Heartburn Support - Results-some help with explanation

Author

Results-some help with explanation

tdonline

2006-04-28, 6:07 pm

I got a letter from the GI with my results. In summary, I do not have
actual reflux but apparently I do get some acid where it doesn't belong
because of belching. Please read the following and help me out with
some of the details. My ENT and GI were locked in a turf war and I
guess the GI is technically right...but the ENT wasn't wrong either
because I'm getting some acid up into my pharynx...I think.

START
"The esophageal motility was normal. Values for distal esophageal acid
expsosure are normal with a total time below pH 4 in the distal
esophagus of 1.8% with 2.9% upright and 0% supine. Proximal acid reflux
is present, however, the predominant feature there is "pseudo-reflux"
which is thought to represent probe drying. A pattern of repetitive
belching is present which is associated with some hypopharyngeal acid
exposure.

In summary, the patient has no evidence of pathologic gastroesophageal
reflux, rathter the reflux that is associated with exposure to the
hypopharynx appears to be associated with belching. Belching is a
behavior that is associated with air swallowing and the management of
this includes prolonged proton pump inhibition along with evaluation
for aerophagia."
END

What is a normal %? What is proximal acid reflux? What is probe
drying?

I'm not sure if I should go back to the ENT or not. The thing is I had
symptoms waaaay before I started belching all the time. The belching
started only after a three-week course of antibiotics for what the ENT
thought was a sinus infection. Only after that didn't work did she say
I had LPR.

Howard McCollister

2006-04-29, 11:08 am

"tdonline" <trinhd90@gmail.com> wrote in message
news:1146259962.646265.109010@g10g2000cwb.googlegroups.com...
>I got a letter from the GI with my results. In summary, I do not have
> actual reflux but apparently I do get some acid where it doesn't belong
> because of belching. Please read the following and help me out with
> some of the details. My ENT and GI were locked in a turf war and I
> guess the GI is technically right...but the ENT wasn't wrong either
> because I'm getting some acid up into my pharynx...I think.
>
> START
> "The esophageal motility was normal. Values for distal esophageal acid
> expsosure are normal with a total time below pH 4 in the distal
> esophagus of 1.8% with 2.9% upright and 0% supine. Proximal acid reflux
> is present, however, the predominant feature there is "pseudo-reflux"
> which is thought to represent probe drying. A pattern of repetitive
> belching is present which is associated with some hypopharyngeal acid
> exposure.
>
> In summary, the patient has no evidence of pathologic gastroesophageal
> reflux, rathter the reflux that is associated with exposure to the
> hypopharynx appears to be associated with belching. Belching is a
> behavior that is associated with air swallowing and the management of
> this includes prolonged proton pump inhibition along with evaluation
> for aerophagia."
> END
>
> What is a normal %? What is proximal acid reflux? What is probe
> drying?
>
> I'm not sure if I should go back to the ENT or not. The thing is I had
> symptoms waaaay before I started belching all the time. The belching
> started only after a three-week course of antibiotics for what the ENT
> thought was a sinus infection. Only after that didn't work did she say
> I had LPR.
>

A total reflux percentage of 4% or less of the total 24 hours would be
normal. That does have to be stratified, however, into reflux percentage
while supine, upright, after meals, etc..

Proximal acid reflux refers to the amount of acid that actually makes it up
to the top of the esophagus and therefore potentially into the posterior
pharynx.

Basically, I agree with the gastroenterologist based on the limited
information he has obtained so far - the report you detail here suggests
belching as the primary cause and best treatment is likely to be PPI. The
question is why are you swallowing air? That can be a problem in
interpreting an ambulatory pH test. Are you swallowing air because you
reflux, or are you refluxing because you swallow air? I suspect the latter
explanation, but I confess that I'd be interested to see a repeat pH test,
preferably a 48 hour test (Bravo - no catheter) with a second pH
sensor/transmitter capsule in the proximal esophagus. The other possibility,
and this should definitely be considered, is non-acid reflux. THAT reflux
would not show up on pH testing such as you had and appropriate diagnosis
would require multichannel intraluminal impedance (MII) testing. MII should
most definitely be done in anyone who has reflux symptoms (GERD or LPR)
while on high-dose PPI (eg - Nexium 40 mg twice a day).

HMc

tdonline

2006-04-30, 6:11 pm

Are you swallowing air because you
reflux, or are you refluxing because you swallow air?

Isn't the GI saying I'm not actually refluxing though? Well okay,
maybe not ACID refluxing...

I'm trying to breathe through my nose only, eat and drink slowly, but
still burping. What is considered normal burping? Is it okay to
always have one or two burps after drinking or eating? Which is what
is happening with me. It's not like I'm burping a thousand times a
day, it's just that I always burp a little anytime I eat or drink.

Howard McCollister

2006-04-30, 6:11 pm

"tdonline" <trinhd90@gmail.com> wrote in message
news:1146425053.901866.184750@g10g2000cwb.googlegroups.com...

>
> Isn't the GI saying I'm not actually refluxing though? Well okay,
> maybe not ACID refluxing...
>
> I'm trying to breathe through my nose only, eat and drink slowly, but
> still burping. What is considered normal burping? Is it okay to
> always have one or two burps after drinking or eating? Which is what
> is happening with me. It's not like I'm burping a thousand times a
> day, it's just that I always burp a little anytime I eat or drink.
>

"A pattern of repetitive belching is present which is associated with some
hypopharyngeal acid
exposure."

"Hypopharyngeal acid" with belching can only come from one place - refluxing
from the stomach.

Belching naturally relaxes the LES thereby allowing stomach air, along with
some acid, to reflux. I don't know why you swallow enough air to
demonstrate a "pattern of repetitive belching". People swallow air for many
reasons. In your case, it wouldn't be unreasonable to suspect that the
findings of the pH test might be artifactual - that the mere presence of a
transnasal pH catheter could be related to air-swallowing - either causing
it, or augmenting it. Whichever, I agree that your GERD or LPR, if you have
any, is best treated with PPIs.

This is based on the pH results you posted assumes that the 24 hour
"snapshot" of your upper GI tract is accurate. A transnasal cather will
often have a substantial effect on that accuracy IMHO

HMc

tdonline

2006-05-01, 11:09 am

I have post nasal drip so I clear my throat throughout the day. It's
eased up some, but yeah when my "acid reflux" symptoms were at their
worse, I was probably constantly clearing my throat. It became second
nature. I'm much more conscious of it now and try to not do it, but
it's a struggle.