For those who might have symptoms of reflux, but don't necessarily feel any sensation of acid heartburn, you might want to look into having an impedence test.
I have done all the GI tests for reflux, and although I am quite sure there is some issue with reflux, all my testing; self, and doctors tests show that there is no ph imbalance. That has left me confused for years.
Recently someone brought up bile reflux again on this forum. Bile reflux isn't well known about and doctors really haven't been testing for it, up until a few years ago. Actually if you don't bring it up, they might not. I brought up bie relux and got my doctor to pause and recheck his notes and resources. He agreed that he hadn't considered it over the years, and that the doctors he referred me to weren't even administering tests for it 3 years ago.
Well, now he has suggested me take an impedence test, after I explained to him some of my findings and the (gut) feelings I have. An impedence test checks to see if stomach contents are travelling in the right direction ie: down. Acid may not be an issue, but if bile is, this test is designed to check for it.
If you have erosive esophagus, but no ph imbalance, talk to your doctor.
Sorry this isn't a fancy scientific article (yeah they mean nothing to me), there are no facts here. Only you know of this may or may not help you. This is not an attempt to convince anyone of anything.
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Impedence testing
nice post, Eliott,
I feel sorry this test is not available in my country..do let us know when u go through it..
I never had chest pains and for a while thought I had bile reflux, but it was also possible that the refluxate was formed just by activated pepsin, which wouldn`t cause chest pain yet would lead to LPR and bb..
Have u ever been told u have bile in your stomach after an endoscopy? That might suggest u have bile reflux
I feel sorry this test is not available in my country..do let us know when u go through it..
I never had chest pains and for a while thought I had bile reflux, but it was also possible that the refluxate was formed just by activated pepsin, which wouldn`t cause chest pain yet would lead to LPR and bb..
Have u ever been told u have bile in your stomach after an endoscopy? That might suggest u have bile reflux
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bbforyears
- Newbie
- Posts: 35
- Joined: Wed Oct 21, 2009 3:10 am
Hi guys, so I was on to the next doc today.
I am having the actual test next wednesday, and this doc is extremely knowledgeable. He actually holds all sorts of studies on gastrointestinal, esophageal, throat and intestinal issues. He was so impressed by my personal knowledge (LOL) of gastro issues, that we ended in tangents discussing all things digestion, ph, reflux, etc. I think he enjoyed the perspective of a patient who has gathered so much info from things like this forum. He wrote every word I said down, even if it meant me sitting there in his freezing office for the next hour.
Anyway, we did discuss the rarity of bile reflux, but he certainly did not dismiss it. It only made him more curious. We spent 30 minutes reviewing everything I had done over the past 3 years medically, and insisted that acid did not seem to be a problem, regardless of hiatus hernia. He was the one who did my esophageal manometry (this tests esophagus pressure while swallowing, I believe he is one of very few doctors that does it... actually the time I did it, he used me as a guinea pig so to speak, and he had other professional doctors learning the procedure while he did it!) ... and 24 hour (non impedence) ph test 3 years ago. The tests were reviewed in full. Again, I did not look to be a person with acid reflux. To this day, I don't get heartburn... it has never been a problem unless I force down an entire pizza and 5 beers (back in college)
He says that most people take the proton pump inhibitors (prevacid, purple pill, etc) and the acid decreases for normal acid reflux patients (the great majority). He mentioned that on the other hand there are rare cases of people with B12 issues that do not produce enough acid at all, these would be cases where bile reflux may be an issue. These people complain also about heavy throat, lump in throat, no heartburn. These cases are usually related to people who have had surgery, stomach patches, etc.
I let him know about my and others' (from this forum) feelings about the sensation of food not properly digesting, bloating, feel of nausea at night (even though I don't experience this). I wonder if this can be related to lack of acid, perhaps abundance of bile. Of course there is no answer to this, but he did not deny a potential connection. Fact is, they have done tests, but with too small a pool of people to make any conclusions. This issue we have is so complex, most people probably don't get into the details with their GI, there is yet a precedent for this.
Anyway, to end the rambling, he is going to redo the manometry (which should be more precise 3 years later) and he will administer a 24 hour impedence ph test, which supposedly will let me know if bile (or acid) is moving upward out of my (remember, I have hernia) stomach. The test seems tough, the tube goes from the esophagus out through the sinus. It will stick out the nose.
