CAN you swallow?

DeLarla · February 2, 2005

Okay, let's try this again, but please think "food" this time. Sometimes it's hard for me to swallow (I have to gulp several times to get food down.) And I choke on liquids. Also, I wake up almost every day with a sore, scratchy, irritated throat. So I'm always thinking I'm getting a cold. I don't have acid reflux, no heartburn, nothing burns, etc. However, while I was in the hospital, I got the answers I needed. I actually DO have acid reflux, which is what's causing my throat irritation. I always thought acid reflux would mean painful burning in my chest and/or belly, like heartburn. I should have been born Mexican, cuz I eat hot sauce and jalepenos on everything, even tuna. Spicy or greasy foods don't bother me at all, but then I wake up with the scratchy throat.

So I've been diagnosed with acid reflux and prescribed 6 months of Pepcid. And THAT is what Penni was trying to get at.

Iluvharleys · February 2, 2005

Oh........ now that is just a little bit different than the first one! lol

So far no problems here with any of that. Hopefully I won't get it, but thanks for the information, it's good to know in case it does happen.

Alexandra · February 2, 2005

Lisa, did Dr. Billy tell you to avoid eating or drinking for several hours before bed? I've had some of the same symptoms--not really burning or irritated throat in the morning, but a sensation of Fluid there that makes me cough, which I'm told is also reflux. But I find that if I don't eat *or drink* anything for like three or four hours before lying down, it really doesn't happen at all. I know nighttime nibbling is a bear for you, but maybe this is an extra kick to help you over that habit. Consider it a message from the bandster god. (So why don't I listen?!? I just finished a bowl of ice cream, less than two hours before bed. ERGH!)

Do you think your difficulty in swallowing has something to do with acid reflux, also? is the Pepcid supposed to have an effect on that? (And is it OTC Pepcid, or a prescription?)

Penni60 · February 2, 2005

You know the first thread was just interpreted the wrong way. IT is all those dirty minds out there and those that don't have a sense of humor that got offended and then deleted the thread. SIGH!!

I too was diagnosed prior to my band placement with acid reflux. I have noticed that the more acid creating foods I eat the more burning I have in my stomach. All those people that are experiencing this same thing should talk to your doctor. Acid Reflux is not a good thing to have with a band. It isn't a good thing to have period.

Sorry to those that were offended by the previous thread. It was not MY intention to cause such an embarrassing situation that it was necessary for someone to delete the thread.

I just wish whoever deleted the thread would have sent me a PM saying did you mean to imply in your post "do you swallow" what is being responded to? I would have done that for someone.

Oh well, we live and learn.

Vickums · February 2, 2005

Aw, Penni, sorry I missed the thread. It sounds like it was a lot of fun; OTOH, I don't get offended, 'cept by people trying to be cruel or mean or nasty or stuff like that. But unintended sexual innuendo? Bring it on, baybee!

As for the topic, I read somewhere that even asthma symptoms can be the result of acid reflux. Who'd have thought, you know? It makes me wonder sometimes how much of the coughing I do after a meal is my Sarcoidosis, and how much is potentially acid reflux. I guess I'll know after I get WLS, eh?

Penni, thanks for taking such good care of our Lisa. She's lucky to have such a wonderful friend/sister as you. This place is marvelous, and you guys are the best.

vinesqueen · February 2, 2005

Asthma can indeed be made worse by acid reflux. You can in advertently inhale some of the acid and burn your lungs... Bad mojo. If your asthma is worse at night, they might suspect acid reflux as well. This is one of the things they think is making my asthma worse....

Innuendo can be too much fun. Maybe that is why the thread was deleted? Shakespeare is full of naught bawdy stuff...

La_madam · February 2, 2005

rinsing out your pouch with a big glass of Water before bed to make sure the pouch is completely empty will help avoid refulx at nightime

DeLarla · February 2, 2005

Hmmm... explains my ghost-asthma. Some docs say I have slight asthma, others say I'm nuts. It's all kinda related, like trying to cough a lil liquid out of my lungs.

Yes, Alex, I am SUPPOSED to stop eating several hours before bed. I'm also supposed to eat Band portions. I have to do my homework today (see Penni's homework thread.) Today is the day I try to get back on track. This means 3 meals and one veggie snack at 7:00 p.m.

I had a hiatal hernia prior to Banding with lots of acid/digestion/coughing problems. But docs marvel at my ability to eat the kinda salsa that makes my head sweat but doesn't burn my belly or give me heartburn. I'm all bass-ackwards.

blossom · February 2, 2005

Where is Penni's homework thread? I've looked and looked and I can't find it.

Penni60 · February 2, 2005

Where is Penni's homework thread? I've looked and looked and I can't find it.

There ya go Blossom!!

LapBandTalk.com - Lap Band Talk Forum - Dr. Billy HOMEWORK - Have pad, pencil, and humor ready

WillPower · February 2, 2005

this might be helpful for all who have tummy issues. I for one have had GERD all my 33 years of life. My mom said that she had to follow me around with a towel when I was a baby...... :sick

Original Article:

http://www.mayoclinic.com/invoke.cfm?id=HQ00312

Barrett's esophagus

Overview

Tums. Maalox. Mylanta. Rolaids. These and other over-the-counter remedies spell "r-e-l-i-e-f" for many of the millions of Americans who regularly have heartburn.

