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Treatment resistant GERD (Gastroesophageal Reflux Disease )

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GERD & Acid Reflux
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Posted 9/12/2009 8:54 PM (GMT 0)
Background:

Male. Late 20, average weight, active. I've been suffering with this for about 5 years now, it's it's getting progressively worse. I've done both an endoscopy, and a barium swallow test. The result was no h pylori, and no hiatial hernia

Indications:
-Bruxism
-Forward head posture
-Mouth breather
-Seasonal allergies

I'm starting to think the reason is in there. Because of the less salivation keeping reflux down at night, and the dry mouth/esophagus from the mouth breathing. There was a study on pubmed linking bruxism and GERD for that reason.

Things I'm trying for GERD:
-Baclofen 10MG 3 x / day
-Famotidine
-Sucalfate before bed
-Ashwaganda (I read it tightens the sphincter)
-6 MG of melatonin (I read a study that say's 6 MG tightens the sphincter)
-d Limonene
-Glutamine
-My bed is raised 6 inches
-I fast 3 hours before bed
-I try to eliminate acidic foods from my diet.

Previously tried:
Proton pump inhibitors, digestive enzymes, probiotics, apple cider vinegar, manuka honey, deglycyrrhizinated licorice, etc...

Even with that regimen of drugs, supplements, and lifestyle changes, I wake up with a sore throat and chest! Everyday. I think it's even coming up to my mouth some nights. The day time reflux isn't that bad anymore though.

Is there anything else I can try? Any other options? Does anyone know of anyway to increase salivation at night during sleep?

At this point it's really worrying me, as I wake up constantly with a sore throat. I want to get this treated now.

Thanks for reading.
Posted 9/13/2009 2:49 PM (GMT 0)
Have you been tested for sleep apnea? It could explain the dry mouth/ mouth breathing at night.
Also ask for a motility test to see if there a weak LES going on.

Joy
Posted 9/13/2009 2:56 PM (GMT 0)
Sorry to hear you're having so much trouble, ljk. You've certainly done your research and have tried lots of options. You've obviously been to a GI doc. Has he/she offered any ideas you haven't tried? There are still other tests you can have (24 hr PH monitor, manometry, etc) that can check for the amount of reflux you have, and see if your LES is working.
I'm sure you'll get lots of support and ideas from other members here.
Good luck!
Denise
Posted 9/14/2009 1:46 AM (GMT 0)

couchtater said...
Have you been tested for sleep apnea? It could explain the dry mouth/ mouth breathing at night.
Also ask for a motility test to see if there a weak LES going on.

Joy

Hey Joy,

I did a sleep study a few years ago and the mention of apnea never came up, so i don't think i have that. I have always had breathing troubles because of constricted nasal pathways, and I also get frequent allergies that clog up my nose/sinuses... so I mouth-breath a lot. I am going to ask my doctor tomorrow about the motility test. Thanks for that tip!
Posted 9/14/2009 1:51 AM (GMT 0)

dencha said...
Sorry to hear you're having so much trouble, ljk. You've certainly done your research and have tried lots of options. You've obviously been to a GI doc. Has he/she offered any ideas you haven't tried? There are still other tests you can have (24 hr PH monitor, manometry, etc) that can check for the amount of reflux you have, and see if your LES is working.
I'm sure you'll get lots of support and ideas from other members here.
Good luck!
Denise

I saw a specialist to do the endoscopy in the spring. After the test he basically told me to avoid certain foods, and that there was no need for another follow-up. I'm going to ask my doctor for a referral to another specialist, hopefully one with experience with treatment resistant GERD to do some more testing, and if needed - surgery.

I'm definitely going to look into the motility test. I want to know how my LES is functioning. The 24 hour manometry test looks pretty severe, so I'll leave that until the end ;)
Posted 9/14/2009 7:32 AM (GMT 0)
Gooooood luck.Keep in touch with these lovely people they cetainly helped me out at a fragile time. .Take care :-)
Posted 9/14/2009 10:21 AM (GMT 0)
Hi ljk,
Actually, the manometry is the challenging test. I had the 24hr ph monitor, and it didn't bother me much. I was glad to get it over with, but it's nothing to avoid.

