Help needed results 24h PH monitoring

[Smiekie_t]

Hi everyone!

Perhaps someone can help me understand the results of my 24h ph monitoring. The GI doctor called me last week to say everything was fine, that I had functional dyspepsia and keep taking PPIs. I wanted to see the results, and requested them. But now I'm confused, as I did have quite a few reflux episodes. Here's the results:

- Total reflux time 0.3 < 4.2 total %

- Number of reflux periods 9.2 < 50 in 24h

- Number of long reflux periods >5 min. 0.0 in 24 h

- Longest reflux 0.7 < 9.2 minutes

- Impedance: 46 refluxes

For impedance, more weak-acid and mixed reflux than acid. Complaints have no relationship with acid or weak-acid reflux.

I don't understand the difference between 'number of reflux periods' and the number of refluxes next to impedance. Can anybody help me?

And what does weak-acid reflux mean? What can I do about this?

[Petrina_gmfc]

Hi you can go on a website for weak acid reflux it will tell you what this.

[Bellaowl in reply to Petrina_gmfc]

That’s good. The post from medexpress is good GP in England. I don’t necessarily endorse what they are selling as treatment since I know nothing about it and haven’t tried. 🦉

[Bellaowl]

He’s saying that there were no reflux episodes that were clinically reflux in the time trialled.

More important is he’s saying the reflux u have is not just stomach acid, it’s a mixture of some stomach acid and some digested food.

I suggested u make an appmt to go through it with him.

As for what u do: it looks as though you may be eating something that is causing this, something your stomach is trying to get rid of because it’s not digesting well.

That’s another question to ask about. It could be a food intolerance.

From a personal view I would suggest u look carefully at what u are eating- not just food, everything herbs, spices, food inclusions, vitamins, any tablets- look at fillers.

Make a note of anything u ate or drank about 1hr onwards before it happened. Next time it happens do the same again until u build a list you can compare.

Begin eliminating foods we all know cause reflux eg curry, spices, red tomatoes. Fizzy drinks- particularly alcoholic drinks Etc

U may able to reverse this before it developes if u can understand it better. Find a dietician once u have answers from the medic.

The baseline he is saying is that u don’t have reflux. But he’s not suggested what maybe going on or how u can improve it.

Good hunting.

🦉

[Bellaowl in reply to Bellaowl]

I’ve read quite a few blogs now and only 1 person has mentioned being negative for H. Pylori- a nasty bacterium that can live in the gastric tract and homes in on the stomach.

If u have an endoscopy this should show up gastric ulcers, polyps etc in the stomach. The gastric team should automatically do a test for H. Pylori and if it comes back positive give you an antibiotic to kill it. And your reflux should stop.

If u are into complimentary medicines slippery elm powder is good. When reflux bad I mix mine with a tiny amount of medical grade charcoal and mashed banana (half small banana). Most health food shops sell it as capsules which help, but may not be strong enough initially.

There are other suggestions on the market of foods that help to kill this bacterium.

I understand it’s not regular practice to test for this bacterium in USA, but it certainly is in UK so don’t be afraid to ask.

🦉

[Bellaowl]

Have they tested for H.pylori - See below. It’s not in the records u posted. 🦉

[Smiekie_t in reply to Bellaowl]

Thanks for your reply! I have been tested for H Pylori and it came back negative. I've also had a gastroscopy which also came back negative. The doctors have run out of tests. That's why the diagnosis is functional dyspepsia.

I'm just confused about my results. Do I have reflux or not? Does everyone, even healthy people, show reflux episodes if they have one of these pH tests?

[Bellaowl in reply to Smiekie_t]

Many people show functional reflux mainly for the following reasons: stress, over-weight, food intolerance and some say smoking. Plus I would add, eating on the go and too late at night.

They are all things u can work on.

Not necessarily an over night cure but certainly a pathway out.

If u Try these without success u then have evidence to go back to GI dept. Make sure u keep a good record folder. What eaten & drunk that caused the symptoms within 1-10 hrs.

In the process u may find foods that help. Eg for me: banana, plain boiled & skinned potatoes, egg- scrambled or boiled. The later I find helpful if I’m out for most of the day- make sure it’s hard boiled and transported in an intact shell.