Iva. Endoscopy will not 'see' bile. Again, most people who go in for acid reflux, actually do have it; they take the pill, they are cured. Anyone else, is unfortunately stuck like me, most of us can't get far enough to find a doctor to actually speak in depth about it. Most of us, up until this point where (thanks Jimi you make a difference) have had no way to communicate these issues to even bring them up at the doctor. If you bring up "bile reflux" the doctor will indeed raise his/her eyebrow and have to consider it.
I am having the actual test next wednesday, and this doc is extremely knowledgeable. He actually holds all sorts of studies on gastrointestinal, esophageal, throat and intestinal issues. He was so impressed by my personal knowledge (LOL) of gastro issues, that we ended in tangents discussing all things digestion, ph, reflux, etc. I think he enjoyed the perspective of a patient who has gathered so much info from things like this forum. He wrote every word I said down, even if it meant me sitting there in his freezing office for the next hour.
Anyway, we did discuss the rarity of bile reflux, but he certainly did not dismiss it. It only made him more curious. We spent 30 minutes reviewing everything I had done over the past 3 years medically, and insisted that acid did not seem to be a problem, regardless of hiatus hernia. He was the one who did my esophageal manometry (this tests esophagus pressure while swallowing, I believe he is one of very few doctors that does it... actually the time I did it, he used me as a guinea pig so to speak, and he had other professional doctors learning the procedure while he did it!) ... and 24 hour (non impedence) ph test 3 years ago. The tests were reviewed in full. Again, I did not look to be a person with acid reflux. To this day, I don't get heartburn... it has never been a problem unless I force down an entire pizza and 5 beers (back in college)
He says that most people take the proton pump inhibitors (prevacid, purple pill, etc) and the acid decreases for normal acid reflux patients (the great majority). He mentioned that on the other hand there are rare cases of people with B12 issues that do not produce enough acid at all, these would be cases where bile reflux may be an issue. These people complain also about heavy throat, lump in throat, no heartburn. These cases are usually related to people who have had surgery, stomach patches, etc.
I let him know about my and others' (from this forum) feelings about the sensation of food not properly digesting, bloating, feel of nausea at night (even though I don't experience this). I wonder if this can be related to lack of acid, perhaps abundance of bile. Of course there is no answer to this, but he did not deny a potential connection. Fact is, they have done tests, but with too small a pool of people to make any conclusions. This issue we have is so complex, most people probably don't get into the details with their GI, there is yet a precedent for this.
Anyway, to end the rambling, he is going to redo the manometry (which should be more precise 3 years later) and he will administer a 24 hour impedence ph test, which supposedly will let me know if bile (or acid) is moving upward out of my (remember, I have hernia) stomach. The test seems tough, the tube goes from the esophagus out through the sinus. It will stick out the nose.
Iva. Endoscopy will not 'see' bile. Again, most people who go in for acid reflux, actually do have it; they take the pill, they are cured. Anyone else, is unfortunately stuck like me, most of us can't get far enough to find a doctor to actually speak in depth about it. Most of us, up until this point where (thanks Jimi you make a difference) have had no way to communicate these issues to even bring them up at the doctor. If you bring up "bile reflux" the doctor will indeed raise his/her eyebrow and have to consider it.
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KeepTrying09
- Sheriff
- Posts: 471
- Joined: Sun Nov 15, 2009 3:14 pm
- Location: Thailand
Hey Elliot,elliott wrote:Hi guys, so I was on to the next doc today. I am having the actual test next wednesday, and this doc is extremely knowledgeable. .
If you get any documentation from your tests, such as photos or reports or anything like that, could you scan it and post it here on this forum? I'm just trying to get as many people as possible to provide photos of all these tests so they will have better ammunition when speaking with doctors (because most people's doctors do not take them seriously when they inquire about issues such as these.)
If we can get enough photographic evidence regarding our problems, perhaps doctors will be forced to consider the possibilities of all these possible causes of bad breath.
Thanks!
Eliott,
I really hope u will be able to find exactly what is the case with ur acid/bile reflux...
"Endoscopy will not 'see' bile" you say. Well I`ve been told TWICE after an ecdoscopy that there is bile in my stomach. I guess a gstro would know bile when he sees it through the endoscope.
