|
Home > Archive > Heartburn Support > March 2006 > Nissen fundoplication Surgery Last Option.....A few questions from a Power Lifter
You are viewing an archived Text-only version of the thread.
To view this thread in it's original format and/or if you want to reply to
this thread please [click here]
| Author |
Nissen fundoplication Surgery Last Option.....A few questions from a Power Lifter
|
|
| MrUsaMike 2006-02-28, 12:54 am |
| Hello Fellow Heartburn Members:
I am a 43 year old male, in relatively good health, who approximately
(4) months ago had my gallbladder removed. Since the surgery, I have
suffered from severe GERD. I have tried every combination of
prescription cocktails to stop the pain and acid reflux, which has met
with negative results. I cant stop thinking that the removal of my
gallbladder contributed to my increased acid production. I recently
concluded my 24PH test, manometry test, and a battery of other tests.
The diagnosis was severe acid reflex, especially when lying down. In
addition, I have a weak LES valve. My doctor has suggested that I have
the surgery. In researching the NF surgery, it appears that your lucky
if the valve works for 10 years before it weakens. If this is the case,
do you have to go in every few years for a tune-up? I'm 43 so that
means if I live long enough; I'll have 4-5 FE surgeries. Yikes!!!
Another question, how do I know if I am a good candidate for the
surgery? I also have a Hiatal Hernia how much of my pain/ grief that I
am suffering from is caused by my 3-5mm hernia? I compete in power
lifting competitions...Will this surgery end my career in power
lifting? I don't want to tear the stitching while doing a deadlift. I
get the feeling that my physical activity will be limited after the
surgery. Any suggestions would be greatly appreciated.
Mike
| |
| Howard McCollister 2006-02-28, 10:55 am |
|
"MrUsaMike" <mrusamike@hotmail.com> wrote in message
news:1141099273.253856.80950@t39g2000cwt.googlegroups.com...
> Hello Fellow Heartburn Members:
>
> I am a 43 year old male, in relatively good health, who approximately
> (4) months ago had my gallbladder removed. Since the surgery, I have
> suffered from severe GERD. I have tried every combination of
> prescription cocktails to stop the pain and acid reflux, which has met
> with negative results. I cant stop thinking that the removal of my
> gallbladder contributed to my increased acid production. I recently
> concluded my 24PH test, manometry test, and a battery of other tests.
> The diagnosis was severe acid reflex, especially when lying down. In
> addition, I have a weak LES valve. My doctor has suggested that I have
> the surgery. In researching the NF surgery, it appears that your lucky
> if the valve works for 10 years before it weakens. If this is the case,
> do you have to go in every few years for a tune-up? I'm 43 so that
> means if I live long enough; I'll have 4-5 FE surgeries. Yikes!!!
> Another question, how do I know if I am a good candidate for the
> surgery? I also have a Hiatal Hernia how much of my pain/ grief that I
> am suffering from is caused by my 3-5mm hernia? I compete in power
> lifting competitions...Will this surgery end my career in power
> lifting? I don't want to tear the stitching while doing a deadlift. I
> get the feeling that my physical activity will be limited after the
> surgery. Any suggestions would be greatly appreciated.
>
In a fundoplication, the stomach is wrapped on itself to reinforce the LES
and prevent it from loosening inappropriately. Unfortunately, the stomach
stretches, and as a result there is a potential for the wrap to stretch too.
This loosening of the wrap may cause a return of reflux symptoms at some
point in the future. Studies indicate that that 10 year recurrence rate is
somewhere between 10% and 30%.
The differences in those percentages are reflective of the surgeon's
technique. Patterns of recurrence have been studied and the issues are
basically understood. Unidentified shortening of the esophagus, excessive
mobilization of the esophageal supporting tissues (phrenoesophageal
ligaments), and creating too loose a fundoplication.