Eggs can be boiled and put in fridge for 4 days without going off- but pencil on the shell the date u boiled it.

God luck 🦉

[Hidden in reply to Bellaowl]

I’ve been suffering from digestive issues for nearly thirteen years now (ever since a really bad bout of norovirus in fact) and the docs still haven’t discovered what’s going on. I do have two medical conditions that are almost certainly connected (EDS and asthma) and I’ve been through the menopause in that time so there may be hormonal involvement (but no tests done to check that) but the only thing they’ve discovered is oesophageal thrush and (on the latest gastroscopy) a small lipoma in my stomach. In those thirteen years I’ve had three gastroscopies, one MRI and (most recently) a stomach emptying scan. The last caused more problems than it solved. For some reason the food the hospital decided to give me to eat was a small cottage pie (the radioactive element was in the potato). Sadly said cottage pie was a bit heavy on the pepper front. I ate it all (not easy) to give them the best images possible and felt the first warning signs of protest from my stomach twenty minutes later. Of course, you can’t take anything to relieve heartburn/reflux while the scans are on going so it was almost three hours before I was able to take something for it by which time things were really uncomfortable. It’s taken almost two months for things to calm down from that despite the meds I’m on.

I’m not stupid about my diet (even my gastro cons and the dietician he referred me to four years ago have admitted that) and I’m careful about portion sizes and to avoid things which I know will cause issues. I’m not overweight (BMI around 19.5 - 20) and I’ve never smoked. Food allergies for some twenty different foods including all the common ones (and some less so) have been checked and come back negative. As I mentioned on a recent post, I’m now awaiting the test that Smiekie_t has had, but given how things are I’m worried about what’s going to happen when I come off the meds in preparation for that.

[Bellaowl in reply to Hidden]

That’s a lot to put up with. My thought is u get your gut to settle before putting it through anything else.

And learn the lesson about checking what is in anything they give u to eat before putting in your system.

I had E.coli in 1971 and my gut has never been the same since. Mostly it reacts by intolerances which don’t show up on allergy testing. However reactions to Candida / yeast can show up as over growths, including on the skin. I find that Candida does show up on skin prick tests.

I’ve also had nori since, about 10yrs ago. I found it took a long time for the mucosa to settle, which is where the slippery elm came in.

There could have been yeast in your meat pie, in the gravy if commercial. As well as the over heavy pepper.

Make a list of everything that sets it off and be Sherlock Holmes.

Ask yourself, ‘do I really need this new test, particularly right now?’

What am I hoping it will achieve?

What will it achieve?

Could it make things worse?

Things to ponder.

🦉

[Hidden in reply to Bellaowl]

The team conducting the stomach emptying scan did make note of what happened as far as the pepper was concerned (I could taste it as I ate it - there’s no way they should be giving something that highly seasoned to people with stomach issues). I must admit I was surprised by the use of cottage pie. Most other places seem to go with something quite bland for this test: an egg sandwich for example.

I admit that having had a really bad time of it through May and June of last year I was desperate. I just want to find out what’s going on. Nor was it my usual gastro cons who requested the tests. A gastro cons who had worked at that hospital came out of retirement to help the other gastros clear the backlog of outpatient appointments; I was one who got shunted onto his list.

[Bellaowl in reply to Hidden]

So old school!

I suggest u cancel any appointments until u can see a doctor u trust, who understands your problems.

Agree- it’s usually egg sandwich.

Personally I try a few tests and if an answer is not readily forth coming I let things settle, physically and mentally, before agreeing to anything else. In the meantime research any other ideas.

Sometimes try complimentary meds eg craniosacral therapy- but go for a recommendation because they can be a mixed bunch. The good ones are usually very good and knowledgable. But I’ve met some less good- walk away.

U learn to get discerning and go on instinct. I’m quite sinical at times now. My God daughter tells me she can see my antennae twitching 😀

🦉

[Hidden in reply to Bellaowl]

At the moment everything’s on hold because of covid. But there is another reason to try and find out what’s going on. I said they discovered oesophageal thrush. That is being blamed largely on my asthma preventer inhalers. I’m sceptical about them being entirely to blame; if they were I would have been having symptoms of it all the time and I’m not: on each occasion it’s been found when I have had symptoms there’s been six years with none. I am more inclined to think (and a GP I’ve discussed this with agrees) that my current cocktail of meds is a more likely explanation. However, there is no doubt that my asthma meds are part of that.