"most people who go in for acid reflux, actually do have it; they take the pill, they are cured" - well for me ppi just make the refluxate non-acidic, they do not stop reflux.
Have u ever considered the idea that if u do not have bile or acid reflux u may have a reflux consisting merely of activated pepsin, which is enough to cause bb when reaching as high as the throat?
I really hope u will be able to find exactly what is the case with ur acid/bile reflux...
"Endoscopy will not 'see' bile" you say. Well I`ve been told TWICE after an ecdoscopy that there is bile in my stomach. I guess a gstro would know bile when he sees it through the endoscope.
"most people who go in for acid reflux, actually do have it; they take the pill, they are cured" - well for me ppi just make the refluxate non-acidic, they do not stop reflux.
Have u ever considered the idea that if u do not have bile or acid reflux u may have a reflux consisting merely of activated pepsin, which is enough to cause bb when reaching as high as the throat?
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bbforyears
- Newbie
- Posts: 35
- Joined: Wed Oct 21, 2009 3:10 am
OMG Elliott--
I am so freaking out right now! Thank you for that post!
I have had other "strange" symptoms unrelated to my bb and I think you might have just explained it for me. I was up all night researching B-12 deficiency.
Some of my other strange symptoms that have somewhat improved on Carafate are:
Extreme cold intolerance (i would shiver in 80 degree weather)
Numbness in the extremities (hands, arms, feet and legs--I complained to my mom and boyfriend a few years back that I thought I was getting MS)
Yellowing of skin (i went to a dermatologist a few years back and was diagnosed with Melasma..)
Irritated eyes (alternating dry eyes and watery eyes)
Hair loss-- I would lose clumps of hair everywhere-- people would comment about my shedding all the time
The weird part is I don't have these problems much anymore. Is a B-12 deficiency related to bile reflux? I still have the numbness in my legs and arms sometimes but I no longer shiver in warm weather and I barely lose any hair anymore...
I also read that B-12 deficiency can cause issues with the sense of smell. Remember, I told you guys how I went from an extreme sensitivity to smell to complete smell loss after starting PPI's.
I am going to my primary care doctor today. He checked my thyroid a few years back because of the hairloss and extreme cold and it was fine. Of course, I never complained about the BB back then. It took me 11 1/2 years to muster up the courage to talk about that one!
Thanks so much Elliott!
I am so freaking out right now! Thank you for that post!
I have had other "strange" symptoms unrelated to my bb and I think you might have just explained it for me. I was up all night researching B-12 deficiency.
Some of my other strange symptoms that have somewhat improved on Carafate are:
Extreme cold intolerance (i would shiver in 80 degree weather)
Numbness in the extremities (hands, arms, feet and legs--I complained to my mom and boyfriend a few years back that I thought I was getting MS)
Yellowing of skin (i went to a dermatologist a few years back and was diagnosed with Melasma..)
Irritated eyes (alternating dry eyes and watery eyes)
Hair loss-- I would lose clumps of hair everywhere-- people would comment about my shedding all the time
The weird part is I don't have these problems much anymore. Is a B-12 deficiency related to bile reflux? I still have the numbness in my legs and arms sometimes but I no longer shiver in warm weather and I barely lose any hair anymore...
I also read that B-12 deficiency can cause issues with the sense of smell. Remember, I told you guys how I went from an extreme sensitivity to smell to complete smell loss after starting PPI's.
I am going to my primary care doctor today. He checked my thyroid a few years back because of the hairloss and extreme cold and it was fine. Of course, I never complained about the BB back then. It took me 11 1/2 years to muster up the courage to talk about that one!
Thanks so much Elliott!
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bbforyears
- Newbie
- Posts: 35
- Joined: Wed Oct 21, 2009 3:10 am
Hey Elliot,
I think its great you;ve done so much research and pushing of your GP on this, I have really bad problem with acid reflux from my stomach, I had my first session with a gastroenterologist yesterday and he was very helpful and explained all manner of things that happen with the stomach on digestion.
On occasions people have a muscle spasm on the muscle that closes off the stomach from the foodpipe. This muscle can then relax and cause food to travel back up the foodpipe causing heartburn, back pain and stomach cramps.
Also he is testing for a certain type of stomach bacteria to see if that causes the symptoms.
