Hi everyone,

I am sending this again in hopes that someone can comment on the
questions I had about the 24 hour ph test I had recently.

I have written the group in the past.  I currently take 20 mg of
prilosec in the morning and it seems to be working after the previous PPI
(prevacid) that I took for seven years stopped working.  I tried Protonix
after that and it didn't work either.  I tried both at high doses.  I went
through hell and lost my old gastro after he cut my fundic polyps twice
(which I believe had something to do with my prevacid ceasing to work - you
may recall this story).

I am on my  last gastro where I live (Hagerstown, MD) and he is from the
older school and doesn't believe in cutting hyperplastic fundic polyps (I
believe the younger doctors like to remove them).  I don't know what I can
do if the PPI's keep making the polyps grow or if the prilosec stops
working.  Surgery is out of the question.

I went to Baltimore (Univ of Maryland) to get a second opinion and the
gastro recommended a 24 hour ph and manometry, and for my current gastro to
take some specimens in my duodenum in my next EGD to check for
lymphangectasia (which is a one in a million and usually results in diarrhea
which I don't have - I think this will be a waste of time and an unnecessary
invasion).

I have a copy of the 24 hour ph report and manometry, which was done by
another university gastro who works in the "swallowing center".  They don't
do the test where I live.

I have some questions about the test results that make no sense to me.  I
tried to ask my gastro today and he didn't even know they mailed him a copy
of the test report, and had to go fumbling through my chart looking for it,
and he could not answer my questions and said he would have to look at the
graphs I was referring to later.  I don't think he knew how to read them, or
had ever seen a report like this before, because he does not order the test.

I am an engineer and study medicine, and am pretty good at reading charts
and graphs, and I could easily see how to interpret the ph waveform which
has the 24 hours (in military time) on the x-axis and the ph values on the
y-axis (one set for the proximal sensor which was 5 cm above the LES and the
other set for the distal sensor which is about 10 cm in the stomach below
the LES - total of 15 cm between sensors).

Sorry for the long lead in.  My main question is as follows.  I consider the
stomach to be a reservoir and have an ambient ph value which would be
mimicked in the esophagus as you refluxed up acid and acid fumes (or bile)
into the esophagus.  Therefore, I do not see how the ph of the esophagus can
ever be lower than that of the stomach unless a puddle of acid is sitting in
the esophagus and the LES remains closed and the stomach went from acid to
basic all of a sudden (perhaps from refluxing bile through the pyloric
sphincter into the stomach).

Anyway, from 3:30 AM til 9:00 AM (recumbent position), the ph in my stomach
was significantly higher than the ph in my esophagus [stomach was 7-8 and
above (graph stops at 8), and the esophagus was approx in the 6 range].  I
got up around 9:15 AM, and the stomach ph still stayed higher than the
esophagus (but not as pronounced) until I had the probe removed around noon.
The histogram analysis also clearly indicates a higher percentage of the
time that the stomach was above ph 7 versus the esophagus.

Twenty mg's of Prilosec will not raise the ph of the stomach near that much
and I believe the stomach acidity should go up during the night (i.e. lower
ph) as the PPI wears off after taking it in the morning.  My stomach acid
decreased during the night (after 3:30 AM) and even went to the basic side
of the neutral 7.0.  This makes no sense to me unless I am refluxing bile
into the stomach, and if so why didn't the bile also reflux into the
esophagus, unless the LES stayed tight.  Incidentally the stomach ph was
significantly more acid than the esophagus between 12:30 AM (when I went to
bed) and 3:00 AM.

I will quote the "impression" the gastro wrote in the report.  "Gastric acid
breakthrough late in the day and at night as expected on PPI qAM without
evidence of associated pathologic gastroesophageal reflux".  I don't agree
with this because of my statements above, and I saw no acid breakthrough
after 11:30 PM (I assume acid breakthrough means the ph of the esophagus
dropping below 4 - correct me if I'm wrong).  He wrote nothing about this
quandary I am asking about.

I apologize for this being so long but I was trying to save you from saying
you need more information, etc. If I could show you the charts it would all
be there.  I know that basic can burn just as bad as acid, but I can not
live without the PPI acid blockers.  If I stop them I will start burning
within a day, and the H2 blockers don't touch it.

Please comment on this the best you can.  It's a shame I can't talk to my
doctor about this.  I tried.  Thanks for reading this and I look forward to
your comments.

Pete