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Results of my recent Manometry/24hrPH and Impedence study

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Posted 11/12/2014 8:11 PM (GMT 0)
I had above tests on the 8th of last month.

Manometry showed normal esophageal and lower esophageael function.
24 hr Impedence PH monitoring showed evidence of increased total number of reflux events but these were not associated with significant reflux-symptom association.

Acid reflux was recorded in the distal esophagus for 3.4% (normal <4.2%). The total number of reflux events (acid + nonacid) was greater than the upper limit of normal (86; normal ,73) and the majority of these were acid in nature.

Out of 86 reflux events 53 were acid.


DeMeester Score is 9.37 anything below 14.72 is considered normal.

So my tests are considered normal.

My symptoms are predomenently LPR-like (sore dry throat/sour nasty taste in mouth/burning dry tongue/sinus feeling behind nose when lying down/painful full ear at times).

I had the difficulty during the test that when I get a symptom like dry sore throat and tongue it goes on and I really didn't know if I should continually press the button or just at the beginning of each episode as the doctor advised. So I don't really think the test gave a good indication of symptoms corresponding to reflux events.

Anyway I saw the consultant two weeks ago and he said that my tests showed only marginal evidence of increased total number of reflux events. But he still wanted me to go back on PPIs plus gaviscon and an H2 blocker. He seemed annoyed when I said that I find it very hard to tolerate those medications. He then suggested something like Amitryptyline or Mirtazapine as he thought that there might be some sensitivity too. He also said that he could offer some help in "altering my perception of reflux events". I thought great!! .. he thinks it's all in my head!

I most definitely have these symptoms, but am thinking that maybe they may really not be related to reflux and may be something for an ENT consultant to have a look at. The only thing with that is, then why are they related to the food I eat?? More questions than answers!... sigh

I would really appreciate your thoughts on this.

Noelle
Posted 11/12/2014 8:48 PM (GMT 0)
Hi Noelle,

it could be related to a stress and depression that you are stomach triggering with your acid. What about your lower esophageal sphincter, have they mentioned like if its weak or loose, its interesting that they told you its normal, they need to give you a specific meaning of your lower esophageal sphincter.

Sorry for asking you this but are you overweight by any chance or you are slim a good perfect body!

Do you have stress and depression by any chance?

Have they by any chance tested you for H.pylori?
Posted 11/12/2014 9:15 PM (GMT 0)
Hi ninjakiller,

Thank you for responding.

No, I don't suffer from depression or anxiety, apart from the usual anxiety that getting to the bottom of these things can cause and anxiety caused when taking PPIS. According to my manometry my LES is working fine and I'm not overweight. Also had manometry at another hospital in Autumn of last year which said the same thing.

I did have an endoscopy at the beginning of July which showed gastritis. The consultant said this would cause naseau (which I have most mornings) but not reflux. It also showed a small patch of intestinal metaplasia which they are going to keep an eye on by giving me another endoscopy in a year's time.

Take care.
Noelle
Posted 11/12/2014 10:22 PM (GMT 0)
Hi Noelle!

Actually I have sometimes anxiety even not been taking PPI for nearly 2 months now but it takes time for my stomach to get used to without PPI.

May I ask, do you drink fizzy stuff? spicy foods, chocolates, Tea and coffer, this all triggers all our symptoms as worse. Also don't even think about having cabbage juice, it will make it worse of your symptoms.

For your symptoms, do you have this problems as well: Wind pipe, bloating, excessive burping, Excessive saliva, also swallowing alot of wind, as well chest pain, farting.

Are you taking normal Gaviscon , you can try Gaviscon Double Action Liquid as to see how it would help you for while!

Its weird because those two medication you mentioned as Amitryptyline & Mirtazapine, they are related to a anti-depression but as you stated that you don't have those problems.


ENT as Ear, nose and throat, its good thing to see them, because I had ENT as well, they checked my ears and throat and nose by inserting a tiny cable with camera inside. You can get that referral from your GP.


This might be awkward but do you exercise like say everyday for running and doing abs, it really helps alot.