Will let you knwo the results. I hope your GP is as helpful as he was.
x
Sally
I think its great you;ve done so much research and pushing of your GP on this, I have really bad problem with acid reflux from my stomach, I had my first session with a gastroenterologist yesterday and he was very helpful and explained all manner of things that happen with the stomach on digestion.
On occasions people have a muscle spasm on the muscle that closes off the stomach from the foodpipe. This muscle can then relax and cause food to travel back up the foodpipe causing heartburn, back pain and stomach cramps.
Also he is testing for a certain type of stomach bacteria to see if that causes the symptoms.
Will let you knwo the results. I hope your GP is as helpful as he was.
x
Sally
Hello,
you guys are probably right about endoscopy being able to detect bile. I have gotten contradicting info from my GIs so I'm certainly not sure,. I know that bile was never detected or even questioned at the time I had my endoscopies, and that my current GI suggests that I have this impedence test. Perhaps endoscopy can detect abundance of bile (everyone has some bile in their stomach) but the test does not assess if the bile is passing up thru the muscle (stomach opening/sphincter)?
Interesting tidbits I've read in here, bbforyears. Thanks for sharing. Regarding thyroid, I had mine checked as well years ago and the conclusion was it was slightly inflamed, but ok.
I had a coworker, that had BB, had hairloss, cold intolerance, skin issues, dryness, fatigue, just as you describe. Her BB lasted about a year from the time she was hired, and suddenly went away after she had been taking some korean "potion" medicine, who knows what else she did, but I remember her not smelling anymore. This was before I had BB. Interestingly enough, a year later, I have the odor issues... none of the other skin or cell issues. hmmm
So yeah, I'm getting ready to take the tube out. It was not fun. The tube is connected to a device that will record ph level in esophagus and sinus, over a 20 hour period. I can input when I am eating or lying down. The device is heavy, I have to wear it as a necklace. It has 2 cords, one connected to my chest to monitor heart rate (I guess) and the other is a long cord that is taped to my face and nose, passed thru the sinus, beyond the tonsils, and into the esophagus. The good news is that I can eat a normal meal, since it would be pointless not to. I live in US so it's a decent day to have a huge meal
I also had manometry testing before they put in the 20 hour device, suffice to say, the cord for manometry is 3 times thicker. Just imagine someone holding you back while they shove a knife thru your nose into your throat, and telling you to swallow it for 15 minutes.
Iva, you are clearer than I! Yes, the ppi only neutralizes the reflux, it doesn't stop it PPI can also help to heal an erosive sphincter. I think my doctor's point was that most people are satisfied after seeing him on acid reflux, taking the pill for 4 months.
I haven't considered pepsin, never heard of it, but I will now keep it in mind. I'll ask about it. And I will try to have them fax me copies of my lab tests, if it could help anyone. I understand doctors not taking people seriously. I think the only reason this doc is being helpful, is because I have not brought up bad breath per se. You have to bring up something specific (such as stomach bloating, heartburn), explain all related symptoms, and let him connect the dots. In the past when I have walked in and said "BB", I felt the doctor's confusion and frustration at an issue too broad for him to pinpoint anything.
Happy turkey day for the 'murikins !!
you guys are probably right about endoscopy being able to detect bile. I have gotten contradicting info from my GIs so I'm certainly not sure,. I know that bile was never detected or even questioned at the time I had my endoscopies, and that my current GI suggests that I have this impedence test. Perhaps endoscopy can detect abundance of bile (everyone has some bile in their stomach) but the test does not assess if the bile is passing up thru the muscle (stomach opening/sphincter)?
Interesting tidbits I've read in here, bbforyears. Thanks for sharing. Regarding thyroid, I had mine checked as well years ago and the conclusion was it was slightly inflamed, but ok.
