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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18194
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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At 2am this morning, I woke up with stomach acid filling my

Customer Question

At 2am this morning, I woke up with stomach acid filling my mouth again. I have suffered with acid reflux [Gord] for 30 years, I am 68 now. I had a hiatus hernia 25 years ago there is no sign of it now, and have been on various proton pump inhibitors [PPI] since. I have problems with choking, with food being stuck in the lower oesophagus. I have had three Gastroscopies, in the last three years, with no findings, at a cost of thousands of dollars, an oesophagus dilation was not performed although requested. I have had barium, with marshmallows to follow its path down, curiously that wanted me to chew the marshmallow. No blockage was found (surprise). I've been given a list of acidic foods to avoid and although that included almost everything, it didn't help. But even the so called medical experts can't agree on whether these foods cause my acid reflux, with some saying e.g. lemons, tomatoes are acidic BUT Alkaline forming, my Doctor says it's bullsh*t. Meanwhile I keep on various Nexium, Zoton, Losec, Zantac, Motilium in differing strengths, and still no joy. Choking on stomach acid and at times unable to swallow the smallest of food items. While not being able to enjoy a coffee is no fun. Can't go on like this.
Paul.
Submitted: 8 months ago.
Category: Medical
Expert:  Dr. D. Love replied 8 months ago.

Hello from JustAnswer.

When you say that the three gastroscopies had no findings, do you mean that there was no evidence of ongoing acid reflux?

You mention the gastroscopies and the barium swallow, but have you have an esophageal manometry or a 24-hour esophageal pH probe?

Expert:  Dr. D. Love replied 8 months ago.

I had asked for some additional information and have not heard back.

If the gastroscopies did not show any evidence of ongoing reflux, then it may help to perform a more sensitive test, which is a 24-hour esophageal pH probe, which can quantify the frequency and severity of reflux.

An esophageal manometry test can be done to assess the muscular activity of the esophagus, particularly looking for times that the esophagus may spasm or when the muscles are not coordinated well, call dysmotility.

If there is ongoing reflux despite the PPIs, then it may help to augment the PPI with a different medicine, such as an H2 blocker, e.g., ranitidine. The PPIs are typically stronger than the ranitidine, but the ranitidine can be used to augment the PPI.

Altering the diet can help some people, but many people with reflux find that it does not make much difference. If you find that it helps you, it is certainly fine to continue. Another lifestyle intervention that may help is the placement of blocks under the feet at the head of the bed. The blocks should be about 6 inches/15 cm tall, so that you are sleeping at an angle, which can help keep gravity on your side while asleep. It is also important to note that sleeping on extra pillows does not work as well, as it makes you bend at the waist. It is better to be straight, but at an angle.

In someone with persistent reflux despite multiple medicines, another option to consider would be surgery to prevent the acid reflux, which involves a procedure called a fundoplication, in which a portion of the stomach is used to wrap around the lower esophagus. We do nt need to do this procedure anywhere near as often as we once did, because the PPIs are generally very good medicines, but there still are some people with stubborn reflux that require surgery.

If I can provide any additional information, please let me know.

Customer: replied 8 months ago.
Sorry for the delay but I had to go out.
The Gastroscopy showed some acid reflux but the Surgeon said he has seen a lot worse and in his opinion it's not of any consequence.
No I have not had an esophageal manometry or the PH probe.
I have had blocks under the bed for quite some time.
It is the choking problem that is my major concern.
Expert:  Dr. D. Love replied 8 months ago.

The key issue is whether the choking sensation is due to reflux that is not adequately controlled or from a muscular problem of the esophagus, which is why the evaluation above would be appropriate.

Customer: replied 8 months ago.
Thank-you, will look into it.
Expert:  Dr. D. Love replied 8 months ago.

You are most welcome.

Please remember to provide a positive rating so that I am credited for assisting you.