LPR readout- any similarties to you

[esimpkins]

All
I wanted to see what everyones comments about if I was heading down the right track. I am 36 yr old male and 8 mths ago I developed pressure /pain right under my sternum. No real burning just pressure pain. Then came more symptoms:
1) Pain would get worse when talking for extended period
2) Stress made worse
3) Neck/ throat became sore
4) Globulus sensation (ball in throat)
5) Lymph nodes on neck felt sore
6) Fatigue (although not debilatating)
7) Occasionaly touble breathing

Doctor referred to Gastro specialist and the following has been done
1) Chest X- ray (ok)
2) Barium swallow (moderate to copious reflux with Valsalva manuver)
3) Scope (mild to moderate erosion)

Meds presecribed
Prevacid -once a day (did not work)
Protronix once a day (did not work)
Aciphex once a day (did not work)
Nexium once a day (work a very little but headaches aagh)
Prevacid once a day Rantidine at night (did not work)
Currently on:
Prevacid 30 mg twice a day and 10mg of generic Elavil (moderate imrovment)

I believe the next steps to ask for are 24 Hr esophageal Manamomentry. Does this sound right?? Should I get to an ENT? Mhy GI doc says they generally just refer you back to Gastro doc since he believes it is cause by reflux. Everyone has such good insight on this website can you provide your opinion. This seems like LPR with possible functional disorder of esophagus. Have others had succes with other med combinations? Hani, Robinbird, Steve 28, Stacybrevin and Daw, yu guys seem to have similar track records can you provide insight. All others please add your two cents

We can beat this
Thanks

Erik

[Diana]

Hi,

I recommend looking for an ENT who is a laryngologist for a complete ENT evaluation. The doc will do a laryngoscope for which mine often did not even anesthetize my nose- It was quick and easy and I don't do tubes well.

It would be a double pH probe with the proximal probe being pharyngeal and esophageal manometry. I would recommend doing the pH study in particular at a big city hospital. You generally can get reduced medical rates at hotels near by.

Sleeping with your head elevated (prop up pillow etc.) and not eating before bed and following the LPR diet are helpful. The articles by Koufman in the Sept. ENT Journal supplement and the Wake Forest site might interest you and are online.

Good luck.

[Rebecca]

Hi Erik,

As a long-time LPR sufferer who also had the same symptoms as you describe I'll add my 2 cents. I'm not sure how long you've been on your current meds, but for LPR it requires a long time for things to get better (can be up to several months depending on the amount of damage). If you read the archives and the articles Diana mentioned you can read about this.

As for what to do next, it depends on what you and your doctor feel is the cause of your symptoms. If you're both sure it is from the acid refluxing into the esophagus & throat then the only way to fix or manage that is through the meds or surgery. If there is still some doubt as to the root cause of the problem, further testing would be good idea. If I were you, and was sure acid reflux was the problem, I'd give the meds some time to work. If after a certain period of time (at least 3 months) you haven't seen a noticeable improvement, then I'd go for more testing. That said, of course a visit to the ENT or a manometry test certainly wouldn't hurt if you're so inclined. But if acid is indeed the problem your doctor is right in that they would all still lead to the same point of putting/keeping you on PPIs.


Bottom line is these meds take a long time to work. I wish I would have known that in the beginning when all this started. I had many docs say if PPIs didn't do the trick in 4-6 weeks then GERD wasn't my problem. That had me on a wild goose chase for almost a year in terms of unnecessary, expensive and sometimes painful medical tests when I really just needed to give the meds time to work. In my case it took several months, but things did improve with high-dose PPIs and now I am symptom-free and on much lower doses of PPIs (one every other day).

Finally, even though you are on PPIs it is very important to make the necessary lifestyle changes that prevent acid reflux. Everybody's a little different but the prevailing wisdom is healthy diet, avoid caffeine,alcohol, peppermint,chocolate, citrus, and other "trigger foods", and eat small meals and nothing for a few hours before bedtime. There are others too, stress & anxiety can make things worse. Good Luck erik, hope you feel better soon. - Rebecca

[daw]

1) LPR is usually treated with twice a day doses of PPIs for 6 months or more. You did not say how long you were on any of the meds. Sometimes they take a while to work. It seems the Prevacid 30mg twice a day is helping. Elavil is sometimes prescribed for esophageal spasms. There is controversy over whether the antidepressants SSRIs or Tricyclics are the drug of choice in GERD.

