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Medical Forum / Diseases and Disorders / Sinusitis / April 2006

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No pathological acid reflux

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tdonline - 28 Apr 2006 22:37 GMT
I got a letter from the GI with my pH probe results. In summary, I do
not have actual reflux but apparently I do get some acid where it
doesn't belong because of belching. Please read the following and help
me out with some of the details. My ENT and GI were locked in a turf
war and I guess the GI is technically right...but the ENT wasn't wrong
either because I'm getting some acid up into my pharynx...I think.

START
"The esophageal motility was normal. Values for distal esophageal acid
expsosure are normal with a total time below pH 4 in the distal
esophagus of 1.8% with 2.9% upright and 0% supine. Proximal acid reflux
is present, however, the predominant feature there is "pseudo-reflux"
which is thought to represent probe drying. A pattern of repetitive
belching is present which is associated with some hypopharyngeal acid
exposure.

In summary, the patient has no evidence of pathologic gastroesophageal
reflux, rathter the reflux that is associated with exposure to the
hypopharynx appears to be associated with belching. Belching is a
behavior that is associated with air swallowing and the management of
this includes prolonged proton pump inhibition along with evaluation
for aerophagia."
END

What is probe drying?

I'm not sure if I should go back to the ENT or not. The thing is I had
symptoms waaaay before I started belching all the time. The belching
started only after a three-week course of antibiotics.  I still wake up
with an irritated throat but according to the test, I have 0% supine
reflux.  Would the sore throat be from the irritated area being dried
out while I sleep?
tdonline - 28 Apr 2006 22:41 GMT
Oops, I have been here for a bit, but just in case, the background is
that the ENT thinks I have both nasal inflammation and LPR.  I've been
doing nasal irrigation which have helped but it has never alleviated my
9 month-long sore throat.  I also get post nasal drip which has  also
benefitted from the irrigations but have never abated.
Shirley Ann - 29 Apr 2006 11:44 GMT
My acid reflux was diagnosed from my symptoms, The reflux was there in
the morning from during the night.
I was told to use Pepcid AC and Prilosec if I got more complications
like coughing as it was in my esoph. track.

Two years later I had a endoscope and no acid reflux damage .

I sleep with my head raised 4" so I get very little reflux now.

shirleyann
dkuhajda@locl.net - 29 Apr 2006 16:19 GMT
See responses within your text for some explanations.

> I got a letter from the GI with my pH probe results. In summary, I do
> not have actual reflux but apparently I do get some acid where it
[quoted text clipped - 5 lines]
> START
> "The esophageal motility was normal.

** How well the esophagus moves food and fluids from the mouth to the
stomach was normal **

Values for distal esophageal acid
> expsosure are normal with a total time below pH 4 in the distal
> esophagus of 1.8% with 2.9% upright and 0% supine. Proximal acid reflux
> is present, however, the predominant feature there is "pseudo-reflux"
> which is thought to represent probe drying.

** Dry mouth and throat, could be due to breathing through the mouth
due to sinus and nasal airway problems **

A pattern of repetitive
> belching is present which is associated with some hypopharyngeal acid
> exposure.

** Low pharyngeal acid exposure,  Belching is putting some minor acid
into the pharynx **

> In summary, the patient has no evidence of pathologic gastroesophageal
> reflux, rathter the reflux that is associated with exposure to the
> hypopharynx appears to be associated with belching. Belching is a
> behavior that is associated with air swallowing and the management of
> this includes prolonged proton pump inhibition along with evaluation
> for aerophagia."

** Aerophagia, swallowing air **

> END
>
> What is probe drying?

** The probe is drying out, probably because you were breathing through
the mouth or had an excessively dry sinus airway. **

> I'm not sure if I should go back to the ENT or not. The thing is I had
> symptoms waaaay before I started belching all the time. The belching
> started only after a three-week course of antibiotics.  I still wake up
> with an irritated throat but according to the test, I have 0% supine
> reflux.  Would the sore throat be from the irritated area being dried
> out while I sleep?