I had a coworker, that had BB, had hairloss, cold intolerance, skin issues, dryness, fatigue, just as you describe. Her BB lasted about a year from the time she was hired, and suddenly went away after she had been taking some korean "potion" medicine, who knows what else she did, but I remember her not smelling anymore. This was before I had BB. Interestingly enough, a year later, I have the odor issues... none of the other skin or cell issues. hmmm
So yeah, I'm getting ready to take the tube out. It was not fun. The tube is connected to a device that will record ph level in esophagus and sinus, over a 20 hour period. I can input when I am eating or lying down. The device is heavy, I have to wear it as a necklace. It has 2 cords, one connected to my chest to monitor heart rate (I guess) and the other is a long cord that is taped to my face and nose, passed thru the sinus, beyond the tonsils, and into the esophagus. The good news is that I can eat a normal meal, since it would be pointless not to. I live in US so it's a decent day to have a huge meal
I also had manometry testing before they put in the 20 hour device, suffice to say, the cord for manometry is 3 times thicker. Just imagine someone holding you back while they shove a knife thru your nose into your throat, and telling you to swallow it for 15 minutes.
Iva, you are clearer than I! Yes, the ppi only neutralizes the reflux, it doesn't stop it PPI can also help to heal an erosive sphincter. I think my doctor's point was that most people are satisfied after seeing him on acid reflux, taking the pill for 4 months.
I haven't considered pepsin, never heard of it, but I will now keep it in mind. I'll ask about it. And I will try to have them fax me copies of my lab tests, if it could help anyone. I understand doctors not taking people seriously. I think the only reason this doc is being helpful, is because I have not brought up bad breath per se. You have to bring up something specific (such as stomach bloating, heartburn), explain all related symptoms, and let him connect the dots. In the past when I have walked in and said "BB", I felt the doctor's confusion and frustration at an issue too broad for him to pinpoint anything.
Happy turkey day for the 'murikins !!
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bbforyears
- Newbie
- Posts: 35
- Joined: Wed Oct 21, 2009 3:10 am
Elliott,
Please do keep us posted on your test results. Did the tech mention anything to you about your pressures? Sometimes they will tell you something, sometimes they won't.
I know what you mean about the probe and manometry. They did the manometry first and I thought I was going to puke. It was pretty uncomfortable to say the least. I was like...uh....I have to wear this thing for 24 hours? The tech was like "No, the tubes will be much smaller for the ph monitoring." I said "Thank god, because I don't think I could handle these tubes for 24 hours!" It was still uncomfortable for the 24 hour study (especially trying to eat) but not nearly as horrible as that manometry!
I really hope you get some answers from this.
They put me on another medication now since I bombed my Gastric Emptying Test. Now I take Reglan too. Reglan is an awful drug! I've taken it only twice and have already had horrible side effects. They have me on 10 pills a day now...Kapidex 2X daily, Carafate 4X daily and Reglan 4X daily (although I am NOT taking it that many times a day--I would be comatose if I did).
They had me do another barium swallow on Wednesday. I passed that one with flying colors. I know in my heart of hearts that the meds are what is slowing my digestion down....I never had a problem with constipation before the ppi and Carafate. In fact, I had the opposite problem.
It is so frustrating sometimes, isn't it? In my case, I KNOW what is wrong with me, but the doctors are still baffled as to why/how. They want to blame everything on my "slow" stomach now....before that they said I had Nutcracker Esophagus and that is what was causing the reflux. They now know I don't have Nutcracker Esophagus. So very frustrating! I cried for 2 hours on Wednesday when the surgeon said he's too scared to do a Nissen on me. I was like "If I had a Nissen I wouldn't have to take all these damn pills and my digestion would speed up!!!" How can one have chronic diarrhea for 6 years and have slow digestion? It's impossible! Since being on all these pills I have been to the hospital 3 times for an Ileus. You can't tell me there is no correlation there!
Please do keep us posted on your test results. Did the tech mention anything to you about your pressures? Sometimes they will tell you something, sometimes they won't.
I know what you mean about the probe and manometry. They did the manometry first and I thought I was going to puke. It was pretty uncomfortable to say the least. I was like...uh....I have to wear this thing for 24 hours? The tech was like "No, the tubes will be much smaller for the ph monitoring." I said "Thank god, because I don't think I could handle these tubes for 24 hours!" It was still uncomfortable for the 24 hour study (especially trying to eat) but not nearly as horrible as that manometry!
I really hope you get some answers from this.
They put me on another medication now since I bombed my Gastric Emptying Test. Now I take Reglan too. Reglan is an awful drug! I've taken it only twice and have already had horrible side effects. They have me on 10 pills a day now...Kapidex 2X daily, Carafate 4X daily and Reglan 4X daily (although I am NOT taking it that many times a day--I would be comatose if I did).