I assume you mean that you have a 3-5 *cm* hiatus hernia. That is fixed at
the time of surgery, but a hiatus hernia of that size raises the liflihood
that there has been esophageal shortening. This is a MAJOR element in the
contribution to recurrent reflux ("slipped" Nissen) and mandates that the
esophagus be lengthened at the time of fundoplication with a wedge
fundoplasty of the stomach. Most surgeons don't do this because it's hard,
instead they just crank down on the stomach pulling it back into the
abdominal cavity under tension. That tension is a key element of failure
down the road.
HMc
| |
| Bill Poston 2006-03-02, 12:52 pm |
| Hello,
About seven years ago I was right on the verge of making the phone
call to schedule the surgery, nisson fundoplication because I had
heartburn so bad the only thing I could eat was milk and cereal. My
esophagus was raw.
Thankfully just before I made the call I posted a plea for help just
like you did.
A guy answered my pleas and introduced me to Ginger Root Juice (GRJ)
and raising the head of my bed.
He explained that the GRJ must be obtained from freshly juiced Ginger
Root. I immediately got some Ginger Root and a JUiceMan Jr. and
started juicing Ginger. The GRJ is hot and will burn your mouth, lips,
tongue but when it goes down your esophagus it becomes a warm healing
balm. I have been taking GRJ for over 7 years now every morning a
tablespoon full sipped. After sipping the GRJ I lay down on a flat bed
and roll from side to side to keep the GRJ in the esophagus as long as
possible. When I first started I took several tablespoonfuls every day
until the esophagus began to heal. I still do it now to keep the
esophagus healed.
I had a special aluminum metal frame built to lift the head of the bed
frame up about 17"s.
Heartburn is caused by a weak LES. The LES is weakened by stomach acid
constantly being in contact with the LES. Your condition has taken
place over many years so it will probably take many years of keeping
the stomach acid off the LES.
I also have a small hiatal hernia. Millions of people have small
hiatal hernias and don't even know it. That is not the problem it is
the weakened LES.
Lifting weights is a big no-no. The sudden pressure to your diaphragm
will cause the tear in your diaphragm to continue to tear.
Please, do a google on the nisson fundoplication and read about all
the problems that most people have with this operation before you have
it done to you.
Best wishes. I will be glad to talk to you by phone 770-973-4590 if
you like.
Bill
On 27 Feb 2006 20:01:13 -0800, "MrUsaMike" <mrusamike@hotmail.com>
wrote:
>Hello Fellow Heartburn Members:
>
>I am a 43 year old male, in relatively good health, who approximately
>(4) months ago had my gallbladder removed. Since the surgery, I have
>suffered from severe GERD. I have tried every combination of
>prescription cocktails to stop the pain and acid reflux, which has met
>with negative results. I cant stop thinking that the removal of my
>gallbladder contributed to my increased acid production. I recently
>concluded my 24PH test, manometry test, and a battery of other tests.
>The diagnosis was severe acid reflex, especially when lying down. In
>addition, I have a weak LES valve. My doctor has suggested that I have
>the surgery. In researching the NF surgery, it appears that your lucky
>if the valve works for 10 years before it weakens. If this is the case,
>do you have to go in every few years for a tune-up? I'm 43 so that
>means if I live long enough; I'll have 4-5 FE surgeries. Yikes!!!
>Another question, how do I know if I am a good candidate for the
>surgery? I also have a Hiatal Hernia how much of my pain/ grief that I
>am suffering from is caused by my 3-5mm hernia? I compete in power
>lifting competitions...Will this surgery end my career in power
>lifting? I don't want to tear the stitching while doing a deadlift. I
>get the feeling that my physical activity will be limited after the
>surgery. Any suggestions would be greatly appreciated.
>
>Mike
Bill Poston
To reply correct [at] and [dot]
| |
|
| Bill Poston wrote:
> Hello,
>
> About seven years ago I was right on the verge of making the phone
> call to schedule the surgery, nisson fundoplication because I had
> heartburn so bad the only thing I could eat was milk and cereal. My
> esophagus was raw.
>
> Thankfully just before I made the call I posted a plea for help just
> like you did.
>
> A guy answered my pleas and introduced me to Ginger Root Juice (GRJ)
> and raising the head of my bed.
