YNMD: Trouble swallowing leads to endoscope, dilation, and biopsy. What happens next?
April 10, 2012 8:30 AM Subscribe
YNMD: Trouble swallowing leads to endoscope, dilation, and biopsy. What happens next?
A friend was having trouble swallowing. She had an endoscopy where they found inflammation, took biopsies, and did a dilation. They gave her two weeks of PPIs. Follow up appointment today and I'm having some trouble understanding the medical literature.
I understand that the biopsy can positively identify a variety of possible problems. Will it also be able to confirm/deny GERD?
She hadn't had symptoms other than the trouble swallowing. From reading the literature, it sounds like the next step it to assume the problem is GERD (barring biopsy findings to the contrary) and see if GERD treatment improves her symptoms. *If* GERD is the underlying cause and she begins a "step-down" treatment, how will she know if any step is working, since there are no detectable symptoms to reduce?
Of course, you are not her doctor, but she'd like to go into this appointment as well informed as possible.
A friend was having trouble swallowing. She had an endoscopy where they found inflammation, took biopsies, and did a dilation. They gave her two weeks of PPIs. Follow up appointment today and I'm having some trouble understanding the medical literature.
I understand that the biopsy can positively identify a variety of possible problems. Will it also be able to confirm/deny GERD?
She hadn't had symptoms other than the trouble swallowing. From reading the literature, it sounds like the next step it to assume the problem is GERD (barring biopsy findings to the contrary) and see if GERD treatment improves her symptoms. *If* GERD is the underlying cause and she begins a "step-down" treatment, how will she know if any step is working, since there are no detectable symptoms to reduce?
Of course, you are not her doctor, but she'd like to go into this appointment as well informed as possible.
I had an endoscopy due to trouble swallowing - which confirmed a diagnosis of GERD. I'm on PPIs for life according to my doctor. He has never discussed the step down thing with me.
I believe the biopsy is to make sure that the lesions from the esophagus are not pre-cancerous. The big concern with long term untreated GERD is that it can be precursor to esophageal cancer.
posted by COD at 9:31 AM on April 10, 2012
I believe the biopsy is to make sure that the lesions from the esophagus are not pre-cancerous. The big concern with long term untreated GERD is that it can be precursor to esophageal cancer.
posted by COD at 9:31 AM on April 10, 2012
Mr. Llama had a similar problem and it turned out to be EE, referenced above.
posted by A Terrible Llama at 9:38 AM on April 10, 2012
posted by A Terrible Llama at 9:38 AM on April 10, 2012
I had this problem. Turned out to be a symptom of Generalized Anxiety Disorder... which is nothing my internist & eyes/ears/throat specialist thought of.
When I'm on my meds, it almost never happens. Without them, it's frequent.
Read up on AD, and see if it could fit, because choking is a known symptom.
posted by IAmBroom at 9:49 AM on April 10, 2012
When I'm on my meds, it almost never happens. Without them, it's frequent.
Read up on AD, and see if it could fit, because choking is a known symptom.
posted by IAmBroom at 9:49 AM on April 10, 2012
I had a similar situation where, after an endoscopy, I was diagnosed with GERD and prescribed PPIs. Like stated above, I never had a swallowing issue when I was on the pills. So, if she starts having trouble swallowing again after coming off the pills, that is a definitely sign of the drugs having worked.
However, after three years of drugs, and some prodding from my doctor, I decided I was done with the pills. I quit cold turkey and ratcheted back my diet to the basics to understand what was causing me the trouble. I've been able to identify the foods that give me the most trouble, but basically it comes down to eating a balanced diet with smaller portions.
I still have swallowing issues on occasion, but I know what food gives me the most trouble, so at least I can be prepard while eating them.
posted by bwilms at 10:31 AM on April 10, 2012
However, after three years of drugs, and some prodding from my doctor, I decided I was done with the pills. I quit cold turkey and ratcheted back my diet to the basics to understand what was causing me the trouble. I've been able to identify the foods that give me the most trouble, but basically it comes down to eating a balanced diet with smaller portions.
I still have swallowing issues on occasion, but I know what food gives me the most trouble, so at least I can be prepard while eating them.
posted by bwilms at 10:31 AM on April 10, 2012
It sounds like there are detectable symptoms - difficulty swallowing. So why not titrate the meds to getting rid of that symptom?
Also, there are objective ways to monitor for the esophagitis caused by recurrent GERD, like surveillance EGD or esophageal pH monitoring.
IANYD and not a gastroenterologist.
posted by treehorn+bunny at 10:34 AM on April 10, 2012
Also, there are objective ways to monitor for the esophagitis caused by recurrent GERD, like surveillance EGD or esophageal pH monitoring.
IANYD and not a gastroenterologist.
posted by treehorn+bunny at 10:34 AM on April 10, 2012
Seconding the "she is having symptoms, they're just not classical GERD symptoms." I am on Nexium for stomach pain and gastritis, even though I've never had any classical GERD symptoms. When I taper off we are going to monitor those symptoms, per my gastroenterologist.
posted by Sidhedevil at 12:30 PM on April 10, 2012
posted by Sidhedevil at 12:30 PM on April 10, 2012
Best answer: I too had food get stuck in my throat sometimes. Saw a gastroenterologist, who did the upper endoscopy thing, found the problem, fixed it by inflating a balloon, and sent me home with a prescription for Prilosec. I took the Rx for a month (I think it was just to let the throat heal from the procedure) then tapered off the Rx and have been doing fine ever since. So: If the symptom is "can't swallow" and the procedure fixed that, be happy. And thankful for modern medicine.
posted by exphysicist345 at 1:21 PM on April 10, 2012 [1 favorite]
posted by exphysicist345 at 1:21 PM on April 10, 2012 [1 favorite]
Response by poster: Follow up: exphysicist345 for the win. Same procedure, same outcome.
posted by elmonobonobo at 8:19 AM on May 1, 2012
posted by elmonobonobo at 8:19 AM on May 1, 2012
This thread is closed to new comments.
I would imagine the biopsy is to detect the presence of eosinophils in her throat - ie to diagnose eosinophillic esophagitis (EE). EE is typically caused by intolerance ("allergy") to something. The first treatment for this is a topical steriod such as fluticasone or albuterol. Note that the medical community has only begun to recognize this disease relatively recently and as such your doctor may not know very much about it.
Something else they may do is a swallow study. They put you in a big x-ray machine and make you eat and drink things with a tracer (barium). They get images of how things go down your esophagus, and if they come back up (ie reflux).
posted by Adamsmasher at 9:14 AM on April 10, 2012