Gastroenterologist or ENT did not help me, who Dr is next?

[Renato]

Hi all,

I'm almost 100% sure that my BB is caused for a silent reflux I feel.This is, I do not have the burning sensation, but after any meal, I have a feeling of regurgitation and full stomach, I also burp moderately.

I usually go to bed 4-5 hrs after my last meal to diminish my BB next morning. When lying down I can feel fluid coming up to my throat.
I have been suffering of this BB since long time ago, but I just paid attention that I have a silent reflux problem. Initially, since it does not hurt, I thought it was normal, but is not, since after talking to many people they told me not to have this sensation, I also salivate a lot on my pillow just because the fluid in my mouth.

The stomach fluids in my esophagus, throat and sinus during bed time is causing the BB next morning, which lasts all day, no matter what.

Mouth washes keep my mouth fresh but not my more deep areas in throat or sinus.

Of couse my oral hygiene is impeccable.




I visited the ENT 17 years ago for my BB problem in my country. I just told them that I had recurrent throat infections to convince them to get rid of my palatine tonsils.

What I achieved from them:

1-They removed a supposedly cyst from my left sinus.
2-They fixed a nasal septum deviation.
3-They finally removed my palatine tonsils.

My BB never went away even a little.

I gave up, time was away, until I once again focused on my BB problem....This time I visited the Gastroenterologist. This happened 13 years ago.

Since that time, I did not know of my silent reflux.They did not look for reflux but they where looking for polyps(http://www.reflux1.com/care/condition20.cfm/20) on my esophagus, which may have the potential of retaining food, then BB may come out.

I had my first endoscopy, but it came out with nothing. I was so frustrated.

I moved then to USA and thinking that in a first world country I would find my cure, but naah,.... the system here is worst, Drs do not move a finger if my only problem is BB. They often said if my reflux is silent, then what the hell, where is the pain.....

My fluid in throat sensation, which comes from my stomach and not from my sinus (I know that just because when lying down on my sides, which applies pressure to my stomach, exacerbate the reflux sensation) is worst now. I think it is related to the age (I'm on my 30s).

Ok, so I visited an US gastroenterologist and told them of my silent reflux problem, so they immediately recommended an endoscopy and many other test for reflux.

Here the test they have done on me:

1-Stomach and esophageal endoscopy(2 years ago).
Results: nothing wrong, except they saw a little relaxation of the sphincter between stomach and esophagus.

2-PH test, they check for acid on my esophagus. They introduced me a pH probe in my esophagus and monitored the pH environment for 24 hours.
Result: Normal pH.


4-They also tested fluid contents with another probe, and monitor for 24 hours.
Result: Normal (I did not trust this particular test, since all the time during the assay I felt the fluid sensation on my esophagus and throat.

5- A barium swallow test, which is used to determine the cause of painful swallowing, that I do not have.
Result: Normal.

Again, I got frustrated and depressed.

I did not give up so beginning 2010, I started again with new tests....


I have to make a break here, come back later

[Renato]

Of course, I have tried all type of medications:

1-Oral antibiotics, which helped, but after stopping, BB came back.

2-Antifungals did not work.

3- PPis and carefate did not work, those made my BB worse(logically, I do not have the acid reflux.)

In my case, drinking water does not help.The regurgitation sensation is worse if I drink too much water.

I wonder if other BB suffers have paid attention to this silent reflux.

I have white tongue, which is hairy now, after using Hydrogen peroxide for a long time, but helped me just for a little to decrease my BB.

Ok. so two weeks ago, I went back to the ENT after almost two dacades of visiting the first one. I was decided to get rid of my lingual and adenoid tonsils.

What a surprise, after Dr introduced a telescope to my sinus, they observed deep inside, the areas looked clean, with no mucous at all, moreover, he did not find adenoides. This is normal in adult people.

He also told me that my lingual tonsil looked fine and almost not visible. I was watching to the screen by myself and I could corroborate that my adenoides were not there, however, even if my lingual tonsils were not visible, I can feel them when rubbing with my fingers on the back of my tongue, so I did not believe him respect of this.

I also mentioned to the ENT Dr, my theory of BB. When sleeping, fluids from my stomach reach the lingual and adenoides and sinuses, where bacteria overgrowth happen. This also caused me itching ears. He told me is unlikely that fluids reach my sinuses, since they looked fine. However he noticed plaque formation inside of my left ear, which is the area more itching. He told me that it happens by unattended ear infection in the childhood, but nothing related to my symptoms and nothing to worry about.

