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Shocked - new diagnosis and prescription from a consultant gastroenterologist

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GERD & Acid Reflux
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Posted Yesterday 2:02 PM (GMT 0)
I was referred by a friend to see an experienced doctor. After hearing carefully my own description of my symptoms, he looked at my endoscopy report. He said It seemed normal to him and people like me should not have gotten this disease. The root cause of my symptoms is stress and anxiety. Somehow my brain has made my stomach behaved abnormally.

He prescribed me an anti-depressant at minimal dosage, to be taken at bedtime.
A PPI to be taken as when necessary
A stomach tranquilizer to be taken as when necessary

I would like to know, did any of you know someone who has gotten well from GERD as a result of a treatment that aims at the stress? I still have some doubts, because what he told me is so different from what other docs have said.
Posted Yesterday 4:11 PM (GMT 0)
Endoscopy findings are not necessarily indicative of what's going on. My first scope was normal but my 2nd (3 years later) was a not - yet my symptoms at both points in time were identical. So I know I'm capable of having very symptomatic GERD without the hernia, the gastritis and the oesophagitis that they say they can see now.

Also, if you were on a ppi at the time of the tests, how do they know it doesn't look normal because the drug is working well?!

If things don't go well with the new regime, maybe you'll have to push for a repeat scope when you've been off ppis for a while? However, the new approach is certainly worth a go, and if it doesn't help you can go back and tell them so! If it does work, then it'll be of great interest to those of us whose GERD just doesn't behave whilst taking ppis - so do keep us informed!!

MMM
Posted Yesterday 5:15 PM (GMT 0)
Hi WJF,

Like MMM, my endoscopies have always been normal.  I've been on PPIs and they've protected it from damage.  Just because it's not affected (because we're medicated) doesn't mean that you're not suffering from reflux.

That's my experience at least.

Good luck!  Hey, give it a try and see if that approach works for you! 

Take care,

Denise

Posted Yesterday 5:21 PM (GMT 0)
It has been a revelation to me that the medical science does not yet have a clear etiology on the root cause behind the transient relaxations of the LES.

In some cases, it is distension of the stomach after a meal that can cause it. In other cases, nervous system disorders or imbalances can cause it. Stress, anxiety definitely has a role to play - but I am not convinced it is the root cause. GERD is very tricky. GERD can cause anxiety which can then cause the GERD to get worse. So, the cause and effect can get all intertwined.

Vagus nerve controls various functions and tLESr is one of them. So in the absence of other causes (hernia, being overweight etc.), it is a good idea to target it. Antidepressants, benzos etc. do help in that regard. In my case, I can not tolerate these drugs either. So, I've been using other natural ways (yoga, meditation, therapy etc.) to calm the nerves in some way.

So, you should definitely give these drugs a try and see where you land. I do know a person in my town who got better once his job became less stressful.
Posted Yesterday 5:37 PM (GMT 0)
PPI,

I agree that there is no way that stress is the root cause of reflux.  If your anatormy is already set up for GERD or LPR, then stress, anxiety, and emotional angst, can just get it revved up, that's all. 

Best wishes,

Denise

Posted Yesterday 6:19 PM (GMT 0)
Stess at work definitely brought on my GERD. I went from eating anything I wanted in Jan 2011, to GERD with severe gastritis in March, and Barretts's esophagitis in July. The stress at work was significantly reduced by June or so, but I still am working on my better health in regard to these conditions. Before I developed these conditions I ate mostly high-quality food, exercised regularly, and was of normal weight.

Another thread mentioned using elavil for LPR symptoms, this approach is not unheard of. The docs using traditional approaches definitely don't have the answer for many of us.
Posted 12/7/2011 2:38 AM (GMT 0)
An update.

I have stopped taking PPI and switched to anti-depressant for 6 days. Strangely my GERD has gone into remission. I haven't experienced heartburn nor reflux, not even a minor irritation. I shall watch out for any rebound for another 8 days. But it seems the doctor's diagnosis is correct so far. All the while, I have been under the wrong diagnosis and medications by other gastro doctors. The PPI may have resulted in stomach distention (it wants acid but acid was suppressed) leading to malfunctioning of the LES? My goodness........ I can't believe this.

I still have very tough time at night due to insomnia and panic attacks. But I am positive they will resolve.
Posted 12/7/2011 2:55 AM (GMT 0)
Excellent news WJF!

Which anti-depressant are you on?
Posted 12/7/2011 3:54 AM (GMT 0)
Lexapro at a minimal dosage - 5mg nightly
Posted 12/8/2011 1:10 PM (GMT 0)
Great news for you WJF.

I am also on a low dose anti-depressant. Mine is desipramine, but I have heard SSRI's like the one you are taking are good for functional heartburn and hypersensitive esophagus as well. This is what I am currently being treated for...I haven't had luck yet but keep in mind that your prescription there may be a standard one for functional heartburn and hypersensitive esophagus as well, so that may be the route it is working through. It might not be the stress itself, but the increased nerve sensitivity (or something similar), that the drug is helping with.

Either way, great news for you! Hope it continues to work well.
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