What can I do about severe GERD?
Saturday, October 17th, 2009 at
5:09 pm
had EKG etc, done – it’s not my heart…but am still experiencing severe chest pains in midle of chest. dr. says its GERD. my left arm is tingly, and so are my lips. could GERD cause tingling sensations? I have taken prilosec, protonix, apple cider vinegar – pain still persists. how can i make pain go away?
Filed under: Gerd Causes
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Gastroesophageal Reflux Disease (GERD)
How is it treated?
The goals of treatment for GERD are to:
alleviate or eliminate symptoms
decrease the frequency or recurrence and duration of the disease
promote healing of the injured tissues of the esophagus
Patients with mild symptoms are treated as needed with non-prescription remedies like antacids, a non-prescription H2 blocker, or the non-prescription proton pump inhibitor (PPI), omeprazole (brand name: Prilosec OTC). For patients with more severe symptoms, or for those who do not respond adequately to non-prescription therapies, continuous treatment with a prescription-strength H2 blocker or PPI is recommended. H2 blockers and PPIs both work by decreasing the production of stomach acid that causes many of the symptoms of GERD.
In patients where GERD may be due to slow movement of food through their gastrointestinal system, the next step is to try a pro-motility agent such as Reglan (metoclopramide) that increases the rate at which food moves throughout the gastrointestinal system. Maintenance therapy with an acid suppressing agent (like an H2 blocker, PPI, or antacid), a pro-motility agent, or both may be needed to control symptoms and prevent complications of GERD. It is recommended that you consult your doctor to decide which therapy is needed for you.
In cases where the esophagus has been badly injured by GERD, or when medical therapy fails, surgery is considered on an individual basis. In April 2003, the Food and Drug Administration approved Enteryx, a permanently implanted device to help patients with symptoms of GERD. Enteryx must be inserted through a surgical procedure. This device prevents the reflux of stomach acid into the throat, potentially allowing patients with chronic GERD to avoid daily medications.
If you are experiencing tingling in your arm, it is not GERD. It is either heart troubles, or anxiety symptoms. I suggest you start off by telling your doctor that the symptoms are persisting, then if he still shrugs you off, get a second opinion from another doctor. If that doctor also says they can’t find a good cause for it, then consult a psychologist (or counsellor/therapist) and ask about anxiety/panic attacks.
If you’re worried that it’s GERD, see a gastroenterologist for a definitive yes/no.
If the suspicion of reflux is correct, then it sounds like you’ve got it bad. You may even have some erosive esophagitis from it as well. Anti-acid medication will reduce the erosive acid quality of the material refluxing up into your esophagus, but it won’t instantly heal the injured esophagus, if that’s what is going on.
Step one is to lock down the diagnosis. If you are having esophageal pain, then you deserve to have an esophageal inspection. Upper endoscopy is a pretty mild procedure. It involves getting some intravenous sedation and pain medication, and then while you’re in twilight la-la-land, a scope quickly goes down the esophagus, into the stomach, looks around, biopsies anything that looks abnormal, characterizes the behavior of the esophago-gastric junction and then leaves. Afterward, most people remember nothing and feel nothing. The only reason that the rest of the day is wrecked is because of the space-headedness of recent sedation. By the next day, it has completely worn off and you’re good to go.
There are several obvious findings in patients who are being troubled by bad reflux. First, the normal light pink lining of the esophagus is eaten away and angry red healing tissue is found instead. This is typically just above the normal esophago-gastric junction. This material gets biopsied in order to characterize any regions where the lining is being replaced by abnormal tissue. A condition called "Barrett’s esophagus" can happen which has the potential (rarely) to become cancerous. Barrett’s is a direct result of chronic reflux esophagitis.
Another effect sometimes found in refluxers is stricture. A stricture is a narrowed spot where the scar process developing as a result of chronic injury and healing then contracts down, narrowing the passageway. All scars contract, so when there is a scar which goes all the way around the inner lining of the esophagus, it has the potential to contract down aggressively. Strictures can cause difficulty in passing normal swallowed food items. This leads to more inflammation and pain. The sensation of food being stuck mixed with the burning feeling of erosive esophagitis can be very painful.
Sometimes, based on what we hear from the patient, we would expect to see a really pissed-off esophagus – angry and red, even bleeding! Yet, when we scope, we see something that looks basically normal. This is just as informative a result. When the story and the exam are very very different, it proves beyond a shadow of a doubt that we are on the WRONG TRACK and there is something else that needs to be diagnosed. Ruling out a diagnosis is just as important as confirming one.
A number of esophageal conditions can cause tremendous pain but not by way of acid-burn. These conditions are diagnosed by additional studies including something called "esophageal manometry" which is a technique for measuring pressure waves in the esophagus during the action of swallowing. There are a number of tests that can be performed to help us understand what the esophagus is doing. this is one of the most important ones.
For people who do have bad reflux, medications help by reducing the amount of acid in the refluxed material (refluxate). These medications do NOT stop the reflux events from occurring. They turn acid reflux into bland reflux. Bland reflux can have injurious effects all by itself. Bile reflux into the esophagus at non-acidic pH can contribute to the derrangement of Barrett’s esophagus in the transition toward cancer. For people who have mild reflux, symptom control with medication is appropriate. However, for people with severe reflux, or worsening reflux symptoms despite medication, or for people who are just sick and tired of taking medication all the time, one option is to repair the normal esophago-gastric anti-reflux mechanism. This requires surgery.
Anti-reflux surgery is typically performed by specially trained minimally invasive surgeons. A series of small incisions are made into the abdominal wall, a scope is inserted as well as some working tools, and then under the guidance of the videoscope, the top portion of the stomach is used to wrap around the base of the esophagus and improve its mechanical performance.
This operation is very successful in correctly selected patients. Surgeons all over the country are doing this operation in increasing numbers. The data supporting it are substantial. If you want to learn more about this surgery, search using google for things like "nissen fundoplication". I’d be happy to answer any additional questions if you like. Also, if you search back through some of my answers, you’ll see that I"ve answered a lot of reflux related questions, although it’s been a while!
Remember, the first thing is proper diagnosis.
Get scoped.
I hope that helps!
First, be sure to rule out a hiatal hernia.
Second, buy a copy of the book "No More Heartburn" by Sherry Rogers, M.D. This amazing clinician is an expert with over 35 years of experience in treating the causes of chronic diseases (rather than using drugs to mask symptoms). She is a specialist in nutritional biochemistry, environmental medicine and functional medicine. She has authored many books, published numerous research papers, and teaches other physicians at national conferences.
In this book she explains the many CAUSES of ‘GERD’ such as:
1) Intestinal dysbiosis
2) Heavy metal toxicities
3) Food allergies/intolerances
4) Many other common causes that docs do not test for.
She also explains how to effectively treat the underlying causes.
The book is available at Amazon.com. Best wishes and good luck.
GERD is difficult….To add to the other pots let me suggest that you need to have patience with your medication. Nothing is going to help it in 1 day. Tingling in your arms can very well be GERD…so don’t worry.
Your diet is the biggest thing that should change to include alcohol,and smoking. Smoking is a hugh aggrivator as is Soda.