He also mentioned me to have noticed frothy fluid on my top esophagus close to my vocal folds, which is sign of reflux.

He finalized telling to go back to my gastroenterologist.

What the hell...., why the GE, told me that not reflux at all after many tests, and the ENT noticed in a single test.

So a week and a half ago I went back to the GE decided to confront my Dr and told her the findings of the ENT. I also requested him an achoridria study and Helycobacter P culture.

A month ago, I started taking Betaine-HCl and apple cider vinager. The ACV helped me to have pink tongue and perhaps pink esophagus. An the B-HCl helped me at least to digest my dinner a litte faster than the usual time ( I can take up to 5 tablets per meal without any sign of acidity).

Based on this I was very anxious about doing the achloriadria test.


But guess what, she told me, I have to understand that I do not have reflux, nor achloridria. SHe told me that my previous pH test showed pH of 1,7 into my stomach. I do know if she told me the true or just wanted to get rid of me. SO I requested her all my records to see it by my self.

[Renato]

Finally, on april 2010 the GE accepted to do an extra test on me to rule out the silent reflux, and possible accumulation of undigested food in my stomach.
She ordered a Gastric Emptying study for solid foods.

The gastric emptying study is a procedure that is done by nuclear medicine physicians using radioactive chemicals that measures the speed with which food empties from the stomach and enters the small intestine.

Gastric emptying studies are used for testing patients who are having symptoms that may be due to slow and, less commonly, rapid emptying of the stomach. The symptoms of slow emptying are primarily abdominal fullness after eating.


Early on morning in the radiology lab, a girl gave me a radioactive egg for breakfast, and minutes after eating it, she put me between two big flat metals on a machine as making a sandwich with me. Then, the computer were recording the movement of the labeled food along my stomach and intestine every 15 minutes during a period of 2 hours.

I could not see the screen by myself. I was so anxious thinking that this test may finally reveal the cause of my BB problem. I also felt the fluid and food sensation on my throat and upper stomach and burped a little during the test.

Two days after the test, I visted back my GE doctor to see the results.

Once again, I was so frustrated when she told me that my results turned out normal. She told me my food moved from stomach to intestine in a normal speed, so she ruled out possible achloriadria or other abnormality related with the movement of the stomach.

The sad thing, was when discussing my results she also noticed my BB. She latter let me know about it.
But she also told to feel sorry that she could not help me, and suggested my to stop with my search and learn to live with this.

This unsensible Dr as many others told me to visit other Dr. But she was done.

I was so angry, so I asked her to refer me to the GE surgeon and I will never see her again.

Long time ago I kept in mind to fix this silent reflux(which Drs do not see it), which 100% sure is causing my BB.

I knew about the Nissen fundoaplication, a procedure to fix weak closing of the esophagus to stomach. I was decided to undergo this surgery on my esophageal sphincter.

[dark]

Several years ago, I was sure that I had acid reflux because I have chronic halitosis, the taste of food stays in my mouth for hours, white tongue, can´t lie down after a meal, feeling of regurgitation. Then I went to the GE and told her my problem and that I wanted a surgery to stop this (Nissen fundoplication).

She told me that the surgery it´s ok but first I had to pass some tests:

- 3 gastric endoscopies (normal)
- esophageal pH test, a phobe for 24h (normal)
- 2 esophagography with contrast, bario (normal)
- esophageal manometry, test the pressure (normal)
- also I used omeprazol (reduces acid in stomach) for 6 months and mosapride (speed up the digestion) with no improvement.

So, with all normal tests, she told me that I didnt have acid reflux and a surgery won´t help me. After all the test I understood that I had no reflux.

[Renato]

After all tests performed on me, ruled out the reflux thing. However the sensation of full stomach and fluids coming up to my stomach is so real, that I can wake up on mornings with a lot of saliva on my pillow. Little pressure on my stomach when lying down favors the fluid to reach my mouth.

I'm desperate, so I will try the fundo application no matter what, I know that It will be difficult to be peformed by a surgeon in USA, so I will try it in my country this december.

In the meanwhile, I will see the US surgeon and try to convince him about the Nissen, if not convinced, then, I will request another gastric endoscopy, but now, covering my small and large intestines.