There is one inhaled steroid - just one - which is known to significantly reduce the risk of oesophageal thrush developing, and it’s because of the way it delivers the steroid to the lungs. But it’s expensive and I will need to see a respiratory cons to get approval for it. I’ve been referred to one (though given covid goodness knows when I’ll get to see one) by this same gastro cons who, understandably, is all in favour of this different inhaler. Given the feeling is that the two conditions are linked, the more info we have on what is going on with my stomach the better.

[Bellaowl in reply to Hidden]

Try speaking to asthma uk, or BLF helpline or even write in asking about the inhalers. They have Mike, a consultant from Brompton who runs info videos.

I take as little as possible, easier with lockdown. I have many others that can’t have a break.

U probably already know all that. 🦉

[Bellaowl in reply to Hidden]

By EDS do u mean Ehlers? Does this affect the gut? I thought it was mainly connective tissue but some types affect blood vessels.

Asthma can certainly affect the gut and the steroids used to treat it.

Mainly a bad asthma attack begins to loosen the diaphragm and it can tear away from its muscle support- at least that’s how a physio describes it to me.

I don’t know if noro causes holes/ leaky areas to large proteins the same at E.coli - it would be worth enquiring.

🦉

[Hidden in reply to Bellaowl]

Yup Ehlers danlos, and you are correct, it affects the connective tissue. But connective tissue is present throughout the body and yes, it can affect the gut. We already know that my bowel is unusually long and floppy; we also know now that my bladder has twice the capacity of a normal bladder. I was only diagnosed with EDS six and a half years ago even though looking back at my medical history (which is long and involved - first op when I was just nine weeks old) there are symptoms which point to it and were missed. Not unusual I might add.

[Bellaowl in reply to Hidden]

I worked in paediatrics and our patients were diagnosed in childhood partic if hereditary.

So u know there is connective tissue involvement in the lower abdomen. So does it also affect the upper abdomen eg diaphragm? Plus the sphincter between the stomach and the oesophagus.

Have you seen an osteopath?

Does your diaphragm feel too loose or too tight to her? Too loose would be more usual with EDS. It may be worth getting an opinion. Just a thought.

How would it help to know any more? Can you improve your symptoms without knowing more, however satisfactory that may be? Have u reached the ‘good enough’ mother stage?

Sorry I think I’m in a philosophical mood today.

🦉

[Hidden in reply to Bellaowl]

We’re talking 1960s - a lot of things were missed back then. I went undiagnosed as an asthmatic for five years because of it even though there was family history and I’d had eczema for most of my first year of life - very common in the 60s I might add. Yes EDS is hereditary - with my version of it autosomal dominant. We’re fairly certain I got it from my father (who also has hyperextended joints etc). We think he got it from his mother.

The sphincter muscles are the obvious possibility for any weakness. After the first gastroscopy I had I was told by the cons who did it that my LOS was not quite closing and I was also told that could only get worse. Interestingly no subsequent gastroscopy has commented on it. I have been told by one cons that different doctors see different things. Hmm...

[Bellaowl in reply to Hidden]

I was in France for the early 60s at a school for Eng army TB children. So don’t remember much. My father had been a Jap POW for four yrs in Nagasaki.

I suspect the first diagnosis of a weak LOS was correct and that may be a cause of a lot of your problems now - +the challenge of the norovirus.

Can u find someone who specialises in LOS? Look up who is writing any papers on it. It will need a surgeon to say if helps to operate or would make it worse. Pub Med is open to the public. 🦉

[Bellaowl in reply to Bellaowl]

An asthmatic friend has recently been changed from 3 inhalers to one. He was delighted until on closer inspection we noticed it was still all 3 meds but all together in one canister. So he wasn’t decreasing his steroid load at all!

He had been really happy to think he may lose some weight. His GP hadn’t told him- let him believe it was less medication! 🦉

[Hidden in reply to Bellaowl]

I’m not sure that Steroid inhalers are usually associated with weight gain, unlike oral steroids which can cause issues of that nature if taken on a regular basis or for longer periods of time. Certainly I’ve never had a problem like that brought on my steroid inhalers and I’ve been on them for over thirty years:-).

