Mother just diagnosed: esophageal stricture, GERD, gastric polyps

[HowToBe]

The gist of what happened today is that my mother tried to eat some roast beef she cooked and it got caught at her lower esophageal valve, causing pain and vomiting that didn't dislodge it. The EGD (an endoscopy procedure to look at her esophagus and stomach) performed at the emergency room showed "stricture" (_http://emedicine.medscape.com/article/175098-overview -- description of what stricture is) near or on that valve, with a bit of growth or swelling there (doctor took a biopsy), as well as incidentally finding some gastric polyps in the stomach. He diagnosed GERD as part of all of this, given that she described having reflux for many years (cutting out tomatoes has greatly helped that), and that there appeared to be irritation around the stricture presumably due to acid. This problem with

Monotonic asked some questions about stomach acid and the doctor gave a firm no to the idea that low stomach acid could cause reflux-related esophagus damage.

She's been prescribed Protonix (a proton-pump inhibitor - "standard anti-reflux measures" is check-marked on the paperwork he gave us, so I presume that's what this is) leading up to a check-in and possible operation to "stretch out" the stricture at two weeks from now. He also wants to surgically remove the polyps (the pictures show three to six or so of them), is there any necessity to that, given no other information?

We'll have to look into these things. The possibility of having the stricture helped is significant, as it has been a major barrier keeping her from being able to eat more meat, roast beef being one of her favorites, but also the most likely to get lodged. Apparently this sort of problem is sometimes called "steakhouse syndrome" since steak and roast are most likely to get stuck in this way. Apparently food lodged in this manner is called a food bolus.

People who experience steakhouse syndrome are often diagnosed later with an abnormality called Schatzki’s ring, thickened tissue at the lower end of the esophagus from GERD, says Glatter. This ring acts like a speed bump in the esophagus. ‎It also may be associated with inflammatory conditions such as eosinophilic esophagitis, strictures or even cancer of the esophagus.

 

[Gaby]

How does your mother's diet look like?

Digestive issues can often be managed with dietary measures. Carbs, grains, processed foods are the major culprits. Low stomach acidity can cause GERD and its complications. The food "stagnates" and it causes reflux. Proton pump inhibitors can alleviate temporarily, but it would certainly cause a vicious cycle where low stomach acidity is perpetuated.

Here are some useful articles:

Proton Pump Inhibitors: So dangerous that prescriptions border on being criminal
https://www.sott.net/article/320501-Proton-Pump-Inhibitors-So-dangerous-that-prescriptions-border-on-being-criminal

Acid Reflux - A malady of those who eat mainly carbs
https://www.sott.net/article/281996-Acid-Reflux-A-malady-of-those-who-eat-mainly-carbs

GERD: Symptoms, Causes and Remedies
https://www.sott.net/article/234660-GERD-Symptoms-Causes-and-Remedies

Gluten sensitivity induces GERD (Gastroesophageal reflux disease)
https://www.sott.net/article/254451-Gluten-sensitivity-induces-GERD-Gastroesophageal-reflux-disease

Acid Reflux Linked to Gluten Intolerance
https://www.sott.net/article/238736-Acid-Reflux-Linked-to-Gluten-Intolerance

If the reflux has created a mechanical obstruction, it might be worth trying a mechanical relief. In the long term, dietary changes and supplementation would be much better.

Hope she feels better soon!

 

[theos]

Like Gaby said, address the diet first and antacids are real bad news.

Often, people don't take enough time to chew their food. Your mom should be taking small bites and chewing until the food bolus has a paste like consistency. This will decrease the odds of food getting lodged in her throat and it will make digestion easier.

 

[HowToBe]

So apparently the PPI could cause some serious damage over time. Will the doctor have a way of telling whether she's taking it or not? Might it be worth taking just leading up to this surgery, or would other antacid methods be better? I assume part of the goal for the moment is to reduce the inflammation of the esophageal tissue so that the doctor can perform the procedure.

On a side note the polyps immediately made me think of iodine. She had a uterus cyst/polyp removed a few months ago and seems to have some hypothyroid symptoms.

It appears to me that the procedure would make it more feasible for her to attempt a ketogenic or at least a more paleo-type diet. The stricture became a big problem the first time she tried.

 

[monotonic]

Specifically, what the doctor said when I asked about hypochlorhydria was "No, stomach acid and stomach motility are two totally different things that have nothing to do with each other." Another interesting response was "well, if you think about it, it makes sense."

I don't like the idea of taking acid inhibitors at all. Her digestion is already struggling, we don't want to completely sabotage it.

The problem with roast is that it feels like it's chewed, but what happens is because virtually all meat these days is stringy, it just wads up into a ball of fibers. It's a liability.

My thinking is that since it is aggravated by stomach acid, she can take some baking soda any time she notices it's acting up. Reducing the irritation from stomach acid and inflammatory foods could keep it from swelling so much that it interferes with taking supplements. The last thing we want is digestive enzymes to get held up at the stricture and then start trying to digest it.

 

[Konstantin]

My wife also has problems with GERD and esophagus. A few months ago she felt so much pain in her esophagus that she decided to visit a doctor.
After all analyses, the main culprit for that condition in her case was infection with H. Pylori. After some antibiotic and good probiotic her condition is going for the better.
Also, stress and diet are big factors in this condition. She was also prescribed with proton pump and acid inhibitors,but after taking them, her GERD was much worse

I hope that she will feel better soon

 

[Nienna]

Monotonic, here are a few articles from SOTT that discuss acid reflux, GERDS, PPIs, etc. Too much stomach acid is not the problem. Too little stomach acid is. They explain it in these articles, as well as other contributing factors:

https://www.sott.net/article/265343-The-truth-about-stomach-acid-Why-low-stomach-acid-is-jeopardizing-your-health

https://www.sott.net/article/234660-GERD-Symptoms-Causes-and-Remedies

https://www.sott.net/article/320501-Proton-Pump-Inhibitors-So-dangerous-that-prescriptions-border-on-being-criminal

There are many other articles on SOTT if you use the words "acid reflux" (with the quotes).

These articles may help you and your mother in figuring out what to do.

 

[Gaby]

So apparently the PPI could cause some serious damage over time. Will the doctor have a way of telling whether she's taking it or not? Might it be worth taking just leading up to this surgery, or would other antacid methods be better? I assume part of the goal for the moment is to reduce the inflammation of the esophageal tissue so that the doctor can perform the procedure.

And this last thing can be achieved with diet and alternative remedies. Dietary changes are the best thing to reduce inflammation. She can be helped with supplements and other remedies as described in the SOTT articles above.

If she still struggles throughout this phase despite the alternative help, she could take PPIs as an emergency. Just have in mind that she would have to wean off from them gradually. In reality, PPIs are seldom strictly needed when other natural methods are tried first.

PPIs were invented recently and they have strict clinical criteria that are best reserved for the hospital setting. Big Pharma influenced the change in criteria and now people take them like candy. That just destroys their health.

 

[monotonic]

Monotonic, here are a few articles from SOTT that discuss acid reflux, GERDS, PPIs, etc. Too much stomach acid is not the problem. Too little stomach acid is. They explain it in these articles, as well as other contributing factors:

I had the problem myself. You may want to read my post more closely. Thanks for the links though. I've explained the problem to my mother in the past so she has some idea too.

BTW, my mother has a metal disc in her neck and metal rods in her back due to severe scoliosis. Maybe it's related.