Gastroenterology/Endoscopy

[AngelsSix]

Okay, someone give be the ups and downs of this procedure, please.

For the last several months (since Dec.) I have been having trouble swallowing, food feels like it won't go down, pain in my stomach when I get up in the morning, and now even pain just below my ribcage. Thought that it might be something related to my sudden onset of allergies (I do mean sudden, never had an allergy in my life) but my allergist said it sounded like reflux. So I just sort of shrugged it off, take the requisite antacids, etc. Nothing seemed to work.
So I finally give in and go to the doctor, and he says that he wants me to start taking Prilosec OTC and get scoped to see what else could be going on.
Has anyone had this done?? What should I expect?? What will the doc be looking for. He mentioned a precancerous stage or something....I don't think it is that serious.
Thanks

[Air.177]

My Mom had similar problems, severe heartburn, and occasionally food would feel like it had lodged in her esophagus. She found some OTC chewable tablets called Titralac(sp) Whenever the symptoms start, she chews one or two tabs, and then it's gone.

I think you are doing the right thing going to the doc, hope all goes well.

[SP5IC]

Lay back & enjoy the demoral. Scoping (both ends) will allow you to be a menace to you grandchildren. It is VERY important. When I had my bottom done :D , the nurse told me...Mr. Atchison, you're in great shape...We don't get to say that to too many people".

Father of a combat vet.

Mark Atchison

[AngelsSix]

Thanks be, I am only getting the TOP done, LOL!! I am a little worried about that lovely gag reflex I have, I guess they take that into account. They need to dope me up good, I don't like the idea of someone sticking something down my throat while I am awake....

[Sacamuelas]

A6-
I will try and put this in terminology for laymen. Some terms have to remain to keep it clear. Here goes: :)

People with chronic heartburn and/or acid reflux can end up diagnosed with GERD. A heartburn that is severe or that occurs frequently over a long period of time can become harmful. This is known as Gastro esophageal Reflux Disease (GERD). If GERD is untreated, there is constant acid irritation to the lining of the esophagus, and complications can occur.

In @10% of people with GERD, a condition known as Barrett's esophagus is present. Let me explain what that is as this is most likely what your Doc is checking for and diagnosing.

In a normal esophagus(the "food tube" from your mouth into your stomach), there is a difference in the actual type of cells lining the tube portion (esophagus) from the type that line your stomach. There is a one-way valve between the esophagus and the stomach that keeps acid from flowing back up into the esophagus.

If that valve is defective (as in acid reflux), the esophagus type cells are exposed to chronic acid reflux irritation. Your bodies response over time is defensive in nature, the cell type lining your esophagus at the 'bottom' near where it empties into your stomach can change as a response to this irritation. The actual cells found in that area will changeover to that of the type of cell that lines your stomach. This, of course, makes that lower area of your esophagus much more resistant to the acid. This changeover from one type of cell to the type of cell normally only found in the stomach is called Barrett's esophagus.

In and of itself, barrett's is not bad. It is just a reaction to irritation similar to a callous. Except that instead of building up extra layers of the original type of cell (callous), your body actually starts producing a different type of cell in the area that is more resistant to the irritant (acid causes stomach lining cells to lcoate into the esophagus).


The reason he/she called it "pre-cancerous" is that in a small % of barrett's.. the new cell type area can become dysplastic (abnormal under the microscope) usually over years and eventually become cancerous. So if present, they will want to make sure they treat your reflux to remove the irritation then monitor it.

All this can be diagnosed by viewing the junction where the cell types change near the valve at your stomach. They can biopsy any areas that appear 'odd'. IMO, that is why you are getting an endoscopy so the Doc can see the area ( he/she will be able to tell the type of cell just by looking at the junction area). If you do have Barrett's, he/she can biopsy if he so determines and make sure all is "normal" stomach cell types.

Your Doc is playing it safe... you are doing the right thing.

A6- DISCLAIMER: Please remember this is the internet and actual life scenarios are welcome here but should be carefully posted about by those of us trying to help. Since you have already seen a doc and are being treated.. I decided to chime in and try to help.
FWIW, I am only going off VERY limited info based on what you have stated. Your personal Doc is the best source for info on your specific condition. I am just giving you my best "guess" based on what you have told us and combining that with my knowledge and experience with the pathology/physiology/histology of a common disorder that I am familiar with.

