Avoiding an upper endoscopy for already-diagnosed gastritis?

July 19, 2022 3:48 PM

My gastritis is getting worse (despite stopping all alcohol use for a month now), and I need to see a gastroenterologist again. But I want one that will try everything else possible before doing a procedure requiring general anesthesia (such as an upper endoscopy).

That's why I don't want to go back to the gastroenterologist I saw 5 years ago. They insisted on an upper endoscopy even before prescribing antibiotics. And yeah, the resulting h. pylori screen was negative, but I feel they didn't consider enough alternatives before putting me under (and sending me a $1000 anesthesiologist bill to boot).

So I want a place that will look at the records that I'll have the old GI send them, say "yes, we believe you when you say it's still gastritis", and then look into every other possible option before a procedure requiring anesthesia.

The most helpful answers will be from people with relevant experience in this area - either with gastroenterologists in particular, or with getting doctors to prioritize patient health over procedure profitability. I know or know how to find evidence-based advice on coping with the gastritis itself.

If it's relevant, I've been on Pantoprazole for 5 years. I don't think it's helping any more, if it ever was. I'm in the USA and have United Healthcare insurance. I don't have to worry about staying in-network.

posted by commander_fancypants to Health & Fitness (12 answers total)

It sounds like it's the actual procedure, cost, and experience of going under is the real issue for you, and that you're finding it unhelpful/redundant with your gastritis experience.

But just in case general anesthesia itself is your primary concern with avoiding an upper endoscopy, I figured I'd mention that you should be able to find a provider who can use an alternative form of sedation like propofol (or Versed and fentanyl).

The upper endo I got recently used propofol, which is -- I don't know the terminology exactly -- "conscious" or "twilight" sedation, as distinct from general anesthesia. I do not remember the procedure, so I was not fully conscious, I definitely woke up babbling nonsense about something or other, and needed someone to drive me home, so the superficial experience was similar. But medically/biochemically they're different. (I can't easily do general anesthesia without physical consequences for Reasons so I checked on this before going under.)

Disclaimer: I'm not a doctor, just a patient.
posted by cnidaria at 4:01 PM on July 19, 2022 [5 favorites]

FYI the standard for endoscopy in the UK and Ireland is conscious sedation, not general anesthesia. That might be another option to explore.
posted by DarlingBri at 4:03 PM on July 19, 2022 [5 favorites]

I have gastro issues and a gastroenterologist...but I also think no doc is gonna make a diagnosis of anything by looking at your endoscopy from 5 years ago. You do deserve to have your concerns listened to, however, and also to have your priorities heard and respected. I agree that you shouldn't go back to the person you saw years ago, so for you what's the next step at finding a gastro so you can ask these questions? Do you want to go to your GP and get a referral? Ask people you know in real life, in your city, for a recommendation?

FWIW, my gastro went straight to antibiotics for my situation, and told me we wouldn't be doing any procedures unless my conditioned worsened. He went out of his way to say why XYZ procedure would not be the right thing to do up front.
posted by BlahLaLa at 4:35 PM on July 19, 2022 [1 favorite]

Some thoughts:
* My gastritis gets noticeably worse when I stop alcohol
* PPIs? I've never tried Pantoprazole, but I seem to be very resistant to most PPIs (60mg of Nexium does almost nothing for me). However, I found that 60mg of Dexilant works quite well. Have you tried other PPIs?
* I was reluctant to get an upper GI endoscopy due to general fears, but it turned out to be super easy and not a big deal, and I should have done it years ago...
posted by soylent00FF00 at 5:22 PM on July 19, 2022 [1 favorite]

I don't know about alternatives, since I wan't sent to a gastroenterologist until it was clear that I really needed the scans. But this is the first time I've ever heard of an upper endoscopy being done under general anesthesia. Not sure where you're located, but sedation is standard in the US.
posted by The Underpants Monster at 5:46 PM on July 19, 2022 [3 favorites]

Yes, I had an EUS-FNA of my pancreas, which is more invasive, I think, several years ago now and it wasn't general, just twilight. Which, if cost is your concern, should cost significantly less (I say "should" because, you know, US medical system...).
posted by praemunire at 6:42 PM on July 19, 2022 [1 favorite]

Are you in the US? It is generally much more affordable to have your procedure in a freestanding GI practice as opposed to in the hospital-based practice you might have visited before. The hospital has a certain overhead (because their facilities have to conform to more stringent hospital specs) that "GI Centers" don't need to charge for. Since endoscopy is such a simple procedure I would feel comfortable having this procedure there rather than at a hospital. You will probably also have a much more transparent and reasonable cost, since the billing is done by their specialty billers, not the hospital labyrinth. You should also be able to talk to your insurer about your financial responsibility beforehand. They can tell you about the difference in costs at different facilities.

