If Nexium works well on severe symptoms...

[Jasmine]

... is it definitely, unmistakeably GERD?

[daw]

I checked the information given on the Nexium site (http://www.purplepill.com)
and found the following;

"...Symptom relief does not rule out serious stomach conditions."

"...Symptomatic response to therapy with Nexium does not preclude the presence of gastric malignancy."

In my opinion an endoscopy should be performed on anyone with severe or prolonged symptoms regardless of whether or not the medications help them.

[Jasmine]

Hi Daw, thanks for the info.

I had a negative endoscopy, negative ultrasounds and borderline PH (it was a good day). So, looks like no malignancy, gallbladder trouble or ulcers.

However, Nexium works *really* well for me. In fact, I become very ill if I take less than 40mg Nexium daily, but can survive quite well when taking it. Zantac, pantoprazole and Losec are not strong enough. I get unbearable pains and 24-hour nausea.

I am seriously considering the surgery. If malignancy has been ruled out, does the fact that Nexium works so well mean it's definitely GERD? I'm 95 per cent certain it is GERD (including "silent" reflux) but am just afraid of the small chance of having surgery for the wrong thing!

Jasmine

[The Pard]

Hi Jasmine,

How else do you plan to check if you really are a candidate for surgery?

Since you fit one of the molds, are you planning to rule out anxiety as another possible cause?

I don't want to wave any red flags about jumping
into surgery, but trying a low dose of Xanax for
a week could prove if anxiety was a hidden part
of your condition.

I'm sure that you have been keeping up with the
posts outlining GW's success.

The Pard

[daw]

Originally posted by Jasmine
I had a negative endoscopy, negative ultrasounds and borderline PH (it was a good day). So, looks like no malignancy, gallbladder trouble or ulcers.

However, Nexium works *really* well for me. In fact, I become very ill if I take less than 40mg Nexium daily, but can survive quite well when taking it. Zantac, pantoprazole and Losec are not strong enough

It sounds like NERD (non erosive Reflux Disease or in some cases Negative Endoscopy Reflux Disease). Do a search..there have been some posts on the subject. One recent Medscape article I posted yesterday addresses NERD.

Originally posted by Jasmine
I am seriously considering the surgery.
Jasmine

Why? Are you concerned with having to take the meds long term? I think one has to think long and hard (and get the proper workup) before getting fundo surgery for NERD that is relieved with meds. You might consider waiting to see if the newer endoscopic procedures pan out.

[Jasmine]

Hi Daw, I've read a bit on NERD and it does seem to tie in with my experiences.

I'd like to start a family but really cannot manage without Nexium. I've tried several times but there is no way I can manage that amount of pain for 9 months, even with a baby as a reward. I've tried stepping down to H2-blockers but they are not enough. This is why I'm considering the surgery now - if successful, it would allow me a PPI-free pregnancy.

I've heard that the endocinch, stretta etc. are only good for mild cases of GERD... I would wait and see if these procedures improved, but as I'm in my early 30s already, I need to sort this out now if I'm going to be fortunate enough to have kids.

Jasmine

[Jasmine]

Hi Pard

Not sure what else I can do to check if I'm suitable for surgery. I had the manometry and my swallowing is OK. I haven't had the barium swallow - does it show anything the endoscopy doesn't?

Thank you for your suggestions about ruling out anxiety as a cause. I agree it is worth trying everything else before deciding on surgery.

Jasmine

[The Pard]

Hi Jasmine,

The scope is often used for a closer look at suspicious things seen with the barium swallow, so I doubt that it would tell any more. If a growth were observed, the scope would be used for a closer look and to obtain a biopsy.

I am surprised that they didn't use the barium first, but who knows why they didn't unless the doc was being extra careful after a previous
missed diagnosis.

Be well...
The Pard

[Bob]

I once new a very Pretty women with that name. Anytime I hear that name I think of her. (Anyway, old and married now. back to work) Do you know about acid rebound ? It happens when you try to stop ppi's, the acid comes back in full force. (your stomach has been calling for acid while on ppi's with no response. Like calling a child, if the child does not respond, you start to yell and scream, the child runs home quick.) This acid rebound can last a month or two. I hope I made sense. Bob

[KathyMetzger]

Can being on Zantac for just 10 days cause acid rebound? Or is it just PPIs that cause it?

[LSAT]

Please give us more detail. Normally quiting Zantac after only 10 days would not give the same problem as being on a PPI for an extended period of time. The PPI shuts dowm most acid production. The H2 (Zantac) just reduces the amount of acid produced. What problems are you having?

