My email to my GI:
Thank you for responding to my concerns. I am glad to hear that Barrett's was ruled out both in 2010 and 2011. Eases my mind considerably.
Questions:
a) Can I then assume that the intense pain, mostly on eating, that started fairly recently can be attributed to the chronic inflammation of my esophagus?
b) Is the inflammation made chronic by the reflux of acids (which clearly are not controlled by a loose wrap)?
c) PPIs have been isolated as one of the possible causes of MC, and also to make MC worse and not allow healing to happen. Can the fact that I stopped taking them be the cause of the inflammation, the pain and the continued GERD?
Could rebound be causing the pain?
d) Is there anything I can do to relieve the GERD/pain? (Other than PPIs)
e) Can Barrett's develop within a year? Am I safe since I have been ruled free of Barrett's a year ago? Is there a point where the symptoms would prompt a new endoscopy?
His reply to me:
Studies regarding association between PPI and MC are not conclusive. Some studies report an association , the most quoted is from A pharmacology journal. But this was A small study Was flawed by the method by which selection of control patients was made. A study From University of Pennsylvania did not find an association. The answer to your question I would conclude cannot be answered with available information.
Patients with continue symptoms of pain that Is suggestive of esophageal origin but in which the endoscopic findings do not find esophagitis due to reflux and the pain continues inspite of acid suppression is poorly understood. Current explanation is that there Occurs A separation of the tight junctions Between the cells of the esophagus that Allows for irritation of nerve endings that lie below the mucosa. These nerves are then changed so that they Are hypersensitive , similar To a neuropathy.
No One knows how long It Takes Barrett's to develop but is believed to be at least 10 years
someone who Has reflux for 10 years And no Barrett's It is always possible that going forward into the future that They could Develop Barrett's, even one year after A negative EGD. A repeat EGD would always be indicated if bleeding occurs, a change In symptoms occurred, or if difficulty swallowing were to develop.
Hypersensitivity of the esophagus is not A condition where there is agreement as To what Causes it And less As far As treatment . Usual medications That Are tried Are tricyclic antidepressants Because They can assuage the pain of neuropathy.
Any ideas?
BTW I am already taking a tricyclic antidepressant. I am waiting to hear if I should increase this since I have almost completely stopped taking the Norco, though I can't do much.
More questions...
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Well, I can't fault anything that he said, because it's true that there is no proof that any medications can cause MC - all the studies are based on associations, not double-blind, random trials. Of course, there is no proof that those medications do not cause MC, either. Medical research is very selective, and overall, very limited, as far as actual scientific proof of anything, is concerned.
I wasn't aware that the esophagus can be "leaky", also, but it certainly stands to reason that it might, since the rest of the GI tract can have increased permeability that causes issues, so I wouldn't question that observation. And he's right in pointing out that little is known about hypersensitivity of the esophagus. The truth is, little is known about the entire GI tract, when you get down to it.
As far as medications suitable for treatments are concerned, I don't have a clue. These are uncharted waters, because as far as I'm aware, any medication options available, have been associated with MC, and/or other health issues.
All in all, I thought that was a good response, even though it wasn't very helpful. Of course his point is, there are no good solutions.
Tex
I wasn't aware that the esophagus can be "leaky", also, but it certainly stands to reason that it might, since the rest of the GI tract can have increased permeability that causes issues, so I wouldn't question that observation. And he's right in pointing out that little is known about hypersensitivity of the esophagus. The truth is, little is known about the entire GI tract, when you get down to it.
As far as medications suitable for treatments are concerned, I don't have a clue. These are uncharted waters, because as far as I'm aware, any medication options available, have been associated with MC, and/or other health issues.
All in all, I thought that was a good response, even though it wasn't very helpful. Of course his point is, there are no good solutions.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
For some reason I thought that the research shows PPIs as being a cause of MC. Did I understand wrong? (not unusual!)
So in order to control this - should I go back on PPIs?
I have had reflux for more than 10 years, and the specific pain in the esophagus did start a while after the last endoscopy. It hurts to swallow, and the pain is all the way down. Wouldn't that suggest the need for another endoscopy?
So in order to control this - should I go back on PPIs?
I have had reflux for more than 10 years, and the specific pain in the esophagus did start a while after the last endoscopy. It hurts to swallow, and the pain is all the way down. Wouldn't that suggest the need for another endoscopy?
PPIs are indeed a cause of MC, and various other problems, (including, but not limited to, leaky gut, osteoporosis, an increased risk of C. diff, etc.), but all the evidence is empirical. No one has ever done a double blind, controlled trial, to prove it, and they never will. That's for sure - who would pay for it? The pharmaceutical companies are never going to spend one penny to prove that a drug might cause problems, (but they will sometimes go to extremes to cover up such data).
Tex
If that's a new symptom since the last exam, then yes, that would suggest the need for another endoscopy exam.Lesley wrote:It hurts to swallow, and the pain is all the way down. Wouldn't that suggest the need for another endoscopy?
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I have no personal experience on this issue, but was just talking to someone at work that was told 6 months ago that he has Barretts. He has been drinking aloe juice every day and just went in to have his endoscopy redone and the dr asked him what he was doing, said he could see clear signs of emprovement and to keep doing whatever it was he was doing.
