Floppy Sphincter?

[Puddleperson]

Hello again everyone. I'm still trying to find a way through my hiatus hernia/inflamed oesophagus problem. The high dose of PPI's actually made it worse and I am more convinced than ever that my real problem is too low not too high stomach acid. I've been hypothyroid for 30 years so there's plenty of time for this to have developed. I have a GP appointment on Friday and want as much written data as I can muster to convince him that I need a change of direction with my treatment. Someone has suggested this to me:-

'What happens is that when your stomach acid is too low the sphincter valve at the top of your stomach just by your oesophagus doesn't close properly ( I think I read that it becomes a little floppy )and it causes leakage back into your oesophagus , when the acid in your stomach increases the valve closes properly and you don't get the reflux.'

Unfortunately they can't remember where the information came from. Does anyone here recognise it? If so it would be great to know where it came from, especially if it was from unarguable source. I need all the help I can get not yet more PPI's!

[humanbean]

I take PPIs, specifically Lansoprazole. I was first prescribed one 30mg capsule per day. It made me feel sick. I asked to be switched to 15mg, one capsule twice a day. I do a lot better with that.

Occasionally I can skip the morning capsule, which I'm pleased about. But there is zero flexibility in dosing just once a day.

You might find the information and links given in this reply of some interest :

healthunlocked.com/thyroidu...

I've had acid reflux, heartburn, and indigestion since I was a teenager. I'm now in my 60s. (I am convinced that I've had hypothyroidism since birth, but I was in my 50s before I first got treated, and I think that lack of treatment of my hypothyroidism, as well as non-treatment of my gut issues caused me most of my long-term gut problems.) Then I got an ulcer in my late 20s. And then I was told that I had (chronic) gastritis in my 40s. Despite the fact that I know ideally how to deal with acid reflux I have never been able to come off PPIs. But I do think knowing how the oesophagus and stomach valves work is worth knowing, and the links to the info is given in the link above.

[Rosebud1955 in reply to humanbean]

Sorry that you’re suffering like many others, myself included. Is it possible to ask your doctor to refer you to a motility clinic? They can arrange for you to have a esophageal motility study and a gastric ph monitoring. They insert a small tube in through your nose to your esophagus and leave it there for 24 hours to measure the ph. When they do the gastric motility study it can see the valve opening and closing and also examine for weakness of the valve. I’m booked for them both in a week. If I have low stomach acid the I will be prescribed hydrochloride acid. If I have high acid then I would be willing to take the ppi’s . The gastroenterologist told me there is surgery that can be performed to tighten the valve if is “floppy”. A lot of patients end up taking ppi’s when in fact they have low acid so it makes matters worse. Very complicated. Good luck, I hope you get some sort of relief.

[Puddleperson in reply to Rosebud1955]

That all sounds pretty gruesome but I am so fed up of being diagnosed by assumptions that I'll try anything. It would be so good to know the real cause of all this. I'm pretty sure that there are probably some food intolerances in the mix too. Up until 20 odd years ago I could enjoy a glass of wine like most people, now though it tastes like poison and makes be vomit. There's probably a lot I could do to help myself if only I had facts instead of assumptions. Fingers crossed tor a good hearing with the GP.

[Rosebud1955 in reply to humanbean]

Sorry, I meant to reply to Uddleperson, I’m not very savvy

[Puddleperson in reply to humanbean]

Hi Humanbean, thanks for pointing me at the Chris Kressor information. I have read it all, it makes perfect sense, I agree with everything he says. It is definitely the way I want to go. However...! I had my GP appointment this morning, he was lovely but it felt something like a thyroid conversation in that there is only one way that the medical profession deals with this. With thyroid it's TSH, with reflux it's PPI's and it seems the only possible cause of reflux is too much stomach acid, end of story. I didn't dare mention that my information came from a nutritionist, I don't think that would have helped my cause! So I accepted a referral to a gastroenterologist. Never say never but I guess it will be bigger and stronger PPI's for life☹️

[gset]

having similar issues I am trying iqoro and after 6 weeks am seeing improvement

iqoro.com

[Batty1]

Whoever told you that yes it’s possible but I believe its a surgery to fix it…. Did you have a scope done they definitely would have seen that? What type of PPI are you on a hard tablet or capsule?

