Sedation for gastroscopy

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Hi all. Following my inability to stop omeprazole without having apparent reflux symptoms I am scheduled for a gastroscopy in a few weeks time. I am an extremely anxious person prone to panic attacks and am freaking out about the procedure already. I think I will need sedation, but I am also really quite sensitive to benzos, for anxiety 0.5 or 1 mg diazepam is usually sufficient to calm me down and 2mg makes me woozy and sleepy and makes me feel a bit like I'm not breathing enough. I'm a bit worried that the normal dose of midazolam or diagram (5mg) might be too much for me. I'm only 33 so I expect they will want to give me the full dose. Does anyone have any advice on this?

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  • Posted

    Two weeks to go and I took my last dose of omeprazole on Friday. I gradually weaned off, and unlike last time, have only experienced an acidic sensation in my stomach, a little nausea, a few flashes of heartburn and a couple of days of a vaguely sore throat but now I'm left wondering why I'm having this endoscopy done!! If I truly don't have bad reflux or gastritis symptoms without omeprazole then I feel like I'm wasting everyone's time with having this procedure just to put my mind at rest. I'm honestly worried that when I get to the hospital they are going to be angry with me or something. Having said that I've stopped caffeine entirely and am eating a rather boring stomach safe diet. Maybe if I have a big dinner with wine followed up with chocolates and coffee then it may well be a different story!
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    • Posted

      Your doctor certainly won't be angry with you for not having the gastroscopy. All doctors prefer to do as many investigations as possible. You're more likely to get into trouble if you don't have it.

      But you're making a valid point about diet.

      I started getting acid reflux 40 years ago, when I was in my early 30s. I got severe pains in the centre of my chest nearly every night and sometimes during the day too. Because I prefer not to live a "medicalised" life, I started looking at what triggered attacks and how to avoid the triggers. As a result, I quickly reduced my attacks to three or four per year, and it's stayed that way ever since.

      I certainly don't have a boring diet. I drink a bit too much wine for a start! (Though I'm working on that one for other reasons.) The main culprit in my case is bread. I can still eat a little at breakfast or lunch-time, but eating bread late in the evening is a guaranteed way of waking up with an acid attack at 2am. Combinations of foods are also important. In my case it's eating very oily foods with acids. That means my favourite smoked salmon with plenty of lemon juice (and toast!) has to be kept for special occasions, and only at lunch-time. One of the main things that made a difference to me was slightly raising the head of my mattress. That halved night-time attacks even before I figured out all the food rules. I also learned that constipation can bring on an attack, as well as wearing tight trousers. The last one sounds comical, but I think too-tight pants increase my lower abdominal pressure and force gas and stomach contents upwards. People who are overweight or obese often find losing a bit of weight is helpful too.

      There are very few things I've had to cut out. The only ones I can think of are neat spirits - I used to enjoy a very occasional brandy but can't tolerate the stuff now - and hard green apples like Granny Smiths, which I used to love. But that's only happened since the menopause, which often changes your metabolism. I also have to be a bit careful with stone fruits, especially cherries - again only since the menopause - but can still eat small amounts earlier in the day.

      I've never taken omeprazole. I find a single tablet of Motilium (domperidone) is enough to see off my occasional attacks. It was a bit of a bummer when this went to prescription-only all over Europe a few years ago. When I first asked my doctor to prescribe it, he tried to sell me on omeprazole - even though that has to be taken every day to work. Fortunately, I live in a country where you can fire your GP and get another one as often as you like, so that tends to concentrate their minds wonderfully! I get my prescription for 30 tablets of Motilium every two years, and that's more than enough.

      It really is worth working out your triggers - which might be completely different from mine. It doesn't work for everyone, but I suspect quite a lot of people who've condemned themselves to a lifetime on omeprazole, with all its side-effects, could just as easily cure themselves with a bit of observation and a few minor lifestyle changes.

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    • Posted

      Oops, I just happened to re-read this one and saw a major blooper in the first line!

      Sparklypickle: I meant to say your doctor won't be angry with you for having the gastroscopy even though you no longer have any symptoms. Sorry if I confused you. I confuse myself sometimes.rolleyes

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    • Posted

      Thanks lily. I figured that was what you meant!

      I remember many years ago I was given motilium for nausea and it worked really well. Maybe that is a better strategy! For IBS (that I think was caused by either omeprazole or the antibiotics I took for helicobacter) I have to do the FODMAP elimination diet, so hopefully during this experiment I will discover what my triggers are for my stomach too. I am very heartened to hear that someone out there gets reflux who can not only control it with diet but can also still enjoy drinking wine (it's been years, I'm too scared to try...). Like I said before. I didn't used to have any reflux symptoms. It only seems to happen when I reduce or stop omeprazole. I read somewhere that If the stomach ph is not low enough then the LES weakens, it gets stronger in response to more acid (makes sense) so of you stop ppi's suddenly then you've got excess acid and a poor valve to stop it coming back up your throat. Hopefully my gradual cessation has allowed a bit of adaption time or something...I have a bit of a scratchy throat this morning so maybe I need to take more gaviscon and not just two before bed.