2) You should see an ENT just to make sure there has been no damage to your vocal cords or the surrounding area. Also he can rule out any growths.

3) A manometry would be good if you are contemplating any surgery or procedures as it finds out if your LES pressure is strong or not and whether your esophageal peristalsis is good (strength of your swallow). It should be done for every person before surgery to prove they are a good candidate.

4)A dual 24 hour PH test is sometimes done to prove there is acid reflux in the esophagus at the lower and upper sphincter. Since you were diagnosed with mild to moderate erosion, that is usually proof enough that you are refluxing. Some people will do this test while on medications to see how good they are working.

If after following all the GERD/LPR rules (most of which are mentioned on this board) and if you have tried alternative things like Aloe, gum chewing, etc.....your symptoms get worse, are not controlled by your medications to your liking or your next scope results are worse then you should consider discussing surgery or other endoscopic procedures with your doctor.

[esimpkins]

Daw, Rebecca and Diane

Thanks for all your input. I have only been on the twice a day PPI for a couple weeks so I guess I should be more patient. I will get to an ENT just to check out the vocal chords etc.

I defintely got bounced around on the meds switching PPI's every 5 to 6 weeks. I will stay with the Prevacid twice a day and the elavil at night. Do the lifestyle changes and go from there.

The sites mentioned in your responses were right on.

Thanks to all

Erik
PS ANyone know a good ENT guy in the So. California area??

[doctormom]

Where in So, Calif. do you live? Is it Los Angeles?

[esimpkins]

Actually in the Orange County area. Halfway between Sand diego and LA

[doctormom]

Hi,
There are ENT's at UCLA, USC and Scripps who speicalize in LPR. Are these areas too far for you? I can give you the names if you have interest.

[esimpkins]

Thanks
These are all close enough. I would love names

Thanks again
Erik

[doctormom]

Hi Erik,
If LaJolla is not too far I would try Dr. Peter Belafsky as he has written papers on this. 858-458-1287
Dr. Attum Sinha, USC., 323-442-5790 and
Dr. Geral Berke, UCLA, 310-206-6688 UCLA is like a zoo but USC is not. Good luck. Sandy

[tad]

Just a suggestion from someone who has been through all of tests and meds, with LPR symptoms and early small-segment Barrett's - try some of the unorthidox things. Chewing gum, baking soda in water, etc. Those things have helped me a great deal. Also, be prepared for the long haul. This stuff doesn't abate for folks like us easily. Hope you improve soon.

[doctormom]

Has anyone used chewable DGL. It is DeGlycyrrhizinated Licorice. It is 380mg. and supposed to do the same job as the PPI's. They are found in health food stores and chewed after each meal. It is used for digestive disturbances such as Vocal Cord Dysfunction and acid reflux. Thanks

[daw]

Originally posted by doctormom
Has anyone used chewable DGL. It is DeGlycyrrhizinated Licorice. It is 380mg. and supposed to do the same job as the PPI's. They are found in health food stores and chewed after each meal. It is used for digestive disturbances such as Vocal Cord Dysfunction and acid reflux. Thanks

I tried the chewable DGL. I threw it out after just taking one tablet. The taste was so bad to me that I couldn't bring myself to take another tablet. I think it comes in a more sweetened type. I suggest not to get the plain tablets. I'm sure it will help some and not others..as is the case when dealing with GERD/LPR.

[doctormom]

Thank you for the feedback regarding DGL. If it would work, I guess I could try to tolerate the taste. I had no idea how horrible it was. Thanks for the warning.

[esimpkins]

I tried it also for about 4 days. The taste was defintely not the best. The instructions say take before a meal. I ddin't really notice any help. Dr. Weil really think the world of it