You should definitely talk to your GI doctor about the anesthesia/sedation experience and their typical charges. (Most propofol/versed sedation is provided by a nurse anesthestist rather than an anesthesiologist, who is an MD specializing in anesthesia), and I don't think you will need much more than your previous endoscopy report and an office visit with the new doctor to catch the new doc up on your condition. There are a number of different medications and they can be taken in different dosages/intervals best handled by a GI doc who specializes in gastritis/dyspespia. Yes, there are specialists within the specialty of gastroenterology! Relief is in your future, but it can take some experimentation with different meds and lifestyle changes.

Check if the practice has a nurse or nurse practitioner that you can call as needed - this can really streamline your access. The doctor will be more difficult to speak with by phone - he or she has days they are doing procedures, days they have office hours, and limited time to return calls.

It is typical not to prescribe antibiotics before performing an endoscopy, so that was not out of the ordinary at all, but practitioners differ on this. It is completely typical to test for h. pylori when performing an endoscopy; not testing would probably be considered negligent.
posted by citygirl at 6:55 PM on July 19, 2022 [2 favorites]

Response by poster: My apologies, folks. I was knocked out for the upper endoscopy via IV only, and had no breathing tube. While I forget what the drug I received was (maybe Versed?), I'm told that the IV-only aspect indicates it was sedation, not general anesthesia.

I remain unhappy about the cost and invasiveness, so I still consider the question valid and everyone's answers helpful. My apologies to those of you who spent time answering under the assumption that it was general anesthesia specifically.

citygirl, I'm pretty sure the place I went counts as a freestanding practice. It was definitely not physically connected to a hospital, and the procedure took place in their center.

I got a referral to a new GI from a knowledgeable and trusted friend today, so will be making an appointment soon. Thanks for the answers so far, everyone, they will definitely help guide my interactions with this new GI!
posted by commander_fancypants at 9:16 PM on July 19, 2022 [1 favorite]

If you're newly off booze, how's your nutrition? Most Western doctors won't talk to you about that.

IME, lots of gluten and dairy can aid and abet digestive problems. And don't get me started on how awful PPIs are. Thankfully I've been off PPIs for years, and a lot of my ability to stay off them had to do with dietary changes and losing unneeded body fat.

Oh, and the cystic rosacea acne that had become untreatable is largely a thing of the past now that I eat very little gluten.

I'll be starting treatment for (environmentally-triggered) thyroid issues and related digestive problems soon. For the first 30 days, I'll be following the autoimmune paleo protocol that my functional medicine guy suggests. I already am less symptomatic now that I've given up dairy, and I won't be going back.
posted by Sheydem-tants at 11:26 PM on July 19, 2022 [2 favorites]

I had another thought, commander_fancypants, because you mentioned the $1000 figure. Is it possible this is actually your yearly deductible through your insurance? I agree that is an eye-popping figure for conscious sedation, but the fact that you mentioned that number prompted that thought. I think it might be worth a phone call to your insurance's member services line to figure out your minimum deductible and co-pay. It's also worth noting that the deductibles are typically per calendar year, so if you have any other (even completely unrelated) procedure in the same year, your deductible is already satisfied.
posted by citygirl at 6:28 AM on July 20, 2022 [2 favorites]

Will also say: I have had one 100% conscious upper endo by a doc in the USA, sitting up in a regular chair. They had one assistant, but the assistant hardly did anything except hover, in case doc asked for something.

It was mostly cake until they pumped in some air to see better, which was painful (because your stomach doesn't really want a bunch of air in there). That only lasted the last 2-3 min, and once they got the air out, all better. Total time was maybe 15 min. Probably also helped that they were super expert; they kept verbally assuring me the whole time, telling me what they were doing, how long each thing would take.

Would I do it again? Well, I'd prefer not to, but it was pretty cool to not have to need an iv, or recover from anesthesia, or as you say, pay so much for that.
posted by bitterkitten at 9:39 AM on July 20, 2022 [2 favorites]

Yes, I’ve known people who, like bitterkitten, have had the procedure with no sedation and described it as uncomfortable but not painful. And I briefly woke during the second one I had, and while I preferred the sedation, it certainly wasn’t the worst thing I’ve ever felt in a medical setting.

Have also been through multiple elimination diets, which were annoying and inconvenient, but ruled out a lot of things.
posted by The Underpants Monster at 9:06 PM on July 20, 2022 [1 favorite]