I hope this helped you understand...
Good luck and HTH. :cool:

[AngelsSix]

That sounds more like what he was explaining. I do remember the Barret's thing, first thing popped into my mind when he said that was.....GUN?? LOL

Thanks for your clarifying that for me. I did read that they can do some sort of surgery too....not sure if it pertains here. It mentioned something about hiatal hernias in the same article I read. I have been diagnosed (years ago when they did a barium (sp) test thinking I had an ulcer) with a slight hernia. I sort of wonder if I have just made it worse and if so, will they see this when they do the scope??

[Kyobanim]

I had the scope thingy done a couple years ago. They sprayed something down my throat that numbed it. Between that and the valium it wasn't bad. I've had friends that were put under for it, doctors choice I guess.

[Bill Harsey]

Interesting stuff, good job Saca, Even I thought I understood what you wrote. AngelsSix, wishing you all the best. Heal up so you can kick ass!

[AngelsSix]

Thanks, Bill.

The doc said that I would be given some stuff to make me sleepy. I just have to remember to ask him for a copy of the tape, LOL!!!

[ccrn]

Usually for endoscpy they will use conscious sedation. That entails a peripheral IV, a small amount of sedative (ie versed) and some hurricane spray down the throat (maybe).

Its a routine procedure that can be diagnostic but also interventional if they found bleeding. They can also dilate any stricures found.

A risk is perferation (poking a hole) of the esophagus. That would mean a trip to OR. This will all be in the consent that is mandatory for you to sign.

Most people Ive spoken to post procedure dont remember a thing-

ccrn

[Bill Harsey]

Originally posted by ccrn
Usually for endoscpy they will use conscious sedation. That entails a peripheral IV, a small amount of sedative (ie versed) and some hurricane spray down the throat (maybe).

Its a routine procedure that can be diagnostic but also interventional if they found bleeding. They can also dilate any stricures found.

A risk is perferation (poking a hole) of the esophagus. That would mean a trip to OR. This will all be in the consent that is mandatory for you to sign.

Most people Ive spoken to post procedure dont remember a thing-

ccrn Had to check your profile, knew you couldn't be another knifemaker...

[ccrn]

Originally posted by Bill Harsey
... knew you couldn't be another knifemaker...


No sir...

Though it would be an honor to own one of yours some day (earned and paid for of course)-

ccrn

[steel71]

I had the similar problem a couple of months ago. I saw my doc, and he asked me about my stress level. Sure enough, i've made it a point every day to decrease the stress, and I been go to go since. Good luck, oh when it hurts in the morning, does it hurt on palpation? mine started below the left rib cage, and after a month. I begin to experience transverse pain from left to the right side. FYI

[AngelsSix]

I did explain about how stressed I had been over the last year (since Dec.) and also about the fact that I had been living on coffee and not sleeping well.
Caffeine is a big problem, as well as chocolate. I have managed to stop drinking coffee (I do have one cup decaf once in a while now), soda, and alcohol. I mostly drink water and make it a point to eat three meals a day. I am still having issues though.
I have the same pain under my left ribcage, which gets even worse when I run. They ran a liver panel, it came back fine. My food feels like it sticks right at the center of my ribcage.....that and my throat feels like it's closing up. Not to mention that my food tries to come right back up when I eat.
I found some real good video's in the net and at least know a little about what it will look like if there is something there.

[swatsurgeon]

you guys have it all wrong: when in doubt, cut it out!
Preferably using one of Mr. Harsey's instruments......
can you tell who's a surgeon?

be careful of hurricane sprays (and similiar products) a 2 second spray is all you should get. There is a high potential for toxicity causing MAJOR problems with oxygenation. I don't list this to scare anyone, just to warn of a potential problem. I don't let our residents (surgeons in training) use it anymore because it's so easy to abuse and cause a patient to become toxic.

[Roguish Lawyer]

Originally posted by AngelsSix
Okay, someone give be the ups and downs of this procedure, please.