They had me do another barium swallow on Wednesday. I passed that one with flying colors. I know in my heart of hearts that the meds are what is slowing my digestion down....I never had a problem with constipation before the ppi and Carafate. In fact, I had the opposite problem.
It is so frustrating sometimes, isn't it? In my case, I KNOW what is wrong with me, but the doctors are still baffled as to why/how. They want to blame everything on my "slow" stomach now....before that they said I had Nutcracker Esophagus and that is what was causing the reflux. They now know I don't have Nutcracker Esophagus. So very frustrating! I cried for 2 hours on Wednesday when the surgeon said he's too scared to do a Nissen on me. I was like "If I had a Nissen I wouldn't have to take all these damn pills and my digestion would speed up!!!" How can one have chronic diarrhea for 6 years and have slow digestion? It's impossible! Since being on all these pills I have been to the hospital 3 times for an Ileus. You can't tell me there is no correlation there!
eliott,
I am truly interested in ur efforts and the results u will get. I completely agree that u have to bring up a specific problem infront of the doctor and discuss the accompanying symptoms instead of telling him "I have bb"..
bbforyears, are u sure ppis affect the gastric emptying? I agree they affect the frequency of the bowel movements, but not sure about the gastric emptying..The doctor is right to be cautious about performing the Nissen on u because if u are not eligible for the Nissen, and u still have it, u might have tremendous problems and wish u never did!
I am truly interested in ur efforts and the results u will get. I completely agree that u have to bring up a specific problem infront of the doctor and discuss the accompanying symptoms instead of telling him "I have bb"..
bbforyears, are u sure ppis affect the gastric emptying? I agree they affect the frequency of the bowel movements, but not sure about the gastric emptying..The doctor is right to be cautious about performing the Nissen on u because if u are not eligible for the Nissen, and u still have it, u might have tremendous problems and wish u never did!
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bbforyears
- Newbie
- Posts: 35
- Joined: Wed Oct 21, 2009 3:10 am
Hi Iva!
I was so happy to see you on.....
I know I have a bit of a problem with constipation now but I never had it at all before the meds. I was literally running to the bathroom right after eating before. One of the side effects of Carafate is constipation. I would think that eliminating acid in the stomach would slow digestion down as well because acid is what breaks down the food when you eat.
I understand the surgeon's concern. It makes complete sense to me that he would not want to perform the surgery if it would make me worse. I think I know my body better than he does tho! I KNOW how things were before the meds. I also know that having that upset tummy and diarrhea all the time made the taste in my mouth so much worse! So I question whether I had the slow stomach before....
I just HATE being on so many pills a day. I've read so many bad things about Reglan so it scares the crap out of me (no pun intended) to be on it for an indefinite period of time. Plus, I am concerned that being on 120 mg daily of PPI forever would be detrimental to my health as well. I am just looking for a way to be off all these pills. It's frustrating because it seems I've traded "one" problem for another....
How are you doing, Iva? Has the post nasal drip disappeared yet? How is the taste doing?
I was so happy to see you on.....
I know I have a bit of a problem with constipation now but I never had it at all before the meds. I was literally running to the bathroom right after eating before. One of the side effects of Carafate is constipation. I would think that eliminating acid in the stomach would slow digestion down as well because acid is what breaks down the food when you eat.
I understand the surgeon's concern. It makes complete sense to me that he would not want to perform the surgery if it would make me worse. I think I know my body better than he does tho! I KNOW how things were before the meds. I also know that having that upset tummy and diarrhea all the time made the taste in my mouth so much worse! So I question whether I had the slow stomach before....
I just HATE being on so many pills a day. I've read so many bad things about Reglan so it scares the crap out of me (no pun intended) to be on it for an indefinite period of time. Plus, I am concerned that being on 120 mg daily of PPI forever would be detrimental to my health as well. I am just looking for a way to be off all these pills. It's frustrating because it seems I've traded "one" problem for another....
How are you doing, Iva? Has the post nasal drip disappeared yet? How is the taste doing?
There`s an episode in "The doctors" that showed a doctor using a pill that contains a camera to diagnose difficult digestion problems of his patients. He allows his patients to swallow the camera pill & record what happens during digestion. I think that is a lot better than any endoscopy available right now. You may want to check it out.
Anyways, Goodluck.
Anyways, Goodluck.
