Question MLP

Skooby,

Years and years. I really don't remember -- I would guess at least five years to perhaps ten years.

It's kind of funny thinking back on it now. I didn't have much acid reflux so I didn't have any other symptoms. I had never thought to mention the choking incidents to my doctor at the annual physicals since none of them happened just before an exam. Over time I would simply adjust my lifestyle: chew longer, take caplets instead of tablets where possible, avoid steak sandwiches and other tough foods I couldn't cut first with a knife. I even had a mortar and pestle I would use on non-time released medicines from time to time. I know for a fact I had the mortar and pestle for more than five years prior to being diagnosed.

I now know it wasn't acid reflux that caused it, but eosinophilic esophagitis (ee). The acid reflux over the last few years made the most recent stricutre a little worse and made my doctor concerned as to what had changed inside my esophagus so that I had started feeling pain. I believe it was stress. I developed a small ulcer last year thanks to a problem teenage son who had to be placed in a treatment facility and I have a hiatel hernia.

My 1999 stricture was as severe as any my gastro doctor has seen. He still pulls out the photos every time I see him. However, he was able to dilate it without a problem. The biggest risk of dilation is that the esophagus is torn. My gastro doctor dilated it two or three times over a few month period in order not to tear it. Most people can have it dilated in one procedure. I also gather the risk of damage to the esophagus is small. I have had it done several times. BTW, I have recently found out the risk of damage is higher if you have ee & my gastro doctor is less likely to dilate it in the future. For you, IF dilation is needed and it's due to GERD/acid reflux, the risk of side effects is small. Ask your doctor if you're worried, but he/she will probably do it without consulting you while your under the influence of the happy juice.

I have read somewhere else that another risk is that it can stretch the LES a bit and for a couple of days afterwards worsen the acid reflux. This was written by a former patient on a website I found last year, not writen by a medical expert. My doctor said no, can't be, but I can tell you my acid reflux got VERY severe two days after my esophagus was dilated in 2005. The following evening I could swear I felt acid squirting up my esophagus as if from a squirt gun. It's very possible it happened because the original reason I get the strictures is due to ee, which increased the chances of the LES being stretched (just guessing). I have only heard of one other person complaining and I have done a lot of searching. I wouldn't worry about it.

Another thing. I mentioned elsewhere my brother also has ee and has had a series of choking incidents over the years. His gastro doctor decided not to dilate by said after all these years the stricture isn't severe. He just needs to chew more

Bottom line: I wouldn't worry too much about strictures. My experience is that if you have one, you will be dilated. Your esophagus will be sore for a few days -- not serious, a lot milder than the pain you probably have experienced with the acid reflux. I don't even remember if I was given a pain killer like after surgery. I do know that I didn't take any pain killer. You will have to eat soft foods for a few days. The biggest issue is that you will have to get scoped every so often to make sure the stricture hasn't returned. Your doctor will have to decide how often, depending on your symptoms. After the first year, I went almost five years. I'm going more often now due to the increased pain and my age (approaching 50). He wants to watch out for Barrett's.

I understand being worried about what is found. I was concerned too, especially about the possiblity I might have Barrett's. Last year before being scoped my doctor read me the riot act when I hadn't gone in right away after having more pain and still drinking soda, etc. He wanted me to take it seriously but he wound up scaring me. I suspect that the fear added to the stress and made me feel even worse. Let's face it -- the odds of something more serious being found are small and look at all the the other people who are scoped to find no major issues. Try not to worry about the various possibilites. You are doing the right thing by checking, but it's unlikely it's anything worth worrying about. And don't worry about finding a stricutre -- I don't. I'm as likely to worry about getting in a car accident on the way to be scoped!

Sorry for meandering a bit. Good luck. I'm sure it will go well.

matt

Marsha,

Despite the fact we're now convinced that I had eosinophilic esophagitis that caused the stricture, zantac helped in 1999. My stricture was actually a series of rings in my lower esophagus. When my doctor found the stricture the first time due to the choking (a sliver of nut had "bridged" the top ring "causing" the choking), he could not even get a pediatric dilater down into the stricture after removing the nut. He stopped, content to get rid of the cause of the choking. He put me on a liquid diet for two weeks and prescribed liquid Zantac since he didn't want me to take any pills and risk another incident. Two weeks later he scoped me again and was able to get the pediatric dilater down the stricture. I don't think the medical community knows enough about ee yet to say why PPI may help (at least I can't get a good explanation), but PPIs are still recommended. My gastro doctor wants me to continue to take Nexium. I'm still taking it even though I want to stop and have tried to eliminate the things I'm allergic to that might cause the ee: dust, pets and ragweed. It's been more than a year since the last dilation with very little sign of any stricture occuring. I had some close calls in the early spring, but nothing since I found out about allergens and made a better effort of keeping our bedroom clean. (There is another thread about ee -- I mentioned that allergens seem to be a cause).

I think this is similar to your experience. When the incident calmed down the stricture loosened up a bit. My impression, and it's just an impression, is that there is still some stricture after the breakthrough calms down. If it's bad enough, dilation is required. It was for me.

When I got hearburn, I did't feel any pain in the jaw but it would radiate out through my collarbones, chest and back.

One thing I found out. The GERD/acid reflux can cause a ring called Schatzki's ring. I had multiple rings. This happens more w/ ee. This isn't a determining factor in the diagnosis, but interesting anyway.

One other thing -- I have discovered that I no longer like to wear shirts with snug collars. I don't wear t-shirts as much as I used to. Shirts that rest against my outer throat bother me. Instead I wear open collar polo shirts more often. Thank heavens for business casual. Snug shirts don't bother me as much when I'm fine, such as now, but really bother me after I've had heartburn for awhile. I don't know how much of it is in my head vs. an actual physical issue.

Good luck on your endoscopy.

Matt