[daw]

Originally posted by KathyMetzger
Can being on Zantac for just 10 days cause acid rebound? Or is it just PPIs that cause it?

Yes you can have acid rebound if you suddenly stop H2Blockers. After only ten days...well I don't know...I guess it depends on how high a dose you were on.

[tricia]

Hi Jasmine I don't think any surgeon with any ethics would do surgery on a person with a borderline ph, that person would not be a good candidate for surgery. You should have the ph test repeated before considering your options i'm pretty sure a surgeon would insist it be repeated anyway.-- if he didn't-- i'd run.

PPIs do mask symptoms of other GI problems, if i were you i'd have a few more tests before even considering surgery.

People with NERD have a negative endoscopy , but always have a positive PH. Of course like any other diagnostic test there is room for error, such as improper placement of tube, interpretation of results, and not having symptoms that day. You really should have the test redone.

Also you should get a hida scan for gallbladder- an ultrasound only detects stones -not gallbladder misfunction--- An ultrasound by no means rules out gallbladder or liver problems.

Your symptoms are not gerd typical- with no heartburn and pain under your right rib and nausea. I really feel you need a lot more tests. it could be a lower GI problem as well- or you could have more than one problem. It would be ashame to have the surgery and discover the real problem later. Take Care

[GW]

Originally posted by Jasmine
Hi Daw, thanks for the info.

I had a negative endoscopy, negative ultrasounds and borderline PH (it was a good day). So, looks like no malignancy, gallbladder trouble or ulcers.

However, Nexium works *really* well for me. In fact, I become very ill if I take less than 40mg Nexium daily, but can survive quite well when taking it. Zantac, pantoprazole and Losec are not strong enough. I get unbearable pains and 24-hour nausea.

I am seriously considering the surgery. If malignancy has been ruled out, does the fact that Nexium works so well mean it's definitely GERD? I'm 95 per cent certain it is GERD (including "silent" reflux) but am just afraid of the small chance of having surgery for the wrong thing!

Jasmine

Hello Jasmine

Just because they didn't actually see any inflammation doesn't necessarily mean you don't have reflux problems. There is the condition known as "sensitive esophagus" which will drive some folks nuts as it carries with it ALL the classics symptoms of GERD but most doctors, unfortunately, either mis-diagnose or don't diagnose anything at all when nothing super visible is seen.

This was the case of a guy named Phil, here, who used to write in with all the symptoms you describe and more. I guess the guy went to several tests and doctors only to find one, eventually, that treated him with the regular meds and suggested heartburn-friendly diets and now he never writes because (we assume) he's in good shape.

GERD ranges, in diagnosis terms, from acid-sensitive esophagus to severe esophagitis with stricture.

In my opinion of all things considered here, I too would like to suggest you not jump right into surgical fixes for this. All the reports I read say it's extremely rare for women to have adverse affects during pregnancy using PPIs. Furthermore, if you are a person with the extra sensitive esophageal tissue, surgery won't help. Even just the gas from the acid that still exists in your stomach can rise up through the esophagus and continue to cause problems. I, personally, would only consider surgery if there was evidence of severe erosion in my GI tract.

Here's one of the most honest reports on the matter I've seen. It's not saying that PPIs are 100% safe, but, at the same time it saying that there's not been alot of negative reports or enough testing because of it. Which indicates, if there's not a fire, why send up smoke?

http://www.mydyspepsia.com/Sept2001report.htm

[daw]

I just happened to read the pharmacy info that came with my last Nexium prescription. It states: "Nexium, Prevacid, Protonix and Aciphex are in the FDA pregnancy category B. This means that they are not expected to be harmful to an unborn Baby. Prilosec is in the FDA pregancy catagory C. This means that it is not known whether it will be harmful to an unborn baby. Do not take a PPI without first talking to your doctor if you are pregnant or could become pregnant during treatment. It is not known whether PPIs pass into breast milk. Do not take a PPI without first talking to your doctor if you are breast feeding a baby."

Also, here is another website that talks about pregnancy and meds.
http://www.motherisk.org/drugs/gastrointestinal.php3

[tricia]

Daw said---- the pharmacy info that came with my last Nexium prescription. states:
"Nexium, Prevacid, Protonix and Aciphex are in the FDA pregnancy category B. This means that they are not expected to be harmful to an unborn Baby. Prilosec is in the FDA pregancy catagory C

What category B really means is = Presumed safety based on animal studies

I for one wouldn't put the health of my unborn baby into question based on animal studies. Also when i was given my prescription of Nexium, the doctor told me not to take it if i was pregnant or thought i might be. Also the offical aciphex website states "the safety of this drug during pregnancy has not been established" - and they are catagory B

Nexium was just upgraded to catagory B recently They must of had a favorible study based on 10 pregnant rats or something.