What did you eat when you did 24 ph monitoring: Have you tried eating any like spicy foods and orange juice and coffer, to show your activities of your acid reflux for that moment.
Posted 11/13/2014 1:24 PM (GMT 0)
Amitriptyline and Mirtazapine are often used for upper GI problems.

I don't eat any of the above.

During 24hrPH monitoring I ate spicy food and orange juice etc.
Posted 11/13/2014 2:04 PM (GMT 0)
Hi Noelle

I do know that GI try not allowing you to do procedures for Nissen Fundo, they always try for you to stay on PPI, but just tell them that is not working at all and you wish to do Nissen Fundo, you have right to decline his offer and do the surgery! Even for me PPI is not working at all and I am considering doing Surgery but I have to wait for manometry and 24ph monitoring that I have next week and to show that I have significant acid reflux, its making my life worse. You see I got Acid reflux from h.pylori that I have it for nearly two years and it created bad for my acid that produced huge amount of acid reflux that made of it! My doctor things that I have stress and depression, because of that, I tried to explain to my GP but she only took her own opinion that is right on her decision that she thinks knows that better. I have anxiety because of this Acid reflux that is destroying my life completely, making it to worry, only option is to do the surgery, be brave and demand for going nissen fundo procedure!
Posted 11/13/2014 2:07 PM (GMT 0)
For Amitriptyline , here is the NHS explains it to you what is Amitriptyline for it!

http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Mood%20Disorders&medicine=amitriptyline

and for Mirtazapine, they have a little different name its called Zispin Soltab.

http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Depression&medicine=Zispin%20Soltab&preparation=Zispin%20SolTab%2030mg%20orodispersible%20tablets
Posted 11/13/2014 7:20 PM (GMT 0)
With respect, I think you're getting a bit carried away LOL!
I have no wish to have a Nissen without the proper evidence that I need one! What I need first is a correct diagnosis for my symptoms.
Posted 11/13/2014 7:46 PM (GMT 0)
Well even myself I am not sure either what I can do is just to do the test and see what outcome would come, its just killing me, I have never experienced it in my life or thought about it, till I got this acid reflux, its really hard to deal with it!

I do apologise for that!

Have you thought to try all the tests again, many people have chance to retry all of them again!
Posted 11/15/2014 5:41 PM (GMT 0)
Hi Noelle,

I've got some similarities - I was sent for pH monitoring and manometry and told it was all normal and therefore kicked out of town by the surgeons as ineligible for surgery. They said my valve functioned normally and that I could not reflux. Also told I had visceral hypersensitivity of the oesophagus. After that I saw a GI physician (again) who said I DO have reflux and that it's a clinical diagnosis, not based on the test results of one day! I've managed on Zantac for a year until recently symptomatic again - highly likely the high stress (phobia) of impending repeat gastroscopy.

I was never offered treatment for the hypersensitivity. I very much wanted to try St Johns wort but it irritates my stomach big time - when tried in tablet form. I believe you can get a cream but I'm not sure if enough would get absorbed that way, though very willing to try for my eczema!!

It's very frustrating when you have very real symptoms and very real life/social restrictions as a result, but no pathology to back any of it up and no treatment on offer except acid suppression. I've tried extra Zantac but it has no benefit, so I do think the hypersensitivity, which itself comes as a result of reflux, is amplifying my symptoms a lot. It's not a question of it being psychosomatic, it's that the body's response has got distorted due to having the reflux in the first place!

MMM
Posted 11/15/2014 5:49 PM (GMT 0)

mudmagnetmum said...
Hi Noelle,

I've got some similarities - I was sent for pH monitoring and manometry and told it was all normal and therefore kicked out of town by the surgeons as ineligible for surgery. They said my valve functioned normally and that I could not reflux. Also told I had visceral hypersensitivity of the oesophagus. After that I saw a GI physician (again) who said I DO have reflux and that it's a clinical diagnosis, not based on the test results of one day! I've managed on Zantac for a year until recently symptomatic again - highly likely the high stress (phobia) of impending repeat gastroscopy.

