Dysphagia, LPR, GERD and anxiety help!

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Hello,

 

I am writing here because I am currently suffering immense bouts of anxiety due to LPR and GERD prior to my upper endoscopy.

 

I have just turned 31 but I suffered symptoms for many years. I quit smoking 9 months ago after nearly 5 years of not-so-heavy smoking (average 4 cigarettes a day).

I am nearly 6.2 feet tall (187.5 cm) tall and my weight has varied between 71 kg (11.2 stone/156 pounds and 76 kg (and 12 stone/167.5 pounds). I walk a lot and exercise regularly.

 

My story started several years ago when I experienced thick phlegm in mornings however the symptoms came and went. I blamed it on hay fever or cold weather in Denmark where I studied.

During this time I experienced occasional light-headedness and weakness in my limbs.

In February 2012 I experienced strong primary herpetic infection with tenths of aphthous ulcers that left several lymph nodes on my neck swollen and since then I had persistent lymphadenopathy. Doctors had reassured me that there was nothing to worry about.

 

I started to notice more worrisome symptoms after food alleged food poisoning (cramps, diarrhoea) that I developed in Romania, June 2015 and later was treated in Prague(Czech Republic) without upper endoscopy.

My first bout with GERD was in August 2015 after my friend’s wedding when after binge drinking I attempted to vomit but could not and felt terrible pressure in my chest accompanied by fullness.

I went to gastroenterologist and he diagnosed me with GERD and set me on a month-long omeprazole treatment.

 

My symptoms were light-headedness and pressure in chest with inability to breathe. In that point I have suffered only rare and weak reflux.

In the past three years I had one unsuccessful endoscopy that inspected oesophagus and it came alright (October 2015) but they could not finish the endoscopy because of neck spasms.

The doctor assured me that the chance of any malignancy was really low at that point (now I start to doubt it since they could not fully inspect my stomach).

 

I had several ultrasound investigations and they revealed minor kidney stones, minor hiatal hernia and thickened gallbladder wall, particularly from the side of the liver – but without any other histopathological presentations.

Symptoms however had not subsided in the past three years despite occasional PPI therapy and new symptoms appeared.

 

In March 2018 I started to notice that there is oatmeal sticking in my throat and passing slower to oesophagus. I was had been going to gym really often and once after suffering football injury I woke up at night on horrible heart palpitations, shortness of breath and radiating pain in my abdomen and between shoulder blades. The next day I was referred to emergency services and had tests done where they ruled out any heart disease. The doctor however felt tenderness right under the left ribcage in proximity to a breast bone.

 

Since then (March – June) I developed dysphagia (mostly issues with oatmeal and occasionally larger pieces of vegetables) that leaves me with sensation of something stuck in my throat and something sticking out of my throat. I have frequent pains/aches/discomfort behind the breastbone, shoulder blades and under my rib cage– this is not usually right after the meal. I am constantly burping when doing some sport activity and after drinking/meals. Since then I felt that I have to eat a lot because my stomach is all the time empty – even after eating and produces more acid.

 

Three weeks ago I had sever anxiety attack after reading various studies regarding LPR/GERD and GI carcinoma (oesophageal cancer and cardia adenocarcinoma in particular) and being a data analyst I calculated various models of probability to be diagnosed with GI cancer.

 

My health anxiety got exacerbated by my NHS surgery failing to put referral for endoscopy through and it got postponed by two months so I can expect GI consultation or gastroscopy at the end of August). I have been on Lansoprazole double doses since April, but with no avail so on June 12th the doctor changed medication to Pantoprazole – double doses. The only heartburn and reflux I felt was one hour in the morning after taking PPIs.

 

I have had one strong bout of night heartburn and reflux in the beginning of this month (June) three days after severe anxiety attack and since then I was left with even stronger dysphagia, globus sensation, hoarseness, dry mouth and sore throat with brown phlegm in the mornings.  I have started to watch anxiously my weight to check for any potential weight loss and this has become a downward spiral. Sometimes, my weight fluctuates by 3 pounds in the same day and I feel that overall I have lost 3.5-4kg (7 pounds) since February.