** Yes, you sore throat could be from breathing through the mouth **

Were I you, I would video tape myself several different nights to see
if I was breathing through my mouth.  It might not hurt to also use a
sensitive microphone right above your head so you can listen to your
breathing as well.  I would also ask the ENT to do a review of your
nasal and soft palate part of your airway because if it becomes
obstructed at night, you will be breathing through the mouth.

Yes, I would probably at a minimum go back and see your general
practicioner for a full work up and follow up with your ENT to make
sure you sinuses are clear.

Before my nasopharynx and oropharynx was open and I was breathing
through the mouth at night all the time, I was able to get some relief
by using both a STEAM humidifier in the room and a vaporizer next to
the bed.  I used distilled water in both units and would clean them out
every couple of days with an antifungal and antibacterial cleaner, i.e.
5% bleach solution (5 minutes setting time), rinse,  then isopropyl
alcohol rinse, clean water rinse.
tdonline - 29 Apr 2006 18:52 GMT
Thanks Dhuka, that was very thorough.  I also post at a couple of acid
reflux sites and it's interesting to see their perspectives also.  They
of course come from the GI side and think I should investigate the
reflux angle further.  Ahhh...so many options!  Hopefully, I will
become employeed soon and get some health care!  I have student
healthcare, but am having a hard time witht the deductibles.

How did you get your nasopharynx and orapharynx open?  I had a ct scan
last fall and according to the ENT, it was clear.  Only had minor
issues, a couple of cysts and maybe slightly larger than usual
turbinates.  The ent did a couple of scopes and noted nasal
inflammation, post nasal drip and swollen throat.  She was convinced it
was LPR.  I will bring up your suggestions the next time I see an ent.
dkuhajda@locl.net - 29 Apr 2006 21:22 GMT
My airway had multiple problems that had to be addressed.
1. Block sinus drainage pathways.  I at least sought treatment before
any more serious complications.
2. Moderate left side obstruction from previously broken nose.
3. Enlarged turbinates in the nose from chronic allergy problems.
4. Significantly enlarged and growing tonsils as an adult (not normal).

While I cannot recommend surgery to anyone unless there is simply no
other option and you seek a couple of different opinions to look at the
benefit versus the risk, most of my problems required surgery.

1. Septoplasty to straighten out the nose, while the ENT was there he
reduced the turbinates with Somnoplasty, and opened up the sinus
drainage channels.
2. About 8 months later the tonsils had to come out, after delaying
this almost three years.  As it turned out the tonsils had started to
grow into my cheek, lower gums, soft palate, and one side was nearing
the voice box.  This was a significant and painful surgery recovery.
The plus side was due to the tonsils into the soft palate near the
uvula, a soft palate resection was required to get everything back in
place.  4 weeks of serious pain and healing, followed by a couple of
months of final healing.
3. Very careful control of allergy symptoms.  Careful choice of bedding
and being proactive with prescription antihistamines and occasional use
of prednisone during the worst allergy times, grass pollen and corn
pollen, now prevent the sinus airway problems from allergies.
4. Control of minor acid reflux, especially at night due to hiatel
hernia.  No eating food within two hours of bedtime.  Pecid AC at
night.  Raise entire head of bed a couple of inches.
tdonline - 29 Apr 2006 18:54 GMT
Also, is there a device to wear to ensure you're not mouth breathing
while sleeping?  A sleep guard of some sort?  I've been told that I do
snore very, very ligthtly.
dkuhajda@locl.net - 29 Apr 2006 21:28 GMT
I would still explore if you notice you breathing through your mouth.
Even during the day, if you have any problems through the nose, you
will breath through the mouth and might not notice it right away.  At
night it is a simple matter to video tape yourself with a modern video
camera in IR mode, then you will know if you breath through your mouth
at night.

There is available a simple chin strap to help hold the mouth closed at
night.  There is also a mouth guard available through many dentists
that will help hold the mouth and jaw in position.  The dentists guard
is useful for TMJ, grinding teeth, and there is also a mouth appliance
that will help hold the jaw forward and tongue forward to assist with a
reduction in snoring.

You can do a search for burping/belching and swallowing air for many
possible causes.  Even minor anxiety and stress can cause some people
to unconsiously swallow air, as can constant breathing through the
mouth, chewing gum, and too many other causes to list here.  Do a
search.

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