I've had them both. No big deal. The lower is a pain in the ass, though. LMAO

[Sacamuelas]

SS-
It shouldn't cause a problem if your young cutters would use it as directed, use it on the acceptable patients for this type medication, and watch carefully for cyanosis/low Po2 intially, etc.

In reviewing reported cases of methemoglobinemia, clinicians almost always (every case I read about) used multiple sprays of benzocaine and/or sprays of longer duration than recommended

"Spray in excess of two seconds is contraindicated"

Predisposing factors include age (infants under 6 months of age and older patients with cardiac problems may be sensitive to even low methemoglobin levels); the status of the area that is being sprayed (inflamed areas absorb more drug); concomitant use of other drugs which also have been implicated in causing methemoglobinemia; and the genetic make-up of the patient (due to altered hemoglobin, G6PD deficiency, or methemoglobin reductase enzyme deficiency).4,5

FWIW, Intravenous methylene blue is the treatment of
choice for methemoglobinemia. The typical initial dosage is 1 to 2 mg/kg intravenously; clinical improvement is typically noted within 15 to 30 minutes.

If in doubt, cut it out.... so that applies to pt comfort producing meds too? ;) :p HAHA

THANKS for the warning Sir. I treat a LOT of geriatric patients and use benzo gel daily...with no concerns. I do, however, use the hurricane spray for gagging patients and had not been properly educated to this phenom until you posted it. THANK YOU SIR.:cool:

[swatsurgeon]

Saca,
a man of much wisdom......you are so correct. It is the abuse rather than appropriate use of such products that leads to complications.
I am the pain free king in surgical circles.....never cut out pain meds!!! especially for a wounded soldier/cop/etc that have weapons that could hurt you!!

[AngelsSix]

Posted by Swatsurgeon:

I am the pain free king in surgical circles.....never cut out pain meds!!! especially for a wounded soldier/cop/etc that have weapons that could hurt you!!

I fall into that category. They gave me enough to make me good and not giving a shit when they did the surgery on my foot. Even though I was semi-conscious, I could care less that some dude was down the with a hammer and chisel smashing my joint apart. When they went in to take the hardware out a year later (it started working loose nad the screw head was visible just beneath my skin) I damn near came off the table and killed the doc. He hit a nerve, hadn't bothered to numb it up because he said I wouldn't feel anything. They ended up knocking me completely out.

So.....as long as I am goofy and not gagging I will be okay.....I hope! It's getting done at a civilian hospital. Wheeeee!!

[MAB32]

I have had it done to me 5 times over the past 8 years. The stuff you guys talk about that they numb the throat with IS the worse part. The Demerol and Valium makes the lower portion more comfortable/tolerable.

I was diagnosed with Celiac Sprue 8 years ago. They (the doctors) told me that the MRE's were partly responsible if not the main antagonist for developing the disease. The infectious disease doctor advised me that I am in excellent company as there were quite a few soldiers who developed the disease during and after Desert Storm. Anybody else hear the same thing?

[Team Sergeant]

Originally posted by MAB32
The infectious disease doctor advised me that I am in excellent company as there were quite a few soldiers who developed the disease during and after Desert Storm. Anybody else hear the same thing?

Nope, never heard of anyone developing this disease. Linking it to MRE's? Are MRE's eaten in the M.E. different then eating one in any other country? BTW, I spent six months there and ate a whole lot of MRE's.

TS

[AngelsSix]

QUOTE]I have had it done to me 5 times over the past 8 years. The stuff you guys talk about that they numb the throat with IS the worse part. The Demerol and Valium makes the lower portion more comfortable/tolerable[/QUOTE]

Is it just me having had a couple of glasses of wine or does this not make a whole lot of sense??

Edited to add: I think it means that he's allergic to beer!!!!:eek:

[MAB32]

Ok, I had a bottle too many. I get both the esophogeal something, something where the tube (different one) goes down the throat to the small bowel. They numb the back of the throat so the tube can go down with out your "gag" reflex kicking in. They also will do a colonoscopy. This is where the Demerol and Valium comes into play to relax you so the gastroentenologist has an easier time scoping the entire colons.

I hope this explains it better, Sorry for the confusion.

[AngelsSix]

I am just having the upper end done.....at least that's what they told me.....there isn't a thing wrong with my colon!!