>
> He explained that the GRJ must be obtained from freshly juiced Ginger
> Root. I immediately got some Ginger Root and a JUiceMan Jr. and
> started juicing Ginger. The GRJ is hot and will burn your mouth, lips,
> tongue but when it goes down your esophagus it becomes a warm healing
> balm. I have been taking GRJ for over 7 years now every morning a
> tablespoon full sipped. After sipping the GRJ I lay down on a flat bed
> and roll from side to side to keep the GRJ in the esophagus as long as
> possible. When I first started I took several tablespoonfuls every day
> until the esophagus began to heal. I still do it now to keep the
> esophagus healed.
>
> I had a special aluminum metal frame built to lift the head of the bed
> frame up about 17"s.
>
> Heartburn is caused by a weak LES. The LES is weakened by stomach acid
> constantly being in contact with the LES. Your condition has taken
> place over many years so it will probably take many years of keeping
> the stomach acid off the LES.
Bill...isn't this a contradiction. How are you going to keep the stomach
acid off the LES for many years (as you say), unless you fix the LES, to
prevent the stomach acid from refluxing. Please explain your logic
here...Pete
>
> I also have a small hiatal hernia. Millions of people have small
> hiatal hernias and don't even know it. That is not the problem it is
> the weakened LES.
>
> Lifting weights is a big no-no. The sudden pressure to your diaphragm
> will cause the tear in your diaphragm to continue to tear.
>
> Please, do a google on the nisson fundoplication and read about all
> the problems that most people have with this operation before you have
> it done to you.
>
> Best wishes. I will be glad to talk to you by phone 770-973-4590 if
> you like.
>
> Bill
>
>
> On 27 Feb 2006 20:01:13 -0800, "MrUsaMike" <mrusamike@hotmail.com>
> wrote:
>
>
> Bill Poston
>
> To reply correct [at] and [dot]
| |
| Bill Poston 2006-03-02, 5:54 pm |
| On Thu, 2 Mar 2006 15:00:06 -0500, "Pete" <pete@nospam.net> wrote:
>
>Bill...isn't this a contradiction. How are you going to keep the stomach
>acid off the LES for many years (as you say), unless you fix the LES, to
>prevent the stomach acid from refluxing. Please explain your logic
>here...Pete
>
No contradiction. Just use gravity to keep the acid down in the
stomach like sleeping on a bed with the head raised. Some people even
go to the extreme and sleep in a recliner. Others sleep propped up in
a corner. Anything to keep the esophagus upright. You can demonstrate
this procedure with a half-full bottle of water. Hold the bottle
upright and no water reaches the top. Lean the bottle over to one side
and as it leans over further and further you can see the water reach
the top. The acid in your stomach works the same way. Gravity does the
trick.
The stomach refluxes up onto the esophagus from poor posture, laying
down early after eating and eating too large meals.
Others attempt to do this incorrectly by propping the head up with a
several pillows. This does not do the job correctly. Propping just the
head up actually causes more pressure on the LES and thereby allowing
acid to reflux.
For the procedure to work the person must lie down flat with the head
of the bed raised.
And, it's a dual procedure. Keep the acid off the esophagus and
simultaneously sip the GRJ to heal the esophagus.
It does work but it takes time and actually you have to maintain
keeping the acid off the LES for the rest of your life.
There is no easy 'magic pill' or procedure to do it in a few days,
weeks or even years. I took the GRJ about three years and tried
several times to stop taking it and each time I had reflux again so I
finally just take the GRJ every day and sleep on the raised bed every
night except for a few times when I travel. Even then I try to prop up
the mattress as much as I can.
I hope this helps. I know it works because it worked for me.
Nothing strange or exotic about this. Just common sense and being
willing to do it continuously.
Good luck.