However, common heartburn isn't always just an annoying condition that's quickly remedied by an over-the-counter antacid. It can also be symptomatic of gastroesophageal reflux disease (GERD), which is the chronic regurgitation of acid from your stomach into your lower esophagus. And, long-term GERD can sometimes lead to Barrett's esophagus, a condition in which the color and composition of the cells lining your lower esophagus change because of repeated exposure to stomach acid. Having Barrett's esophagus increases your risk of developing esophageal cancer.

Barrett's esophagus is uncommon. Only a small percentage of people with GERD develop Barrett's. But once it's diagnosed, there's a much greater risk of developing esophageal cancer, which often spreads from the esophagus to lymph nodes and to other organs. Although increased, the absolute risk of esophageal cancer for someone with Barrett's esophagus is small — less than one percent a year.

Signs and symptoms

Barrett's esophagus itself isn't associated with specific symptoms. But, heartburn and acid reflux — the bad-tasting liquid that may enter your mouth from your throat — are common indicators of GERD. And having GERD can lead to Barrett's esophagus.

A telltale sign of Barrett's esophagus occurs when the color of the tissue lining the lower esophagus changes from its normal pink to a salmon color. This process, called metaplasia, is caused by repeated and long-term exposure to stomach acid.

Other signs and symptoms of GERD that also may be associated with Barrett's esophagus or even rarely esophageal cancer include:

Trouble swallowing. Often, a narrowing of the esophagus (esophageal stricture) leads to difficulty swallowing (dysphagia).

Bleeding. You may vomit red blood or blood that looks like coffee grounds.

Unusual stools. Your stools may be black, tarry or bloody.

Weight loss. You may experience an unexpected drop in weight.

Causes

Barrett's esophagus usually develops from gastroesophageal reflux disease (GERD). Heartburn and acid reflux are the most common symptoms of GERD and result from stomach contents washing into the esophagus.

The ring of muscle at the junction of the esophagus and stomach (sphincter) normally traps acid in your stomach by clamping shut. GERD usually results from a weakened sphincter, and it can be aggravated by a protrusion of the upper stomach, where the esophagus passes through the diaphragm (hiatal hernia).

Left untreated, GERD can lead to more serious complications such as severe heartburn (with esophagitis) — the chest pain can be intense enough to resemble a heart attack — stricture, bleeding, Barrett's esophagus and even esophageal cancer.

Risk factors

Chronic heartburn and acid reflux put you at risk of GERD and Barrett's esophagus because the esophagus is designed to carry food and liquid only one way: from your mouth to your stomach. The esophageal lining is sensitive to and unable to handle acid. Your stomach, however, has a lining designed to withstand acid-containing stomach (gastric) contents.

Stomach acid is damaging to esophageal tissue. Repeated and long-term exposure to stomach acid can lead to the transformation of esophageal tissue into the salmon-colored tissue characteristic of Barrett's esophagus, which is actually an acid-resistant lining similar to the lining of your stomach.

Men are more likely to develop Barrett's esophagus than women are. The disease is also more common in people over the age of 60 than it is in younger adults.

When to seek medical advice

See your doctor if you've had long-term trouble with heartburn and acid reflux. Talk to your doctor as soon as possible if you:

Have difficulty swallowing

Are vomiting red blood or blood that looks like

coffee grounds

Are passing black, tarry or bloody stools

Experience an unexpected weight loss.

Screening and diagnosis

Diagnosing Barrett's esophagus is difficult because it often doesn't exhibit specific symptoms. Experiencing the acid reflux of GERD may be the best indication that you either have Barrett's esophagus or may be at risk to acquire the disease.

If you have severe acid reflux, your doctor may discover Barrett's esophagus by examining your esophagus through endoscopy. Endoscopy involves inserting a lighted, flexible tube (endoscope) with a camera on its tip through your mouth and into your esophagus and stomach. Usually, you'll receive a local anesthetic, and you may be sedated for this procedure.

The procedure allows your doctor to search for abnormalities such as precancerous cell changes (dysplasia) or an abnormal junction between your stomach and esophagus. In a healthy esophagus, the stomach-esophagus mucosal junction is at the lower end of the esophagus. In Barrett's esophagus, this junction is displaced upward. If Barrett's esophagus is suspected, your doctor also looks for evidence of cancer.

During endoscopy, your doctor may remove tissue samples (biopsies) of potentially abnormal areas to be examined under a microscope. If specimens reveal intestinal goblet-shaped cells, your doctor may make a diagnosis of Barrett's esophagus.

Complications

Having Barrett's esophagus increases your risk of developing esophageal cancer. The earlier that metaplasia — the telltale changing of the color of the tissue that lines the lower esophagus from its normal pink to a salmon color — is detected, the better.