The truth is that I started to walk more, do less strength training and reduced portions/do not eat training mode portions (140 g of proteins a day). I have been taking Gaviscon Advance syrup, 5ml in the afternoon and 10ml in the evening; however it feels as it gives me a bit of constipation. That is not good because I have suffered of rectal bleeding since my 13 (nearly 18 years) and adds up to my fear of colorectal carcinoma. (had sigmoidoscopy 2 years ago and they found a small fissure in the depth of 45 cm).

 

From all of the aforementioned symptoms I would point out dysphagia (weight loss? explained, unexplained – unable to put it in place), weakness in limbs, light-headedness, shortness of breath, heartburn after hour after taking PPIs(before meal), pressure or discomfort in chest and behind shoulder blades, sore throat in mornings, burping and occasional constipation/bloating.

 

I rarely drink anything else but water and eat (and always have had) lots of fruits and vegetables and high protein/low fat balanced meals. I am quite active and from a middle-class family where we cook fresh food. I quit even occasional/minor drinking I have never drank coffee and generally live a healthy life (despite 4.5 years of smoking). Recently I bought reflux pillow. All of this with minor to no effect.

 

I have a trans-nasal endoscopy 10th July prior to my brother’s wedding on 13th and I am worried sick of being diagnosed GI cancer. Can my anxiety make symptoms worse?

Can aforementioned symptoms be attributed to LPR/GERD amplified by anxiety? I am getting desperate. Anyone with similar symptoms/experience?

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  • Posted

    Kunal,

    8 days ago I started celiac diet (I have also low vitamin d and ferritin) and bloating and gases and burping calmed down significantly. But heartburn is still horrible. 

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    • Posted

      Hi Aya, 

      it is crucial that you lower the amount of gas in your stomach and rule out the intolerances/allergies. Avoiding dairy, gluten and raw vegetables can a way. Stick to cooked veggies, lean meat, porridge and soy milk. Sleep with incline, do not eat and drink! before sleeping, eat every two hours during the day and keep your symptoms+diet journal. Probiotics are also a safe choice. Take one spoonful of G*viscon Advance after meal and two before sleeping. When your stool does not contain any dark-red blood (light one can be caused by frequent colon strain - so do not panic) then low iron can be a side effect of PPIs. Try changing lasoprazole for pantoprazole , omeprazole or esomeprazole with help of your GP. There is a chance that you might try Ranitid*ne - one pill in the evening and one in the morning. Keep track on what helps with symptoms and most importantly - do not stress, I know how devastating anxiety can be!

      Take care, 

      Martin 

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    • Posted

      Hi Martin,

      thank you for your help.

      I tried all these. The whole last month I am eating only chicken breast and mashed potatoe and vegetable soup. Nothing else. Can’t eat eggs, to heavy. I feel sick after all other food except chicken, potatoe, cooked carrots.

      I tried 20mg Nexium but helped me only for 4 hours. I tried also 150 mg ranitadin but helped me only for 6 hours.

      Two days ago I stopped eating sugar...

      I am devastated. I tried all but reflux is still at horrible level.

      And nothing wrong with stomach - no ulcer, no gastritis.

      Any additional ideas would be more than appreciated,

      Aya

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    • Posted

      Hi Aya, 

      did you have H. Pilori test? Do you take probiotics?

      It can be bought for app. 10£ 14$ on Amaz*n or Ebay. Did you try probiotics 10billion units?

      Moreover, do you have a reliable gastroentrologist? Do you have hiatal hernia

      The best way to deal with this would be to have ph manometry to find the patter of GERD occurence and possibly laparoscopic Nissen fundoplication. The truth is that these changes take a long time. Some people have productive life with low cancer risk but they have to endure these symptoms on a daily basis - that' s why Gavisc*on sales rapidly increased since its introduction to market. By some people I mean millions of unfortunate Americans and tenths of millions of sufferers all around the world. Try Gavisc*n advanced one spoonful in the morning, one after lunch and two before going to sleep. This will help to neutralize the acid and heartburn. Do not eat within two hours after taking it. Take it app. 20 min after your meal, when the symptoms start. Worth giving a try wink

      Hope it helps, 

      Thank you, 

      Martin 

       

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  • Posted

    Anxiety can cause acid reflux and make existing reflux worse.  I developed reflux after exam stress.  I frequently cough with heartburn and need Gaviscon and milk to ease it.  Both really help.  Avoid fatty, rich and spicy food.

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