Don't know if it will give any immediate relief and I am not sure how much or how often he does this, although he did started this at the suggestion of his local health food store.
Don't know if it will give any immediate relief and I am not sure how much or how often he does this, although he did started this at the suggestion of his local health food store.
So...I need to persuade him to do another endoscopy and drink aloe juice. I remember that suggestion somewhere but I forgot all about it.
Are you saying I can't argue the meds problem since there is no definitive research? Back on PPIs? I SO don't want to. But how do I stop having this horrible GERD? How do I get away from sugar, which I KNOW is doing me harm?
Oh, I am SO confused. I don't know what to do.
Are you saying I can't argue the meds problem since there is no definitive research? Back on PPIs? I SO don't want to. But how do I stop having this horrible GERD? How do I get away from sugar, which I KNOW is doing me harm?
Oh, I am SO confused. I don't know what to do.
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Gabes-Apg
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Lesley
Have you tried the Vit D? are you taking any anti-histamine medication.
after i eliminated the chronic GERD via the Vit D, eating/drinking habits, sleeping on left hand side in November last year, it only become chronic again when i had the histamine issues. IF i take the antihistamines (H1 and H2) every day i dont have GERD.
Have you tried the Vit D? are you taking any anti-histamine medication.
after i eliminated the chronic GERD via the Vit D, eating/drinking habits, sleeping on left hand side in November last year, it only become chronic again when i had the histamine issues. IF i take the antihistamines (H1 and H2) every day i dont have GERD.
Gabes Ryan
"Anything that contradicts experience and logic should be abandoned"
Dalai Lama
"Anything that contradicts experience and logic should be abandoned"
Dalai Lama
Hi Gabes,
Yes, I am taking 5000 units of Vit D split into am and PM. I am taking both the antihistamines as per your advice. I still have the GERD. I think, though, it's from Barrett's, but it's unconfirmed. I don't know what is going to get this under control, and I am afraid I won't be able to reach remission given all these problems.
I will wait for the MRT results, and try again.
Thanks so much for your caring.
Yes, I am taking 5000 units of Vit D split into am and PM. I am taking both the antihistamines as per your advice. I still have the GERD. I think, though, it's from Barrett's, but it's unconfirmed. I don't know what is going to get this under control, and I am afraid I won't be able to reach remission given all these problems.
I will wait for the MRT results, and try again.
Thanks so much for your caring.
Lesley,
I don't know this for a fact, because there isn't any research that I'm aware of that investigates this, but as far as I can tell, PPIs do not stop or even slow down acid reflux. What they do is to prevent the stomach from producing gastric acid, by modifying the parietal cells in the stomach. So the reflux continues, but it's less harmful, because the pH of the stomach contents is higher, (and therefore, less acidic).
Actually, this process appears to make reflux more likely than before, because it removes the main element that induces the LES to stay closed - namely a low pH on the bottom side of the LES. With weakened stomach acid, the digestion of food slows down, (slowing down motility), and the risk of a food-borne bacterial infection increases. This will, however, reduce the risk of burning the esophagus, because even though it will still be regularly washed with stomach contents, they will be less acidic, if a PPI is used.
Tex
I don't know this for a fact, because there isn't any research that I'm aware of that investigates this, but as far as I can tell, PPIs do not stop or even slow down acid reflux. What they do is to prevent the stomach from producing gastric acid, by modifying the parietal cells in the stomach. So the reflux continues, but it's less harmful, because the pH of the stomach contents is higher, (and therefore, less acidic).
Actually, this process appears to make reflux more likely than before, because it removes the main element that induces the LES to stay closed - namely a low pH on the bottom side of the LES. With weakened stomach acid, the digestion of food slows down, (slowing down motility), and the risk of a food-borne bacterial infection increases. This will, however, reduce the risk of burning the esophagus, because even though it will still be regularly washed with stomach contents, they will be less acidic, if a PPI is used.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Wow! You get up early.
So Tex, are you saying at this point you would go back to using a PPI? Would it be less harmful to do so?This will, however, reduce the risk of burning the esophagus, because even though it will still be regularly washed with stomach contents, they will be less acidic, if a PPI is used.
And another question - I have to redo the blood test for mast cells. Should I stop the antihistamines before doing so? How many days?
Gabes - I didn't mean to gobsmack you! I think this is much more than just GERD now. I think it's Barrett's and that's what's burning so badly. Also, if you read my GI's answer to me you will see that he sorta, kinda explains what causes hypersensitivity, which is what he thinks it is.
Nothing is helping right now. Maybe I need to give in?
No, personally, I wouldn't take one, (unless I felt that I had no choice, such as when I was in the hospital). I believe that PPIs are just one more cruel hoax perpetrated by pharmaceutical companies and doctors on patients who have problems with acid reflux. They guarantee that most patients will come to rely on them, because the rebound effect is worse than the original symptoms. I understand the situation you're in, and if you feel that you would be better off taking one, then you have to do what you think is best. You're caught in a vicious cycle. I agree with Dr. Mercola on this one:Lesley wrote:So Tex, are you saying at this point you would go back to using a PPI? Would it be less harmful to do so?
http://articles.mercola.com/sites/artic ... -asap.aspx
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.