Barrett's esophagus may develop precancerous changes (dysplasia) in grades ranging from none to mild but still significant changes (low-grade), to serious changes (high-grade), and finally to invasive cancer. When high-grade dysplasia is detected, cancer often is already present. Cancer can spread from the esophagus to nearby lymph nodes and to other parts of your body.

Treatment

It's not too late to treat Barrett's esophagus if you don't have advanced cancer. However, many people with esophageal cancer show up so late in the progress of the disease that doctors first discover Barrett's esophagus at the same time they find the cancer.

Treatment for Barrett's esophagus may start with controlling GERD by making a number of lifestyle changes and taking self-care steps. These actions include getting more exercise, avoiding foods that aggravate heartburn, stopping smoking if you smoke, taking antacids or stronger acid blocking medications, and elevating the head of your bed to prevent reflux during sleep.

People with severe GERD and Barrett's esophagus usually need aggressive treatment, which may include medications, other nonsurgical medical

procedures or even surgery.

Medications

Proton pump inhibitors (PPIs) such as omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix) and esomeprazole (Nexium) are drugs that block production of acid and relieve irritated tissue.

Doctors sometimes prescribe another class of drugs called H-2-receptor blockers to treat GERD and Barrett's esophagus. They're weaker than PPIs, although less expensive. Prescription H-2-receptor blockers such as famotidine (Pepcid, Mylanta AR), cimetidine (Tagamet), nizatidine (Axid) and ranitidine (Zantac) are available over the counter in doses less than prescription strength.

Although these medications often are quite effective for GERD, once Barrett's metaplasia is present these drugs won't reliably reverse the condition, and the risk of cancer remains.

Surgery

Anti-reflux surgery (laparoscopic Nissen fundoplication) offers an alternative to dependence on medication for GERD and Barrett's esophagus. The procedure tightens the sphincter by wrapping part of the stomach around the lower esophagus to prevent acid reflux. Laparoscopic surgery involves inserting special instruments through small incisions — less than an inch. The procedure leaves only tiny scars. You can expect to stay in the hospital for one or two days following this surgery.

Although surgery can be effective for GERD, once Barrett's metaplasia is present surgery won't reliably reverse the condition, and the risk of cancer remains.

If you have esophageal cancer, or if you have Barrett's esophagus and high-grade dysplasia, your doctor may recommend you undergo a procedure in which the esophagus is removed completely and the stomach is pulled into the chest (esophagectomy). After this surgery, you may lose up to 20 pounds, spend 10 to 12 days in the hospital and require up to six weeks to recover.

The surgical treatment of people with high-grade dysplasia is controversial. Some experts believe that esophagectomy should be used as a measure to protect against cancer. Other experts believe that surveillance through endoscopies at three- to six-month intervals and esophagectomy — if cancer develops — are sufficient. Doctors generally don't recommend surgery for people with declining health or for those who are too weak to withstand a major procedure.

Alternatives to medications and surgery

Removal (ablation) of dysplasia makes possible the reversal of Barrett's esophagus, and it may prevent esophageal cancer. Combined with PPIs, ablation may be appropriate especially if you're not a good candidate for an esophagectomy. Ablation procedures include:

Photodynamic therapy. First, you'll take a drug to make the Barrett's cells sensitive to light. Then, your doctor inserts a light into your esophagus. Tissues that the light touches are burned off. The food and Drug Administration has approved the photosensitizing agent Photofrin to treat Barrett's esophagus.

Electrocautery. Your doctor inserts an electric wire into your esophagus to burn away dysplasia.

Laser therapy. Your doctor uses a hot beam of light (laser) inserted into your esophagus to burn away Barrett's cells. This procedure is effective but difficult to apply evenly.

Argon plasma coagulation. Your doctor releases a jet of argon gas into your esophagus along with an electric current to burn away dysplasia.

The long-term effectiveness of ablation procedures in preventing cancer is not known.

Self-care

You may eliminate or reduce the frequency of stomach acids flowing up into the lower end of your esophagus by making the following lifestyle changes:

Eat smaller, more frequent meals. Three meals a day, with small Snacks in between, will help you stop overeating. Continual overeating leads to excess weight, which aggravates heartburn.

Loosen your belt. Clothes that fit tightly around your waist put pressure on your abdomen, aggravating reflux.

Avoid stooping or bending. Tying your shoes is OK. Bending over for hours to weed your garden isn't, especially soon after eating.

Don't lie down after eating. Wait at least two to three hours after eating to lie down or go to bed.

Raise the head of your bed. An elevation of 6 to 9 inches puts gravity to work for you. Or you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Wedges are available at drugstores and medical supply stores. Raising your head alone by using pillows isn't a good alternative.

Don't smoke. Smoking may increase stomach acid. The swallowing of air during smoking also may aggravate belching and acid reflux. In addition, smoking and alcohol increase your risk of esophageal cancer.

By mayo Clinic staff

HQ00312

May 19, 2004

© 1998-2005 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "Mayo Clinic Health Information," "Reliable information for a healthier life" and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research.