[Puddleperson in reply to Batty1]

I just wish I could find some decent research to back up this hypothesis - alas nothing so far.

Yes had endoscope 11 years ago hiatus hernia confirmed and been on smallest dose of omeprazole capsules I could get way with ever since. Another endoscope recently showed hh still there described as 'small 2cm' but no way of knowing whether it is bigger or smaller than 11 years ago. 30mg Lansoprazole caps prescribed for 8 weeks but I had to stop after roughly 7 weeks as symptoms much worse than when I started. Should have been called for second endoscope but haven't. All to be discussed with GP later this week!

[Batty1 in reply to Puddleperson]

health.com/hiatal-hernia-ov...

this show the types of hiatal hernias and 11 years ago you probably need another

[Puddleperson in reply to Batty1]

Thanks, mine's the sliding variety 🙂

[Batty1 in reply to Puddleperson]

Different types and I don’t think that medical calls it sliding… I think this is why you having issues locating information about it …. Hiatal hernia is essentially the bulge (hernia) which pushes up through the esophagus which is why it’s called (sliding) … I believe this is how they reference it from medical standpoint … You should ask for another endoscopy since last one was 11 years ago.

[Puddleperson in reply to Batty1]

The first endoscope was 11 years ago the second was just over 3 months ago, The latest endoscopy report referred to '2cm sliding Hiatal hernia'. So I am pretty sure that's what I have. I'm not having issues locating information about it. I am having difficulty finding any serious peer reviewed reports relating low stomach acid, causing oesophageal inflammation and affecting the function of the oesophageal sphincter. It would be so helpful to show my GP and, hopefully, convince them that my problems relate to low not high stomach acid

The report (3 months ago) also requested a second endoscopy 8 weeks later but this hasn't happened. Both myself and local pharmacist have told GP surgery that high dose PPI's worsened the condition and did not achieve desired result but they have failed to respond to either of us. However, I have face to face with referring GP later this week. Wish me luck.

[Batty1 in reply to Puddleperson]

Whats affecting your esophagus is too much stomach acid washing up in the throat and causing a raw esophagus and hiatal hernia …. Low acid doesn't mean you have low or no stomach acid it actually means the opposite at least this is what I have been told numerous times by gastrointestinal doctors.

Look up low stomach acid and hiatal hernia … see what pops up. Good luck

[Rosebud1955 in reply to Batty1]

Yes I had a scope done. Can’t really trust doctors. One told me I had 2 hiatus hernias and gastritis. No mention of high acid but gave me script for PPI. I tried different PPIs, capsules and hard pills- nothing worked. Another gastroenterologist who did a scope refused to give script for PPI because she said she did not see much acid. She’s the one that suggested I do the 24 hr ph monitoring. I’m also desperate and will try anything to get some relief, it’s life altering for me because it’s very bad at nights and interferes with my sleep. The test I’m told is it the most pleasant but I have to try it. I can’t do the guessing game anymore.

I wish everyone who is suffering some good relief from these symptoms.

[Batty1 in reply to Rosebud1955]

mayoclinic.org/diseases-con...

Maybe you should be tested for H-pylori.

[Rosebud1955 in reply to Batty1]

tested negative twice

[Batty1 in reply to Rosebud1955]

Lucky you… my sister lives in misery with H-pylori.

[Rosebud1955 in reply to Batty1]

sorry to hear your sister is suffering. My husband had it, very difficult to treat. He had three bouts of treatment with triple antibiotics and PPI. The infection was irridicated after the third treatment.

[Batty1 in reply to Rosebud1955]

Sadly she can’t be helped because her original doctor misdiagnosed it for years and the bacteria has caused so many problems.