Endoscopia normal, mas ainda com problemas

Saúde digestiva
1

Hi all,

I finally had an endoscopy after having stomach ache, abdominal cramps and dyspepsia. This has all been going on for four months. 

The cramping has been attributed to constipation which has been relieved with daily sachets. However I'm now experiencing what can only be on/off acidity and heartburn since Christmas. 

I generally get a chest pain two hours after my lunch, I'm still burping throughout the day which has been ongoing. My stomach now also feels like I've pulled a muscle in it. 

My questions are:

Would an endoscopy show up GERD? Even if I have only been having sysmptoms for around four months?

What tests can I ask my doctor for if I want them to investigate possible GERD and acid reflux?

Also, I was intially prescribed omeprazole as soon as I visited the doctors but refused to take them having seen how much trouble people had with rebound and with many sites saying they aren't good for you. I will be happy to take PPIs if acidity/GERD is confirmed but I'm worried my doctor won't let me have further tests seeing as I have refused to take the pills. 

Lastly my final question is - have I done this to myself? I have had an eating disorder and ate three very healthy/tiny meals a day e.g salads/clean meals with some shop bought soups. The trouble is, I would put loads of cheese on top and then eat a couple of small handfuls of cheese throughout the day for the two months leading up to these issues. I was also having small-ish quantities of chocolate almost everyday preceding this too. Could I have caused my LES to relax permenantly through this behaviour and is there no way for me to strengthen this and make these terrible symptoms go away?

It's had a massive impact on my mental health, my social life (friends have stopped inviting me out because everything involved eating and drinking) and my boyfriend is getting really fed up with me not being able to join him up the pub for a few once in a while as well as me constantly getting upset about feeling sick/bloated and burping after every meal. I just want this to go away and get back to my old routines. 

FYI - 28yr old female.

Weight 6 stone 5. 

Any thoughts much appreciated. 

2

Hi,

Yes, an endoscopy will show Reflux/GERD or gastritis.  But not always when is done if not later when they get the results from any biopsies.

Omeprazole is the first medication they give you, you can use it safely for 2 weeks and if needed more but if you do take it for more than 2 weeks when you don't need it anymore do not stop at once. Go down to 1 pill every other day and then to 1 pill every 3rd day and then stop.  If all you have is a mild reflux then with 20mg once daily should do.  Sure, just like any other medication what works for some may not work for you.  Can you get side effects frm it?  YES!  But in my personal case It did not and it did nothing for me as well. ;-(  I tried 3 different by Doctors orders and nohting helped and all they found was mild reflux and cronick mild gastritis.

And yes, loads of cheese and chocolate will do this to you.  For now I suggest you stop dairy, wheat products which has Gluten, corn, coffee, alcohol, sugar and peanuts for 2 weeks and go back to them one by one to see which one is not doing well with you.

3

Hello,

Sorry to hear you are having these problems. It is good that the endoscopy didn't find anything obviously attributable to acid damage, ulcer, etc, for it likely would have if your tissues were anywhere inflamed or irritated and so on.

Chocolate, cheese and other high-fat foods can and often do give people problems with heartburn and reflux, milk and dark chocolate for some people two-fold due to having a degree of caffeine in it (white choc is caffeine-free). It is the same with coffee, certain teas. High-salt foods can also irritate tissues. I would suggest dropping the chocolate and cheese experimentally - both effect me badly (you can read more on the net generally about suggested diets for people suffering frequent heartburn).

Other foods that are strongly spiced and hot can affect people as well, and carbonated drinks, though it is a matter of finding out for oneself with many foods, for we are all different with similar but various stomach-related troubles. Minty foods and, in my experience, even toothpaste, can irritate and relax the eosphageal sphincter, so I use a children's fruity one. Overfilling the stomach is not a good thing either, or putting pressure on it through exercise. There are other tips in comments elsewhere on the site from fellow sufferers.

Regarding constipation, most of us need enough food intake throughout a day, with sufficient fibre - soluble and insoluble - to actually form enough matter for fair loo visits, so maybe not eating enough generally, or enough fibre in particular, might be the cause in your case, so you could look into eating more if you can, though I know that could be a problem in your case.

I have seven medium meals each day, avoiding all the foods I mentioned, and I have made progress with my gastritis issues over three years, while experimenting with new foods now and then, for it isn't easy to get enough calories in with limited foods. I am also having Fortisip nutrition drinks presently to help.

About burping. Again, in my experience, burping could bring up some acid and burn my tissues which then had to heal again, so my rule is to not belch at all after about ten minutes following a meal, and this has served me very well.