Here is a list of what the FDA ratings actually mean.

Category A = safety extablished using human studies
Category B = Presumed safety based on animal studies
Category C = Uncertain safety, no human studies and animal studies show
an adverse effect.
Category D = Unsafe - only to be used in special circumstances
Category X = Highly unsafe

[Jasmine]

I would love to have children but there's no way I can manage without Nexium. In addition, pregnancy makes GERD worse and for me even PPIs could struggle to keep the symptoms at bearable level, let alone Zantac. This is why I will probably have surgery, whether or not PPIs are "safe" in pregnancy.

[tricia]

Jasmine I certainly agree with you , everyone knows their own tolerance. I certainly understand why you feel the need for surgery.A small percentage of people really need surgery( and you could be one of them) and it is the only way they can get better. Surgery can turn people's lives around completely. Vomiting and pain must not be fun to live with.

The flip side of this is a lot of people go for the surgery option too hastily- and, without atequate testing- and without trying alternative options- . . I'm not anti surgery, but i beleive in your instance for example that you could benefit from a lot more testing before making such a decision. A gastric emptying study for example- the symptoms of delayed gastric emptying are very similar to yours, a hida scan to check the gallbladder, a Bernstein Test for esoghageal acid sensitivity, and maybe a CT scan.- and a repeat ph and manometry.

The more information one has on their health, the better. Knowledge is power. . As for PPIs being taken during pregnancy, they very well could be harmless, but i personally feel there's not enough information out there yet. - one way or the other-just animal studies. I guess it's a personal choice.

[Jasmine]

Hi Tricia

Thank you for your reply. In particular I appreciate your understanding that everyone knows their own tolerance. Some people seem to think that a pregnant woman "ought" to be able to cope with unbearable pain as a baby is the reward. Much as I want children, there is only so much pain I can take!

Thanks for the suggestions as to the further tests. It's hard to get the balance right as to how long to wait before resorting to surgery. I'm 32 and have had these problems 3 years. I can see it is important to have all the relevant tests to avoid unnecessary surgery, but meanwhile, my biological clock is ticking.

Would gastric emptying or gallbladder problems get worse with pregnancy too?

Jasmine

[daw]

Originally posted by Tricia
The more information one has on their health, the better. Knowledge is power. . As for PPIs being taken during pregnancy, they very well could be harmless, but i personally feel there's not enough information out there yet.

I agree. Thank you for supplying the medication catagory explanations. As I've mentioned in a previous post, when it states "are not expected to be harmful to an unborn Baby" it is just not enough of a guarantee. They choose their words carefully and that's why you should always read between the lines.

[tricia]

Oh i agree Daw You really do have to read between the lines. Here are some animal studies on all of the medications http://www.fetal-exposure.org/REFLUX.html

Jasmine It's hard to say what conditions pregnancy will make worse.It depends on the person. In some instances pregnancy makes a lot of illnesses better.

Even Gerd I have read studies where in quite a few people Gerd disapears when a woman gets pregnant and resurfaces after delivery . It really varies from person to person, Some people it gets worse , others , it improves or goes away.

At the end of this post i'll post some messages from the old message board concerning pregnancy and Gerd. In 3 of these posts, gerd went away. You never know Jasmine, it could happen to you too.

But there's nothing wrong with choosing surgery either. It' your body , your choice, I don't think i could tolerate your particular symptoms myself, and there's nothing wrong with trying to do something about it. -- and going after what you want.

. It's funny, your particular symptoms are not common or typical gerd symptoms in adults , but those symptoms are very common gerd symptoms in children.

Research is important too though, for instance how long would you have to wait after a fundo to get pregnant? ---could it undo the wrap? and have more tests too - just to be sure. It's too bad the medical system is so slow where you are-- i know you are in a hurry" smile" Anyway take care-- here are the posts Have a great day Jasmine

http://www.heartburn-help.com/MessageBoard43/_disc24/0000028c.htm

http://www.heartburn-help.com/MessageBoard43/_disc24/00000282.htm

http://www.heartburn-help.com/%5Fdisc3/00000407.htm

http://www.heartburn-help.com/_disc3/00000384.htm


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