      You are probably right about Dr's not being annoyed: if I don't have the procedure done then my gp seems to want me to keep taking omeprazole indefinately with no real diagnosis. If I don't have a hiatial hernia, gastritis or weak LES then my problem could be anxiety-related or diet I think. If anyone knows more about this then please correct me! The colorectal surgeon I saw the other day said of I have reflux symptoms I should be checked for barretts oesophagus every 5 years...I guess I need to grill my doctors about what constitutes severe enough reflux

      I mean, pretty much everyone gets heartburn every now and then. My partner often has an 'acidic stomach' and heartburn and never takes any medication for it.

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    • Posted

      Interesting that you're referring to "heartburn". I don't know what others experience, but to me oesophageal reflux feels nothing remotely like heartburn. I get very occasional heartburn from eating indigestible combinations of food - everyone does, as you rightly say - and it's totally different from the pain I identify as acid reflux. (And my GP agrees, btw.) I view heartburn - or what I call heartburn anyway - as a minor inconvenience.

      Acid reflux presents as an intense, scary pain - not a burning sensation at all - going all the way up the middle of my chest and sometimes reaching my throat. If it gets very bad I can also feel it in the middle of my back. It comes on very quickly too - becoming almost unbearable within a couple of minutes of starting. I rarely get acid coming up into my mouth during the day either, but this sometimes happens during the night, and occasionally during the day if I suddenly bend over to pick something up - usually when I've been eating bread. However, just to muddy the waters, this is never associated with actual pain!

      I still vividly remember the first time it ever happened, when I was at a small party in someone's garden. I was only about 33 at the time, but the pain felt exactly the same as the definition of the pain of a heart attack! I was absolutely terrified. I didn't say anything, but sat down quietly and wondered whether I should ask someone to call an ambulance. After a few minutes, the former nurse in me (still very recent at that time) kicked in. I checked my pulse, which was on the fast side due to the anxiety but otherwise normal. I wasn't sweating, I didn't actually feel as if my chest was constricted in spite of the terrible pain, and I didn't feel dizzy or really ill except for the pain. I didn't even know what it was at the time, but when it started wearing off half an hour or so later I came to the conclusion it must have been gastric in origin.

      Actually, I'd be quite interested to hear how others experience the pain of GERD. Pain in general is so subjective, even doctors find it tricky to make any diagnosis based on descriptions of pain, even though this can help.

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    • Posted

      Well yes, I always use the British spelling when writing the full word - not because of any prejudice, just because that's how I've always spelled it and it comes naturally. However, GERD seems to be the more recognisable international abbreviation, and these forums - though British-based - aren't inhabited exclusively by British nationals. A non-Brit reading "oesophagus" would recognise it as the same as "esophagus" - and vice versa - but GORD might present more of a challenge. I'll carry on using GERD as the abbreviation!
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    • Posted

      I like Americans, been to the States six times, all four corners. It is just that the name is GORD and if you try Googling NHS GERD, it will come back as NHS GORD. It is the actual medical term used here.

      I did say I was a stickler, so just ignore me anyway.  wink

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    • Posted

      I agree with you RHGB. Lived in the US for 5 years and passed my US nursing exams and had a license to practice, but because of their ludicrous Visa system, was never allowed to work, even though I was offered the first job ( Stroke Co-ordinator) position I applied for whilst still living here in the UK. My husband worked as a Senior Health Care Researcher ( has a doctorate in Health research)  but even with him on a temporary 3 year work visa, I wasn't allowed to work.  
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    • Posted

      Hi Sparkly, I'm glad you raised that point about insufficient stomach acid, hence too-high pH, actually weakening the lower oesophageal sphincter (LES). I regularly surf around on the more serious sites critical of modern medical approaches - without being taken in by all the touchy-feely wellness sites - and this idea seems to be the coming thing.

      First we had people questioning the advisability of handing out statins like sweets, and this one is rapidly becoming mainstream. It's the favourite hobbyhorse of my lovely GP. He's always had doubts about statins and brings up the topic at every occasion - especially as my six-monthly blood tests always turn up LDL well over the limit but astronomical levels of HDL to counteract it. He gets so angry, he practically has steam coming out of his ears when he talks about other doctors putting people like me on statins!

      Now there are moves to question the latest idea creeping in from the US about putting everyone with any risk factors for hypertension (age, weight, blood sugar, cholesterol etc.) on BP meds even if their BP is completely normal. Of course, I believe it's a complete coincidence this follows on the heels of the reduction in statin prescriptions.cheesygrin

      And now PPIs are just beginning to come into the spotlight. Interesting...