Bill Poston
To reply correct [at] and [dot]
| |
|
| Bill Poston wrote:
> On Thu, 2 Mar 2006 15:00:06 -0500, "Pete" <pete@nospam.net> wrote:
>
>
>
>
> No contradiction. Just use gravity to keep the acid down in the
> stomach like sleeping on a bed with the head raised. Some people even
> go to the extreme and sleep in a recliner. Others sleep propped up in
> a corner. Anything to keep the esophagus upright. You can demonstrate
> this procedure with a half-full bottle of water. Hold the bottle
> upright and no water reaches the top. Lean the bottle over to one side
> and as it leans over further and further you can see the water reach
> the top. The acid in your stomach works the same way. Gravity does the
> trick.
Bill...I am an engineer and you don't have to explain the principles of
pressure heads or liquids achieving the levels they do. I don't buy this in
totality. Granted, raising the head of your bed (which I do) will help
(from a pure gravity and spillover effect) nightly reflux of liquid type
reflux, but there are also acidic gaseous fumes that go up the esophagus.
Plus raising your bed will not solve everyones problem necessarily for the
more severe cases. Hell, some people have reflux emissions all through the
day, and their reflux can be worse during the day, even though they are not
laying down.
As far the ginger, I have commented it on before (along with our doctor in
the group) in the "apple vinegar work?" thread, not to far above this
thread. But if your teatment methods work for you, good for you and I wish
you the very best...Pete
> The stomach refluxes up onto the esophagus from poor posture, laying
> down early after eating and eating too large meals.
>
> Others attempt to do this incorrectly by propping the head up with a
> several pillows. This does not do the job correctly. Propping just the
> head up actually causes more pressure on the LES and thereby allowing
> acid to reflux.
>
> For the procedure to work the person must lie down flat with the head
> of the bed raised.
>
> And, it's a dual procedure. Keep the acid off the esophagus and
> simultaneously sip the GRJ to heal the esophagus.
>
> It does work but it takes time and actually you have to maintain
> keeping the acid off the LES for the rest of your life.
>
> There is no easy 'magic pill' or procedure to do it in a few days,
> weeks or even years. I took the GRJ about three years and tried
> several times to stop taking it and each time I had reflux again so I
> finally just take the GRJ every day and sleep on the raised bed every
> night except for a few times when I travel. Even then I try to prop up
> the mattress as much as I can.
Bill...you have made a misstatement here. The ginger has nothing to do with
stopping the reflux, as I am sure you know. The reflux is a physical
phenomena which is a result of weak valves and presure differentials to put
it simply. Modifying the nature of the refluxate (like our doctor Howard
always says), is another matter..Pete
>
> I hope this helps. I know it works because it worked for me.
>
> Nothing strange or exotic about this. Just common sense and being
> willing to do it continuously.
>
> Good luck.
>
>
>
>
>
>
> Bill Poston
>
> To reply correct [at] and [dot]
| |
| Howard McCollister 2006-03-03, 12:53 am |
|
"Pete" <pete@nospam.net> wrote in message
news:120f4s0f6ress2e@corp.supernews.com...
> Bill Poston wrote:
>
> Bill...I am an engineer and you don't have to explain the principles of
> pressure heads or liquids achieving the levels they do. I don't buy this
> in totality. Granted, raising the head of your bed (which I do) will help
> (from a pure gravity and spillover effect) nightly reflux of liquid type
> reflux, but there are also acidic gaseous fumes that go up the esophagus.
> Plus raising your bed will not solve everyones problem necessarily for the
> more severe cases. Hell, some people have reflux emissions all through
> the day, and their reflux can be worse during the day, even though they
> are not laying down.
Gravity is only one part of the issue, and a relatively small one at that.
The problem is indeed pressure heads.While gravity does contribute in that
regard, its contribution is small, especially compared to the effect of
increased intraabdominal pressure from, say, the simple act of tying your
shoelaces.
Ginger root, like most homeopathic nostrums (nostra?) has no proven benefit
in the treatment of GERD. I can assure you that if it did, the giant
worldwide pharma conspiracy would be all over it. Having said that, it won't
cause any harm, so if, by some quirk of anecdotal evidence, it works for
you...go for it.
HMc
| |
| Tim J. 2006-03-03, 12:53 am |
| On Thu, 02 Mar 2006 12:57:03 -0500, Bill Poston
<poston8[at]comcast[dot]net> wrote:
>Please, do a google on the nisson fundoplication and read about all
>the problems that most people have with this operation before you have
>it done to you.