I also have in mind, since long time ago, that this fluid sensation in my throat may be due for the release of gases from my intestine through my stomach and esophagus. When gases pass throughout my esophagus may favor some stomach fluids to reach my throat. Then, fluids also reach my sinus during bed time.BB comes up next.

I have noticed that some food, not to say almost all, cause me different grade of bloating.

Some of them, exacerbate my bad breath.
I'm lactose intolerant, so I avoid diary products, or when taking a little, also I take lactaid.
I also mentioned before, that almost all fruits(including vegetables) cause me diarrhea and gases. Not too long ago somebody in this forum suggeted me to be tested for fructose intolerance or better said, for fructose malabsortion.

This is what I got from my search about this pathology.

Fructose is absorbed in the small intestine without help of digestive enzymes. However, even in healthy people, only about 25-50 g of fructose per sitting can be absorbed.
Persons with fructose malabsorption may absorb less than 25 g per sitting.

In the large intestine the unabsorbed fructose osmotically reduces the absorption of water and is metabolized by normal colonic bacteria to short chain fatty acids and the gases hydrogen, carbon dioxide and methane. The abnormal increase in hydrogen is detected with the hydrogen breath test.

The physiological consequences of fructose malabsorption include:

1- increasing osmotic load, providing substrate for rapid bacterial fermentation.

2- changing on gastrointestinal motility, promoting mucosal biofilm (layers of bacteria) and altering the profile of bacteria.

3- These effects are additive with other short-chain poorly absorbed carbohydrates such as sorbitol.

Typical symptoms of fructose malabsorption include:

* Bloating (because of fermentation in the small and large intestine)
* Diarrhea and / or constipation
* Flatulence
* sometimes stomach pain .

What I think now is that in some people including me, the halitosis maybe directly related to this fructose malabsoprtion.

There is not cure for this problem. At difference of the lactose intolerance, which can be treated taking lactase supplements, there is not such thing for fructose malabsortion.

Diets which contain low amount of fructose are recommended.
The problem is that almost eveything has fructose.

Here some examples:


Unfavorable foods (i.e. more fructose than glucose)

Fruits

apple, pear, guava, honeydew melon, nashi fruit, pawpaw, papaya, quince, star fruit, watermelon

Dried fruit
apple, currant, date, fig, pear, raisin, sultana

Fruit juices
Fruit pastes - chutney, relish, plum sauce, sweet & sour sauce, BBQ sauce.

Coconut
Dried fruit bars
Honey
Fortified wines
High Fructose Corn Syrup - many processed products contain this

Corn syrup solids
Fruit juice concentrates
Agave nectar
Red Ripe Tomato.

Note that foods (such as bread) marked "gluten-free" are usually suitable for fructose malabsorbers, though sufferers need to be careful of gluten-free foods that contain dried fruit or high fructose corn syrup or fructose itself in sugar form.


Many fructose malabsorbers can eat breads made from rye and corn flour. However, these may contain wheat unless marked "wheat-free" (or "gluten-free")

Note that there are many breads on the market that advertise themselves with phrases like: "No High Fructose Corn Syrup".

Many bakeries now produce special breads with a high-inulin content, where inulin is a replacement in the baking process for all three: high fructose corn syrup, flour, and fat.

Fructans also cause malabsortion is some people.

Fructan is a polymer of fructose molecules. They occur in foods such as artichokes, asparagus, green beans, leeks, onions (including spring onions), yacon, jícama, and wheat.


To summarize my theory of BB on me and probably on other people in this forum.

Gases from lactose and fructose intolerance/malabsortion cause leaky stomach, fluid reach the throat and sinus, making a rich environment of nutrients where bacteria can overgrow causing BB.

This BB bacterium establishes on lingual, palatine and adenoide tonsils, and perhaps, on other areas into the sinuses.
We can diminish the bacterial population with mouth washes and all these stuff, but we are not focusing on the actual origin of BB.

I have some time before to undergo Nissen fundoapplication. I will try a fructose free diet and take all kind of antigas medications along with mouth washes based in Hydrogen peroxide, and see if doing this can resolve my problem.

I will post again, perhaps when new interesting data come up.

I wish good luck to all the people. I know how consuming and depressing is this ........king illness.

Oh my god.....Im getting crazy, I also was diagnosed with fat liver.

[terranpatriot]

Renato, congrats on your research and good luck with your endeavors. It sounds to me that you need to find a quality GE out there who is as inquisitive as you are, and who is more competent and seasoned.