I was on a PPI for two months but weaned off over a few weeks as it made my eosphagus feel worse and my throat and mouth intolerably dry. That was in early 2013. So it is with care, foods and avoidance of stress that I manage the matter. Stress is really not good.

The mental aspect of these things can be very severe, for your whole life is suddenly effected, including such things as you mentioned about not getting out with your boyfriend. He clearly can't imagine what you're suffering. If he experienced it he wouldn't even be able to look at drink again let alone think of swallowing it! So you're not alone in your difficulties and upset. It is very hard to adapt to illnesses that don't go away quickly or at all; hard to accept the issues involved. It is a kind of grief really, for the lost life that you knew and enjoyed. Try to bear in mind that time is needed to see what is wrong and what can improve it. Learn what you can of facts and possible useful advice - professional and from sufferers - and give it time.

I hope this gives you some small help, though I know that you and all of us wish there was an instant cure to take us back to being who and how we were.

4

Thanks for reaponsing. I'm working on eating more. At the moment it seems everything I eat (even cold water) is giving me heartburn around 1-3 hours afterwards. This seems like an awfully long time to come on. I would have thought heartburn came on straight after eating?

Anyway, the more I look back on my diet previous to this I think it must have contributed to a weakened LES. I was eating a lot of raw onion almost daily. I'm so annoyed at myself right now. In fact most days I'm suicidal because I don't have any quality of life. I feel like a burden and completely ostrisised from everyone.

Do you know what test I can have to show a weakened LES?

Many thanks

5

Hello again,

I sensed you were in a very troubled state, and I totally empathise. Personal problems, loss and bereavement occurred on top of two years of my stomach troubles, so you can imagine where my mind was, and still is, with all that. It's very trying for you and natural that your normal fight/flight response to this awful pain and discomfort is making you feel the way you are. But don't give up, and don't be afraid to tell your doctor all of this. The more they know the better they might help you..

Water. Even my partner used to get heartburny if she drank water between meals. I can't drink it between meals simply because of having one of seven meals every couple of hours - there's no time to drink between without slowing the digestion down a bit, so I have about 125ml of water, and some Fortisip, sipped with bites of my foods each mealtime. This way I'm not filling my stomach with food that is too liquid, which would likely bring acid more easily to the top where my stomach and lower eosophagus were/are most inflamed and delicate. So you could try this same, rather than drink quantities of water some time after a meal.

Acid takes a while to arrive in the stomach after eating, and that could be why you experience the heartburn when you do, later on, though I have experienced similar discomfort straight after eating butter in the past (can't have much now), as if the butter itself was irritating me.

It is a good thing to eat slowly, relaxed, with a good posture, and chew well so that the food is more easily and quickly broken down further. And after a meal try to be more upright when sitting rather than slouching, bending or lying down; and don't exercise or put pressure on your stomach. Treat yourself gently as you can.

I too cursed myself for past eating errors when gastritis began, though it was really only a matter of high salt and fat with me, and it was actually three courses of antibiotics and painkillers for abscesses through a troublesome wisdom tooth that caused the damage. If not for them I could have been ok still. So don't be too hard on yourself with blame, with the strong onions, choc and so on. We typically learn after an event, the hard way, alas.

I wonder if you take any antacid, like Gaviscon, when the heartburn starts? It could spare you some discomfort while you try to develop a new routine of diet? As for your LES, I imagine that the endoscopy would have detected any slackness there, for that would be something looked for. The thing is to not overfill or squash the stomach so that the contents reach or push up to the LES.

Avoiding known irritating or heartburn-causing foods is one thing. It might take time and trial to find out if others are affecting you . One step at a time. Two of my meals are mixed cereals with some banana, and the rest are wholewheat bread sandwich-based, with three bananas, three, sometimes four hard-boiled eggs and so on each day. In 2014 I was on five eggs a day to get fat and protein that way, and when my cholesterol was measured it was fine, so unless you have a medical problem with cholesterol, don't worry about eggs. My dietician told me to eat as many as I liked (the body adjusts its own production of cholesterol to keep the balance right).

I don't have salads due to aiming for the highest calories I can take in. Whatever food I used to have that was low in calories I tried to replace with something higher, but the nutrition drinks via the dietician are very useful presently. It's a slow process, though.

All this upset and stress, and your feeling of ostracision and suicidalness, is extra difficulty while trying to improve this trouble, so you need to be calm and draw upon all your inner strength to bear up best you can. And you're not alone, nor alone in feeling shut off from everyone either. Comment on here any time you need to.