I was never offered treatment for the hypersensitivity. I very much wanted to try St Johns wort but it irritates my stomach big time - when tried in tablet form. I believe you can get a cream but I'm not sure if enough would get absorbed that way, though very willing to try for my eczema!!

It's very frustrating when you have very real symptoms and very real life/social restrictions as a result, but no pathology to back any of it up and no treatment on offer except acid suppression. I've tried extra Zantac but it has no benefit, so I do think the hypersensitivity, which itself comes as a result of reflux, is amplifying my symptoms a lot. It's not a question of it being psychosomatic, it's that the body's response has got distorted due to having the reflux in the first place!

MMM

Was your ph test an impedance? Your reply admittedly has me a bit worried-!
Posted 11/15/2014 11:19 PM (GMT 0)
I'm not sure - I had to swallow a tube (took three goes due to the pain it caused in my throat), and then measurements were taken whilst I swallowed sips of water. The tube was taken out and replaced with another that was left in for 24 hours. It was a bit of an ordeal, quite painful too, so I don't remember everything they did. I was told to record times and durations of symptoms but there were no buttons to press and the form didn't ask about activity except to record time of going to bed and rising. I was off medication and symptomatic, as active as I could be and yet it showed nothing - I was NOT pleased!!

MMM
Posted 11/15/2014 11:31 PM (GMT 0)
PS: I was told not to drink any fizzy drinks, even carbonated water, which ruled out one trigger!
Posted 11/16/2014 11:55 AM (GMT 0)

mudmagnetmum said...
Hi Noelle,

I've got some similarities - I was sent for pH monitoring and manometry and told it was all normal and therefore kicked out of town by the surgeons as ineligible for surgery. They said my valve functioned normally and that I could not reflux. Also told I had visceral hypersensitivity of the oesophagus. After that I saw a GI physician (again) who said I DO have reflux and that it's a clinical diagnosis, not based on the test results of one day! I've managed on Zantac for a year until recently symptomatic again - highly likely the high stress (phobia) of impending repeat gastroscopy.

I was never offered treatment for the hypersensitivity. I very much wanted to try St Johns wort but it irritates my stomach big time - when tried in tablet form. I believe you can get a cream but I'm not sure if enough would get absorbed that way, though very willing to try for my eczema!!

It's very frustrating when you have very real symptoms and very real life/social restrictions as a result, but no pathology to back any of it up and no treatment on offer except acid suppression. I've tried extra Zantac but it has no benefit, so I do think the hypersensitivity, which itself comes as a result of reflux, is amplifying my symptoms a lot. It's not a question of it being psychosomatic, it's that the body's response has got distorted due to having the reflux in the first place!

MMM


Hi MMM,
I am sorry to read that your are symptomatic again. It's so hard to know exactly what role anxiety plays in our symptoms. I had huge stress in my life at times in the past, but it never affected my digestion in any way. So I find it hard to believe that it may now play some part in it. But what do I know? What you said about "It's not a question of it being psychosomatic, it's that the body's response has got distorted due to having the reflux in the first place" makes a lot of sense!

Last Winter my doctor referred me to another hospital to have a fresh pair of eyes look at my symptoms. Whilst waiting for the appointment I had a big decrease in symptoms in April, May and June which was great. I felt I could actually live with this. I was tentatively introducing more foods back into my diet. Interestingly I hadn't taken any PPIs since February and slowly slowly I thought I was getting better.

Anyway in the meanwhile this new gastro that I finally saw in early June suggested I have an endoscopy and Ph/Impedence study done. So on the 2nd of July I had the endoscopy, after which I had abdominal pain for a couple of days. Then my symptoms returned. I don't know if it was the endoscopy which upset my stomach or what, but they took 3 or 4 biopsies, so perhaps that's what caused it. So now I'm fearful of having any future endoscopies should my symptoms have abated and they are triggered again by this procedure.

Take care.

Noelle
Posted 11/16/2014 8:42 PM (GMT 0)
Thanks Noelle.

Thinking about it, I don't think I had an impedance test as it was about as cheap and basic a test as you could get, compared with others I've read about. I did ask about Bravo as I wanted to avoid swallowing a tube, but it's not available on the NHS where I live.

MMM
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