Maybe it depends on the surgeon. The only regret I have about my NF
is that I didn't have it done sooner. I'm now almost 7 years without
a single reflux incident. I was having between 100-200 a day, every
day pre-op.
| |
| Tim J. 2006-03-03, 12:53 am |
| On Thu, 2 Mar 2006 19:53:15 -0500, "Pete" <pete@nospam.net> wrote:
>Bill Poston wrote:
>
>Bill...I am an engineer and you don't have to explain the principles of
>pressure heads or liquids achieving the levels they do. I don't buy this in
>totality. Granted, raising the head of your bed (which I do) will help
>(from a pure gravity and spillover effect) nightly reflux of liquid type
>reflux, but there are also acidic gaseous fumes that go up the esophagus.
>Plus raising your bed will not solve everyones problem necessarily for the
>more severe cases. Hell, some people have reflux emissions all through the
>day, and their reflux can be worse during the day, even though they are not
>laying down.
Indeed. Pre-op, lying flat on my back was the *only* sure fire,
instant cure for my reflux. I never had a reflux incident lying down,
only when up and active. I even had to fire a doctor because he
refused to believe it. He kept insisting I raise the head of my bed,
which wouldn't have done any good anyways, since it is a waterbed.
| |
|
| Tim J. wrote:
> On Thu, 2 Mar 2006 19:53:15 -0500, "Pete" <pete@nospam.net> wrote:
>
>
> Indeed. Pre-op, lying flat on my back was the *only* sure fire,
> instant cure for my reflux. I never had a reflux incident lying down,
> only when up and active. I even had to fire a doctor because he
> refused to believe it. He kept insisting I raise the head of my bed,
> which wouldn't have done any good anyways, since it is a waterbed.
Good info Tim...here's a little levity for you and the ng (don't know if you
have been reading any of my posts recently). Out of all of my breakups with
bad doctors, I have fired them about one third of the time, they have fired
me about one third of the time, and we have mutually fired each other about
one third of the time - lol . Take care...Pete
| |
| Preesi 2006-03-22, 1:31 pm |
| Tim J. wrote:
> On Thu, 02 Mar 2006 12:57:03 -0500, Bill Poston
> <poston8[at]comcast[dot]net> wrote:
>
>
> Maybe it depends on the surgeon. The only regret I have about my NF
> is that I didn't have it done sooner. I'm now almost 7 years without
> a single reflux incident. I was having between 100-200 a day, every
> day pre-op.
How much does it cost and who is eligible?
--
preesi
~~~~~~~~~
The only thing worse then Mom Jeans, is Mom Jeans on Men!
~~~~~~~~~
My Websites and Favorite Links: http://tinyurl.com/yvw45
Yahoo/SidekickII Name: MissPreesi
Skype: Preesi
| |
| Preesi 2006-03-22, 1:31 pm |
| Tim J. wrote:
> On Thu, 02 Mar 2006 12:57:03 -0500, Bill Poston
> <poston8[at]comcast[dot]net> wrote:
>
>
> Maybe it depends on the surgeon. The only regret I have about my NF
> is that I didn't have it done sooner. I'm now almost 7 years without
> a single reflux incident. I was having between 100-200 a day, every
> day pre-op.
Did you have green mucous coming from your nose and throat every morning
pre-op?
Did you feel like you had the flu?
--
preesi
~~~~~~~~~
The only thing worse then Mom Jeans, is Mom Jeans on Men!
~~~~~~~~~
My Websites and Favorite Links: http://tinyurl.com/yvw45
Yahoo/SidekickII Name: MissPreesi
Skype: Preesi
| |
| Tim J. 2006-03-22, 1:31 pm |
| On Wed, 8 Mar 2006 09:58:46 -0500, "Preesi" <preesi@comcast.net>
wrote:
>Tim J. wrote:
>
>How much does it cost and who is eligible?