Don't let your GI doc's dismissal stop you from pursuing an answer. My first GI doc did not take my symptoms seriously, and allowed me to continue with symptoms for years without any intervention other than PPI's.

I fired him, and went to another GI doc (recommend by my doc--my requirement was that he had good communication skills and would listen to me with an open mind). That still took a couple years, but after he did some tests, continued communication from my family and asthma doc, he finally took my symptoms seriously enough to recommend I talk to a surgeon to give the surgical option consideration. My family doc had been nudging me towards surgery for years, because he was sure the GERD was making my asthma uncontrollable.

Long story short, I decided to have the surgery. (I was tired of being sick.) I am so glad I did. I now have my asthma back into control, and my health is 100% better.

Good luck getting to the bottom of your problem. Don't give up!
Denise
Posted 9/14/2009 10:51 AM (GMT 0)
I really empathise lkj. I have had GERD for over a year - it arose after some very difficult surgery and a stay in intensive care.

My symptoms are also resitant to PPI's although I get a little relief from them. My gastro is about to sign me off too so I know how that feels. Like you, I have tried lots of things to help and the only thing I have found so far that helps my throat to some extent is slippery elm. I really hope things improve for you.

Best wishes,

CeeJay.
Posted 9/14/2009 2:34 PM (GMT 0)
ljk

Hello and Welcome to HealingWell.................I am so glad you found this great group.  I am Kitt. :-)

I see you have received great advice...........I am wondering if you are on any other medications that you may take at bedtime that cause dry mouth? 

I am a mouth breather so I am familiar with the dry mouth issues.  smhair

Have you talked to your dentist?   There are artificial saliva/moisture formulas to help people who have dry mouths. Biotene is one of the products available.  It comes in a variety of different forms, including toothpaste, mouthwash, spray, gel, gum, and liquid. I know this I have only addressed the dry mouth and you have other problems.

Regarding the GERD,  please do get a second opinion as has been suggested by others.  You are your own best advocate so please know it is OK to keep on looking for the answers.

 

I wish you the best and please do stick with us as we are here to help and support in anyway we can.

 

Again, a warm welcome to HealingWell.

 

Kitt

Posted 9/14/2009 6:56 PM (GMT 0)
Thanks for all these great responses! I think I might stick around here... I read some of the best advice I've found so far on this forum.

stkitt: I went away for the weekend, so I didn't take either the Buspar, or Baclofen for 3 days. This morning I woke up with no reflux, or bruxism. I was trying to figure out why until i read your comment and looked it up. Those two drugs cause dry mouth! I would never have thought of that as the reason why. I recently started taking calcium and magnesium, so i figured that was why.

Who would have thought dry mouth could be the cause of both GERd and bruxism for me?

It has just been one night though, so i am not going to get ahead of myself just yet.

And with the bruxism, my issue was never night-time grinding, it was holding tension in my jaw during the day. The buspar got rid of that, but then i started grinding at night as soon as I started taking it. It was like a catch-22: Take the Buspar and not have debilitating pain at during the day, but grind during the night. Or, not take it and not grind at night, but have an aggravating and nagging pain pain during the day. So it's all symptomatic and related i think.

I'm definitely going to ask my doctor about Biotene. Thanks for that tip!

Edit: September 15. This is the 2nd morning in a row that I didn't wake up with reflux, or sore teeth from grinding. I've been off the baclofen and buspar for around 4 days now. I feel I'm salivating a lot more and my mouth is less dry. I'm also wondering if melatonin supplements can aggravate this too. I also just recently stopped taking my omega 3 supplements at night. I was suspicious of this one as well.

And 'maybe' the ashwaganda is helping. That was a recent addition (last week) and that and sucralfate have been the only things I've been taking for GERD.

Post Edited (ljk) : 9/16/2009 12:59:56 AM (GMT-6)

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