I have diabetes and have been experiencing a lot of heartburn and regurgitation. I am taking Nexium but still have symptoms. What else can this be?
While you may be suffering from gastroesophageal reflux disease, some of your symptoms may be related to diabetes. In diabetes, the nerve endings of the gastrointestinal tract can be affected, thereby altering the function of the gastrointestinal tract. One of the things that can happen is a slowing of the emptying of the stomach, or gastroparesis. Patients frequently feel full, and experience nausea and vomiting. At times, stomach contents will regurgitate into the esophagus. The diagnosis of gastroparesis is made best by history, as well as a gastric emptying study. In that test, radio-labeled food and liquid is given to the patient, and measurements as to how long it takes the material to leave the stomach are calculated. If there is slower than expected emptying of the stomach, the diagnosis of gastroparesis is made. The treatment of gastroparesis involves diet (eating more frequent, small meals, as opposed to larger ones) as well as medications that can stimulate gastric emptying. You should check with your doctor to see if tests are indicated to look for this condition.
I have been having symptoms of reflux, as well as episodes of food getting stuck when I eat. A friend of mine with similar symptoms was diagnosed with a Schatzki's Ring. What is that, and how is it treated?
Symptoms of reflux disease with trouble swallowing are worrisome and needs to be evaluated by a physician. It could be a sign of esophageal cancer. An upper endoscopy would be the best test for you. In addition to ruling out esophageal cancer, other conditions that may cause trouble swallowing might be found. This would include a stricture or narrowing in the esophagus from acid exposure, as well as a Schatzki's Ring. A Schatzki's Ring is a thin mucosal ring located at the spot where the esophagus and stomach connect. It is unclear what the cause is. It might be congenital, might be related to prior damage to the area from certain pills or might be related to reflux. Sometimes they don't cause symptoms, but when it does, it typically causes intermittent difficulty swallowing, especially with solid foods. Bread and meat appear to be common foods that frequently precipitate symptoms. Patients often present after rapidly eating meat and drinking alcohol at a restaurant, so it is it sometimes given the name "steakhouse syndrome". The treatment of a Schatzki's Ring involves dilating or stretching the ring, either with a bougie, or a balloon that goes through the scope. Sometimes one dilatation is enough, while other times more are necessary. The ring can recur and cause symptoms again, or can completely disappear. You should certainly check with your doctor so that he can arrange for the proper test to diagnose and treat your condition.