In 1998, the surgeon cost about $2,500, the hospital stay (2 nights)
was around $16,000. As far as eligibility, my GI doc made the
decision. He wanted to do a 24hr pH study, but I have an extremely
sensitive gag reflex. So he opted for me drinking orange juice with a
radioactive marker in it, and we got pictures of the reflux incidents
on x-ray films. The surgeon was satisfied and did the surgery based
on those results.
| |
| Tim J. 2006-03-22, 1:31 pm |
| On Wed, 8 Mar 2006 10:39:31 -0500, "Preesi" <preesi@comcast.net>
wrote:
>Tim J. wrote:
>
>
>Did you have green mucous coming from your nose and throat every morning
>pre-op?
>Did you feel like you had the flu?
No, it was just a severe burning sensation in my esophagus. When the
doctor scoped me, he said he'd never seen one that raw and irritated.
but I never had any strange colored fluids leaking from any openings
and didn't have any flu-like symptoms.
| |
| Howard McCollister 2006-03-22, 1:31 pm |
|
"Tim J." <tj66821@usa.not> wrote in message
news:1b2v02tqe8fov6kd85uut4b6su9j85ogf8@4ax.com...
> In 1998, the surgeon cost about $2,500, the hospital stay (2 nights)
> was around $16,000. As far as eligibility, my GI doc made the
> decision. He wanted to do a 24hr pH study, but I have an extremely
> sensitive gag reflex. So he opted for me drinking orange juice with a
> radioactive marker in it, and we got pictures of the reflux incidents
> on x-ray films. The surgeon was satisfied and did the surgery based
> on those results.
>
Catheter-based ambulatory pH testing can indeed be uncomfortable because of
the 24 hours the patient must walk around with a small tube coming out of
their nose. We abandoned that a few years ago in favor of Medtronic's Bravo
system, which uses no catheter and is more accurate.
Look at http://www.medtronic.com/neuro/gerd/whatisBravo.html
Catheter-based pH testing is still done in some cases, where impedance-based
testing is important. This method is most appropriate in cases where
non-acid reflux events are suspected as the cause of symptoms in the
acid-supressed patient - eg the patient who still has symptoms even while on
PPI's.
For information of non-acid reflux and the rationale for multichannel
intraluminal impedance testing, look at
http://www.google.com/search?hl=en&...eflux+impedance
HMc
| |
|
| Howard McCollister wrote:
> "Tim J." <tj66821@usa.not> wrote in message
> news:1b2v02tqe8fov6kd85uut4b6su9j85ogf8@4ax.com...
>
>
> Catheter-based ambulatory pH testing can indeed be uncomfortable
> because of the 24 hours the patient must walk around with a small
> tube coming out of their nose. We abandoned that a few years ago in
> favor of Medtronic's Bravo system, which uses no catheter and is more
> accurate.
> Look at http://www.medtronic.com/neuro/gerd/whatisBravo.html
>
>
>
> Catheter-based pH testing is still done in some cases, where
> impedance-based testing is important. This method is most appropriate
> in cases where non-acid reflux events are suspected as the cause of
> symptoms in the acid-supressed patient - eg the patient who still has
> symptoms even while on PPI's.
>
> For information of non-acid reflux and the rationale for multichannel
> intraluminal impedance testing, look at
> http://www.google.com/search?hl=en&...eflux+impedance
>
> HMc
Howard...I checked a bunch of sites on the "non acid reflux impedance"
google and it was not clear to me what was going on. There was a lot of
referring to "simultaneous impedence testing with 24 hour ph testing" (as if
if there were two different probes, but I doubt that - dunno, very
confusing - also saw something about two different wires). Are 24 hour
catheter based ph tests inherently "impedence tests" by definition, and if
so what was all the talk about "simultaneous impedence testing".
The 24 hour ph test I had in Baltimore in Jan 2005 was a "dual channel study
on therapy, 15 cm between sensors, with the distal sensor placed in the
stomach, and the proximal sensor located 5 cm above the LES". I also had
the manometry before the ph probe was put in.
