GERD - Long time user

[jjenney]

A little background - I've had GERD for about 8 years now and recently I've seen another Gastroenterologist in the San Diego area because it's gotten worse. I've tried many remedies (pills) in order to cure it. I'm 6'1, male, 242 lbs. I know this runs in the family, but I think I have the worst condition.
I just had another endoscopy done and the bravo ph testing where you have to record in a diary for 48 hours and then return the device so the DR can see ph levels of acid. Well that device malfunctioned My questions are...
1. What's the best over the counter medicine that I can take and not become immune to? The stuff I've been taking so far - Aciphex - causes too many other symptoms like visiting the restroom multiple times a day.
2. The DR's nurses aid wants me to get the bravo test again free of charge because it malfunctioned - they already did the biopsies and I don't have barretts esophaeguous, just really bad heart burn/GERD. Should I have this bravo thing done again? It's the most uncomfortable procedure I've had to do so far.
3. I have difficulty swallowing - this is a newer symptom - I'm sure GERD is just going to get worse and worse and the pills I'm on don't help with swallowing, they just mask the symptoms - what's the best cure?
4. I've been taking the $2.00 Ranitidine they sell at Target as a daily pill - is this one I can take and not outgrow?
5. When I sleep at night, I have to sleep on my right side and my bed is at a 45 degree angle and this GERD is the worse in the morning. I don't eat anything past 6PM the prevoius day and I'm on FMLA. Should I move back to Iowa because this wasn't as bad as it is now living in San Diego CA. Maybe it's the different kinds of food out here?

Thanks for reading this. Any advice you have for me is greatly appreciated. I could supply a list of pills I've taken for this condition. Either insurance didn't cover it or the symptoms from the pills were worse than having the GERD. Is there a pill out there for sensitive people like me? They have sensodyne for sensitive teeth. how about a miracle pill for GERD that doesn't give any other symptoms (Diarrhea especially.)

[Smiley2000]

Hi Andy,

You said you've had acid for a year?  have you tried everything else:  i.e. quit smoking, not overweight, not eating big meals but rather 6 small meals during the day, avoid acid triggers and have you tried Nexium or some other medication?

I can tell you that I had to make sure I had all the lifestyle and dietary changes in place, then went on 60-80mg of Nexium daily and when nothing else worked I went for a lot of tests through a lot of different Specialists before I agreed to the Nissen and that is why I believe I've had success with it.

I would not trust the results from the Bravo test either.  

According to my experience you should get the following tests to make sure you'll benefit from the Nissen Fundo:  24hr Impedance study and a Manomatric study.  The Impedance study is much much more accurate than the normal 24hr PH study and Bravo.  The Impedance study measures all the way from your UES to your LES and it measures acid AND non-acid reflux episodes!  The Manomatric study will test your motility, etc.

Barrets is a pre-cancerous disease and 5% of BE patients will get cancer from it.  Having the Nissen will prevent further damage, but BE is permanent and should be monitored and biopsy taken every 2-3 years.

Let me know if I can be of any further help :)

[Andy823]

Hi Smiley2000,

Do have any suggestions for having Nissen fundoplication?
I have GERD just for one year and they found small area of Barrets recently.
However, my GI doctor said they couldn't do Nissen because my bravo test was normal. But I really don't believe that result. And I would like to have NIssen done to get rid of all symptoms.
What do you think?

Andy

[Smiley2000]

Hi there jjenney,

Out of my experience, I would still advice you to go to a GI and get an Impedance study with a 24hr PH monitor is the best test you could do at this stage.  My Barium swallow test was normal, I do not have a Hiatal Hernia, but a hypotensive LES.  So even though I have SEVERE reflux and all this damage, the Barium was normal.  I must add:  it was a horrible test and I was constipated for a few days afterwards and the bicarb soda that they give you to drink with the "white stuff" burns like hell!

[bigkev414]

Hi - I agree with drpittsburgh, have a barium swallow exam and that's easy. All you do is gulp down a thick white liquid which is a bit like mylanta and they take xrays while it goes down. Will show up hiutus herni, ulcers etc. I've had a couple. Non invasive, and just like drinking a real thick milkshake.

[drpittsburgh]

GERD, so poorly understood by doctors everywhere.  Acid suppressing meds do not stop reflux/regurgitation.  They covert the episodes to non acid reflux so that the episodes don't burn and hurt.  But you are still refluxing.  If you do a bravo study on acid suppressing meds, you will get a false negative.  It will say you aren't regurgitating gastric contents into the esophagus when indeed you are.
If you have reflux esophagitis by EGD, you don't need a Bravo.  And yes, if the doctor doesn't understand reflux...an impedence study would be necessary to prove the reflux.  Do yourself a favor and see a good antireflux surgeon to see if you are a candidate.  A barium swallow or esophagogram is a nice way to demonstrate reflux.  I've seen people with a negative Bravo study (because it's trying to sense acid but the patient is taking acid suppressing meds).  I order a barium study and will show reflux all the way up to the throat.  It's a simple mechanical problem when someone has severe reflux, and so misunderstood.  

[protector2]

Have you tried the Raw Apple cider Vinegar I tablespoon in a glass of warm water with a teaspoon of honey before each meal. It also helps to alkaline the body. You may have to pick it up at the health food store..... grocery stores just carry the process one and that will not work.
It has to be the raw apple cider vinegar. Good luck!

[Smiley2000]

Hi there,

From someone's point of view that have also had years and years of reflux and a lot of sometimes horrible tests done, I would like to give you the following advice:

Do not repeat the Bravo test.  That is a capsule that somehow gets attached to the esophagus and then dislodge and dissolve and from that they get a reading of how severe the GERD is.  To me it sounds like a procedure that can not be very accurate.

Not even the normal 24hr PH Study is very accurate as it ONLY measures PH/acidic levels and misses the rest.

If you can:  please get 24 hr IMPEDANCE STUDY done!  That is the latest technology and so much more effective and gives so much more info on GERD that is non-acid and acid related!

Another tests that is necessary is:  MANOMATRIC study.  This will messure the LES and UES and peristalsis and detect any abnormalities.  I am so sorry, but all of these tests are uncomfortable and actually horrible, but necessary to get a proper diagnoses and treatment.

It is good that you don't have Barrets.  You might still get away without having to have an operation.  With ENT and swallowing issues you definetely also need to go see an ENT for Laryngoscopies and further tests in that regard.

I have had a horrible time with GERD and the related issues and now I have damage like Barrets and some muscle/UES that now needs treatment.  I eventually had my Nissen Fundoplication done 8 Feb. 2012 and from now on I should just get better and better.

With your young age, I would advice you to get the tests and treatment so that you can live a long and happy, GERD free life, without complications and longterm damage.

All the best and let us know if we can help with further info and keep us updated :)

[selmaS]

  Hi...other then the move to a diff state and some new stress that brings, did nething else happen 8 yrs ago? Were u on antibiotics  or have a surgery for something?

Sometimes our system is just off balance, it could be the water, who knows....I have tried and had success with probiotics it restores ur GI track to it's natural balance....worth a try....

Avoid the usual triggers, fatty foods, acidic foods...alcohol, sodas...smoking,...and see if this helps.

  Good luck