      I'm not suggesting for a moment that no one needs hypotensive drugs or PPIs, albeit slightly less sure about statins. (And I'm not being ironic this time!) What I am saying is that we all need to take some responsibility for our own health and try to work in partnership with our doctors, rather than constantly being in thrall to them. And yes, I realise that's a lot easier in some parts of the world than it is in the UK, due to the structure of the NHS. But we have to start somewhere.

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    • Posted

      I too am normally a stickler for British spelling, but only when using it myself. US English is perfectly valid too. Comes from living/working in an international environment for more than 40 years in my case. Dread to think of the pickle I'm going to find myself in after 23/6. It certainly won't be a sparkly one! But let's not go there...confused
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    • Posted

      Ha! you guys with your GERD vs GORD! it's all the same to me. My NHS GP refers to it as GERD anyway! I am intrigued by the description of reflux because that is not really what I experience at all. I had regurgitation of acid up into my mouth once when I had a heavy helicobacter infection and gastritis, but never before or since (thankfully, it was dreadful). I can't see another explanation for a burning throat and chest pains on withdrawal of PPI that doesn't involve inappropriate reflux of acid from the stomach, maybe its the fabled silent reflux, or maybe I actually don't have this problem after all and my GP is over-interpreting my symptoms and rather than think about whats causing the symptoms, be it rebound acid or another medication I am taking, its easier to just hand out some more tablets and send me on my way....

      Interesting Lily that you also found that same research about high pH weakening LES (thanks NCBI!). You make some interesting points about over-prescription of statins etc, they do seem to hand them out pretty freely. I understand that GPs in the NHS don't have time to read up on the latest research and that they have protocols to try and keep us out of their office for as long as possible, but I also do not agree with taking any medication unless there is a clear and irrefutable reason to do so - our bodies are pretty well equipped to cope with minor quirks, after all!

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    • Posted

      Hi Sparkly - I wasn't meaning to imply that the symptoms I (and several GPs over the years) identify as being down to GERD are some kind of gold standard. I've only ever talked in the flesh to one other person who had exactly the same symptoms as me. She and I did our NHS nurse training together in the 60s, she'd spent most of her career working as a practice manager in a GP surgery, had had multiple gastroscopies and had been diagnosed with GERD.

      I'm genuinely interested to hear how other people experience GERD. Although various GPs have told me that's what it is, I've never been officially diagnosed and am not particularly interested in getting a formal diagnosis anyway. The only gastroscopy I've ever had (hence my presence on these boards) was a traumatic emergency affair that never went beyond the entrance to my oesophagus. In any case, I've managed to keep it in check for 40 years now, whatever it is!

      I'll keep my thoughts about the NHS to myself...

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    • Posted

      At least we don't have the same healthcare quality and ethos here as in the USA, where people get an MRI scan before a Doctor even bothers to take a history or examine them, whilst others who don't have medical insurance or state run healthcare aren't entitled to any preventative care.

      Regarding statins,maybe "they" need to do the opposite of what the 1000's of huge International stroke and heart attack prevention clinical trials did, and take people off their statins for 3 years and compare the incidence of heart attack and stroke in those people , compared to the folks who are still taking them? Wonder how many people would volunteer for that trial?

      There are a lot of cynics out there regarding statins, and one guy in particular (can't recall his name) . but he twists the results of clinical trials and is very selective about which bits he chooses to speak about. The NHS is a service provided to the masses, and as such it has to rely on large scale clincial trials which can be translated into clinical practice ans used to develop best practice guidelines for the whole of the NHS. It's far better now that we have NICE etc and we don't have Doctors "doing their own thing" ( well most of the time anyway). We have an increase in Type 2 diabetes, hypertension and obesity here in the UK, but we're reducing the number of strokes that happen ( as well as the number which result in disability) even though we've got better at diagnosing strokes, which might have lead to an increase in numbers. We must be doing something right, and, considering that the USA approved thrombolysis as a treatment for stroke about 10 years before the UK, we also manage to treat more stroke  patients with thrombolysis than the US does. And sorry if this is nit picking, but "hypotensive drugs"  suggests drugs suffering from low BP.  The correct term is anti -hypertensive agents.

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    • Posted

      Sorry about the error of nomenclature. In my day as a nurse we used to refer to drugs that lower hypertension as "hypotensives", but I realise things have probably moved on from them.

      Agree totally about the US system and certainly wouldn't promote it. I've never lived there, but have many American friends and I hear horror stories from them.

      I just wish that my former compatriots in the UK would realise there's a third way... but I realise it ain't gonna happen, which is why I keep quiet.

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