Was my 24 hour ph test an impedence test...Pete
| |
| Howard McCollister 2006-03-22, 1:31 pm |
|
"Pete" <pete@nospam.net> wrote in message
news:121169jh1s5e5da@corp.supernews.com...
> Howard McCollister wrote:
>
> Howard...I checked a bunch of sites on the "non acid reflux impedance"
> google and it was not clear to me what was going on. There was a lot of
> referring to "simultaneous impedence testing with 24 hour ph testing" (as
> if if there were two different probes, but I doubt that - dunno, very
> confusing - also saw something about two different wires). Are 24 hour
> catheter based ph tests inherently "impedence tests" by definition, and if
> so what was all the talk about "simultaneous impedence testing".
>
> The 24 hour ph test I had in Baltimore in Jan 2005 was a "dual channel
> study on therapy, 15 cm between sensors, with the distal sensor placed in
> the stomach, and the proximal sensor located 5 cm above the LES". I also
> had the manometry before the ph probe was put in.
>
> Was my 24 hour ph test an impedence test...Pete
No, almost certainly not. Your test was simply a two-channel pH test with a
sensor 6 cm above the LES, and another one just below the UES, recording
only acid events via an antimony sensor in the catheter.
The concept of non-acid reflux events as a significant cause of GERD
symptoms is relatively new, but the data is compelling. Conventional pH
testing uses only an acid-sensing electrode and only records pH data, with
the idea that any pH value less than 4.0 is a reflux event. Doctors began
noticing that some people were having significant symptoms of GERD even
while on appropriate doses of PPIs, with complete suppression of acid. When
conventional pH testing was done then, it showed no reflux episodes of pH
less than 4.0 in the esophagus. The intital impression of doctors then (an
even now, for the most part) is that the patient's symptoms must be due to
something else other than GERD. Their reflux events weren't being recorded
or scored as reflux events because it was now *non-acid* reflux. The advent
of MII uses impedance changes to show reflux rather than just acid reflux.
As an engineer, you certainly are familiar with the concept that Ohm's law
applies to several other models beyond basic electricity. The impedance
catheters allow us to determine whether or not the refluxate is coming down
from the mouth (such as swallowing orange juice) or up from the stomach. If
a reflux event is recorded coming up from the stomach and the pH isn't below
4, and the patient records pain in their diary at that time, it's a non-acid
event. As I have stated many times here, PPI's don't stop reflux, they only
change the nature of the refluxate. We've known for years that non-acid
reflux can still damage the esophagus, but now MII can let us correlate
non-acid reflux with symptoms. A light bulb came on in my head as I was
chatting about this with Don Castell (gastroenterologist guru of acid
reflux) a couple of years ago, and it explained all those patients we all
have that have significant GERD symptoms despite very high doses of PPI and
normal pH tests, yet still have disabling symptoms. It also explains, at
least in part, why the incidence of esophageal cancer isn't decreasing
despite very effective acid-suppressing medication in the 25+ years since
Tagamet first hit the market with a roar.
HMc
| |
|
| Howard McCollister wrote:
> "Pete" <pete@nospam.net> wrote in message
> news:121169jh1s5e5da@corp.supernews.com...
>
>
> No, almost certainly not. Your test was simply a two-channel pH test
> with a sensor 6 cm above the LES, and another one just below the UES,
> recording only acid events via an antimony sensor in the catheter.
Howard...You must have misread what I wrote (it was a direct quote from my
ambulatory ph procedure report). The distal sensor for my test was placed
in my *stomach* and the proximal sensor was 5 cm above the LES (ie the
distal sensor was checking stomach ph, not the esophagus). I did not have a
sensor just below the UES. Please comment on this...Pete
>
> The concept of non-acid reflux events as a significant cause of GERD
> symptoms is relatively new, but the data is compelling. Conventional
> pH testing uses only an acid-sensing electrode and only records pH
> data, with the idea that any pH value less than 4.0 is a reflux
> event. Doctors began noticing that some people were having
> significant symptoms of GERD even while on appropriate doses of PPIs,
> with complete suppression of acid. When conventional pH testing was
> done then, it showed no reflux episodes of pH less than 4.0 in the
> esophagus. The intital impression of doctors then (an even now, for
> the most part) is that the patient's symptoms must be due to
> something else other than GERD. Their reflux events weren't being
> recorded or scored as reflux events because it was now *non-acid*
> reflux. The advent of MII uses impedance changes to show reflux
> rather than just acid reflux. As an engineer, you certainly are
> familiar with the concept that Ohm's law applies to several other
> models beyond basic electricity. The impedance catheters allow us to
> determine whether or not the refluxate is coming down from the mouth
> (such as swallowing orange juice) or up from the stomach.