[Catatvet05 in reply to Smiekie_t]

RD is what I have. Basically I have all the symptoms of a gord suffer but does not have reflux- associated with anxiety. I was also positive for HP and my ph test was fine. Prob is that I had reflux issues for over 2 years before I finally found HP. I had an endoscopy and stools test all clear. However after 2 years found it! I still suffer with reflux symptoms 4 years on. I haven’t seen my ph results just was told acid level is normal. Maybe get a full comprehensive blood test? Good news I’m healthy but bad news is that I still got reflux symptoms. It takes a very long heal for stomach to heal after HP - I just wonder if doc didn’t catch it or if it really is down to anxiety?

[Hidden]

I hope you don’t mind me asking, but how have things progressed since your result? The reason I ask is I’ve just had word concerning the same test from my consultant who had also said that the results show that the acidity levels are weak - in other words I don’t have acid reflux. He also states that does not mean there isn’t reflux, just that an excessive amount of stomach acid is not a component of it. What he didn’t say is what I should do about the medication I’m on. If my stomach acid levels are fine, then presumably the one thing I don’t need to be on is medication to suppress/reduce it. I’m now trying to find out whether I should come off them.

[Smiekie_t in reply to Hidden]

Sorry, missed this post entirely. Hope you're feeling better. I came of the ppi and haven't had any issues since.

[Hidden in reply to Smiekie_t]

Thanks for replying and I’m so glad to hear that things are so much better for you😀.

Following on from the test result I contacted the consultant’s secretary to ask what I should do. As the consultant isn’t often in (he came out of retirement to help clear the backlog of appointments etc caused by covid and was given those patients who could be dealt with “at distance” of which I was one) she suggested I contact my GP, which I did. My GP and I agreed there was no point staying on the acid suppressants so I began to wean myself off them (I get rebound when coming off acid suppressants so it has to be done carefully) whilst keeping on with Gaviscon advance to manage any reflux. I went back to the secretary and informed her of what was going on so she could pass that on to the consultant. One week later I had a call from her relaying a message from the consultant saying I was to go back on the acid suppressants until a follow up appointment. To say I was astonished is an understatement; my GP was equally astounded when I told her. Six weeks later I had the follow up appointment via a phone call where the consultant told me there was no reason for me to stay on the acid suppressants - at which point I must admit I asked him (and I really couldn’t keep the irritation out of my voice as I did so) why he had felt it necessary to keep me on them for an additional six weeks? The response was rather garbled. So I then had to begin the lengthy process of weaning myself off them all over again.

Things have calmed down now, but I am still on a restricted diet (nothing containing caffeine, no spicy food etc plus avoiding fruits and veg with a pH value of less than five, which has ruled out one or two things which I was previously having). Things are still sensitive and will make me uncomfortable so the problem still hasn’t gone away, it’s just contained.

[Hidden in reply to Smiekie_t]

One other thing that has come to light. By the time I came off the acid suppressants I was getting (on a fairly intermittent basis but becoming more frequent) the feeling of pressure being applied to my larynx. Eventually, after losing an hour and a half’s sleep one night as a result of it, I was referred (on an urgent basis) to an ENT specialist. I was seen just over a week later. The larynx, nasal passages and back of throat were all inflamed and there were significant signs of mucous. The consultant’s view having checked over the history was probable laropharyngeal reflux (LPR) plus additional irritation from excessive mucous resulting from nasal allergies (I have a long history of that) all of which were resulting in inflammation of the larynx etc. When I mentioned this to the gastro cons he sounded unconvinced (certainly by the LPR diagnosis).

[Smiekie_t in reply to Hidden]

Thanks for your message. It's such a struggle sometimes isn't it? To go through the whole process of dealing with these "specialists". Do you know what they told me? That it was functional, but as the pills seemed to be working for me I might as well keep on taking them. I decided myself I was going to get off ppis if they weren't necessary, but the GI specialist didn't see any problems with me taking them indefinitely.

[Hidden in reply to Smiekie_t]

Sympathies!