physician's assistant who gave me a handout on LPR. As soon as I saw the list of symptoms, I knew I had LPR.

I'm going for an EGD (upper endoscopy) in 2 weeks. Hopefully, he will not find Barrett's esophagus, which is pre-cancerous. I suspect that he will at least find a problem with the LES, which is a valve between the stomach and esophagus. For a variety of reasons, including age and improper diet, the LES can stop working correctly, allowing too much acid to get through to the esophagus.

I have also been on a strict acid-reducing diet for 3 weeks now. There are lots of books devoted to such diets, and I have purchased 3 of them. The one I use is "The Acid Watcher Diet" by Jonathan Aviv, M.D. It includes what he calls a "healing phase" that lasts for 28 days, where you are generally limited to foods with a pH 5 or above. The healing phase is followed by a "maintenance phase".

The book includes many recipes. You eat 5 small meals a day, with no eating in between meals. For me, I find the diet relatively easy, primarily because I know it is something I need to do in order to heal. But it is actually relatively tough, and you spend a lot of time shopping and in the kitchen. It's also a very good diet if you want to lose weight. I felt I didn't really need to lose weight but have lost at least 12 pounds since I started it. I'm eating foods I never really ate before, like spinach, sweet potato, and salmon. And I'm NOT eating foods that I used to eat frequently because I thought they were healthy, which they are, but not good if you are trying to reduce stomach acid. Those foods include tomatoes, garlic, onions, and dark chocolate.

Kaz, I would definitely recommend going to an ENT. Be aware that LPR often goes undiagnosed, even by some ENTs. I think this disease/condition was not well known when many of them went to medical school.

DaveT. said...
Yes, I did get mucus, but I wouldn't say it was terribly thick. There was enough of it though that it was very annoying, and I was always spitting it out. It's a good thing I live alone because it is gross always trying to cough it up to spit out. I asked the first ENT that I went to (who failed to diagnose the problem) if constantly trying to cough it up and spit it out could damage the throat. He said no, the throat is resilient. I subsequently read, maybe 6 months ago, that you should swallow it rather than spit it out. Yuck, I could not do that. They didn't say the reason for that, but my guess was that in spitting it out, you are introducing the acid to more tissue. So, if your reflux was confined to the throat, you are now introducing it to the mouth area. But regardless, I never swallow it.

At the beginning the mucus always tasted salty. I now think maybe it was because I must have been eating a lot of salty foods back then. Later, maybe in year 3, I started to call it "sticky throat" because it seemed that no matter what I ate, it stuck to the mucus, as you could tell when spitting it out. about in year 4, it became less thick, and I was spitting it out less, and it now had more of a sour taste. I'm not sure why the taste and consistency of the mucus changes like that.

It seems like ENTs are quick to recommend PPIs (e.g., Omeprazole) as a treatment. I have read lots of bad things about PPIs so wanted to avoid that. My understanding is that they are bad to use long-term, but it is hard to get off of them, and if you do get off of them, your stomach acid is worse than ever. I'm not saying you should change your use of PPIs but would recommend spending some time reading about the experiences of others who have used PPIs to treat reflux. After reading those experiences myself, I chose diet changes over PPI.

Another thing you can consider is use of Gaviscon Advance as a substitute for PPI's or low acid diets. I actually purchased some of that on Amazon about a month ago. My plan was to use that as a backup if the low acid diet did not work for some reason. I'm only going to say a little about Gaviscon Advance here, because I did not investigate it enough to be confident in recommending it. First, Gaviscon Advance is manufactured and sold only in the UK. If you buy it on Amazon, that is where it is shipped from. It's about $40 for 3 bottles of 60 tabs. This is NOT the same as either Gaviscon or Gaviscon Extra Strength sold in the US. The difference is that the UK version contains Sodium Alginate. The directions say to use 1-2 tablets after meals and at bedtime. This can be expensive if taking 2 tablets 4 times a day. However, my impression from reading the reviews was that many or most people are using this only before bed.

On the label, it states that Gaviscon Advance "belongs to a group of medicines called Reflux Suppressants, which form a protective layer on top of the stomach contents to prevent stomach acid escaping from the stomach where it works into the food pipe causing pain and discomfort ... ". If you do get it on Amazon, it comes in a liquid or a tablet form. It seems that the better reviews are for the tablet form. The directions on the bottle say to chew the tablets up. Many reviewers have found it is much better to just let the tablet slowly dissolve on the tongue.