Howard...I don't understand what you mean by this (ie down from the mouth
versus up from the stomach - how does it do it do that). Like I said I read
some of the sites and it was not very clear to me at all - sorry - no need
to explain further...Pete
If a reflux
> event is recorded coming up from the stomach and the pH isn't below
> 4, and the patient records pain in their diary at that time, it's a
> non-acid event. As I have stated many times here, PPI's don't stop
> reflux, they only change the nature of the refluxate. We've known for
> years that non-acid reflux can still damage the esophagus, but now
> MII can let us correlate non-acid reflux with symptoms. A light bulb
> came on in my head as I was chatting about this with Don Castell
> (gastroenterologist guru of acid reflux) a couple of years ago, and
> it explained all those patients we all have that have significant
> GERD symptoms despite very high doses of PPI and normal pH tests, yet
> still have disabling symptoms. It also explains, at least in part,
> why the incidence of esophageal cancer isn't decreasing despite very
> effective acid-suppressing medication in the 25+ years since Tagamet
> first hit the market with a roar.
| |
| Howard McCollister 2006-03-22, 1:31 pm |
|
"Pete" <pete@nospam.net> wrote in message
news:1211n1jnk8vi2d0@corp.supernews.com...
>
> Howard...You must have misread what I wrote (it was a direct quote from my
> ambulatory ph procedure report). The distal sensor for my test was placed
> in my *stomach* and the proximal sensor was 5 cm above the LES (ie the
> distal sensor was checking stomach ph, not the esophagus). I did not have
> a sensor just below the UES. Please comment on this...Pete
>
>
Yes, I misread - sorry. That is indeed an old way of doing it (sensor in
stomach), but still nothing to do with impedance testing, only pH. The more
common dual channel pH testing uses a both a distal and proximal esophageal
sensor. This is done typically in cases where LPR is suspected to see if the
reflux is making its way to the very top of the esophagus and therefore
likely into the posterior pharynx.
HMc
| |
| Tim J. 2006-03-22, 1:31 pm |
| On 9 Mar 2006 06:57:02 -0600, "Howard McCollister" <nospam@nospam.net>
wrote:
>"Tim J." <tj66821@usa.not> wrote in message
>news:1b2v02tqe8fov6kd85uut4b6su9j85ogf8@4ax.com...
>
>
>Catheter-based ambulatory pH testing can indeed be uncomfortable because of
>the 24 hours the patient must walk around with a small tube coming out of
>their nose. We abandoned that a few years ago in favor of Medtronic's Bravo
>system, which uses no catheter and is more accurate.
>
>Look at http://www.medtronic.com/neuro/gerd/whatisBravo.html
>
OK, nice looking device, but how do you put the device in place? Is
the patient under sedation?
| |
| Howard McCollister 2006-03-22, 1:31 pm |
|
"Tim J." <tj66821@usa.not> wrote in message
news:3s631216lq2hhfo7nd81i6nhelobesfu80@4ax.com...
>
> OK, nice looking device, but how do you put the device in place? Is
> the patient under sedation?
>
Yes, usually while sedated at the same time as EGD. Mot patients have no
sensation that the thing is even there. They can eat normally and do normal
activities. And 48 hours is far more accurate than 24.
We still do catheter-based esophageal testing if we suspect non-acid reflux.
In that case, we have to do multichannel intraluminal impedance testing
which requires a catheter. We're still kind of learning the nuances of
MII...it's an amazing testing concept that literally deluges us with data.
HMc
|
| |
|
|