Ask the Doctor: Dr. Eisner Responds to Selected Community Questions.
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.
I have been having what I thought was heartburn, but my symptoms are not responding to Nexium and similar medications. My doctor wants to do a 24 hour pH study to prove or disprove reflux, but it sounds barbaric to me. Are there any other options?
24 hour pH study involves the instillation of a small catheter through the nose. At the end of the catheter is a microscopic chip that measures the pH at the end of the esophagus. The catheter is taped to the nose and stays in place for 24 hours. The following morning, it is removed, and the pH of the past 24 hours analyzed. The patient is to record times of "heartburn", and in addition to assessing as to whether there are episodes of acid in the esophagus, the doctor will check to see if excess acid correlates with symptoms. A new alternative to 24 hour ph testing via catheter is the Bravo monitor. With this test, an endoscopy is performed under sedation, and a capsule, with a pH recorder is suctioned into the end of the esophagus. The capsule, about the size of a gel cap, contains a radio transmitter that sends pH data to a beeper-sized receiver worn on the waist. After 2 days, the capsule sloughs off from the esophagus and is expelled via the gastrointestinal tract. The receiver on the waist is then analyzed for periods of acidity, and correlated with symptoms. You should check with your doctor to see what test is best for you.