What to ask the gastroenterologist

In My Humble Opinion
1

need answers fast-ish

So, 3 months after my endoscopy/colonoscopy, I finally have an appointment to talk to the guy who did it. I’m seeing him tomorrow, Sept 15, at 1PM ET What should I ask him?

background:
the colonoscopy was routine, based on my age, and didn’t find anything interesting. I am a little sad that my colon looks all old and saggy as compared to the last time I had a colonoscopy, but the doctor didn’t seem concerned.

the endoscopy was due to all sorts of issues with acid reflux.

  • I used to have Barrett’s Esophagus, but they seem to have redefined that, and I don’t any longer.
  • My acid reflux was not well controlled by omeprazole twice daily plus an evening nightcap of famotidine. I am now taking 20mg esomeprazole twice daily, having tried 40mg once daily with disastrous results.
  • I have some benign tumor in the stomach which is common in people who take proton pump inhibitors for a long time.
  • I don’t believe the issue is that I make too much acid, I think the issue is that my esophageal sphincter muscle really doesn’t do the job. I’m usually okay upright, but I sometimes taste not-very-acid stomach reflux at night, even with all the drugs I take.

So, should I be worried about nutrition? Are there other things I could try other than drugs to control the reflux? Should I be doing anything about the old saggy colon? I’m sure there are lots of other questions I ought to be asking. But I don’t know what.

(and no, Discourse, this isn’t like "ask the woman who recently returned to the US after being in Brazil for 3 months)

2

Just off the top of my head, I’d ask about whether there’s evidence of delayed gastric emptying, and whether or not treatment for such would improve your reflux situation.

I’d ask about the size and location and prognosis for the benign growth in the stomach. If they’re located in certain areas or get too big over time, they can cause problems just from physical obstruction.

Also ask about nutritional supplements, but if you’ve not lost weight and there’s no evidence of malabsorption and you have anywhere near a normal diet the answer will probably be that you don’t need them.

Discuss whether your reflux is severe enough to consider surgical intervention. In the past those operations were often hit and miss, and all too frequently resulted in a gastro-esophageal stricture that made it hard to swallow. But techniques have improved greatly.

Ask about whether there’s evidence of any esophageal motility problems or strictures as long as you’re there.

Ask about the presence of varices in the stomach and esophagus. Absence of Barrett’s now doesn’t mean absence of varices.

Ask about their opinion about chronic PPI use (esomeprazole-type drugs).

Not knowing more of your history, that’s really all I can think of on the spur of the moment.

3

Thanks!

I have lost some weight. But I’ve sort of been trying to. But not super hard… I am overweight, so I’m certainly not worried about the current value being too low – in fact, I’d be happy to drop another 20-30 pounds. But… I have wonder if there are issues with absorbing calcium or any other nutrients without much stomach acid. For that matter, I wonder if the low stomach acid puts me at higher risk of food-borne disease (not that I’ve ever had an issue with that).

That’s a great list, thanks.

4

I’m happy to help serve those who moderate this joint. If I were to attempt to do that, I’d have horrible heartburn too. ;-D

5

Why ask about varices? (now that I’ve looked that up. :wink:) I would have thought that would be mentioned in the written report, which I’ve seen. My blood tests for liver stuff have always been normal, and except for being overweight, i don’t think i have any of the obvious risk factors for that.

6

If it didn’t mention them, there probably weren’t significant varices. But with a history of Barrett’s, I’d want to know just what the GI doc saw when he looked, regarding venous dilation or lack thereof. I’ve seen too many less than fully descriptive reports of scopings in my career. But that’s just me and my experience.

7

You ask him, “What do you do with a dead gastroenterologist?”

You barium.

*** ducks and runs ***

8

The results were reassuring.

Nope, in fact, there was so little liquid in my stomach that he couldn’t get a sample to test my stomach pH. And no evidence of other issues along those lines.

He says fundic gland polyps (which is what I have) almost never cause problems, even when they are huge. Which mine aren’t.

he thinks not. But recommends a magnesium laxative if I need a laxative, because it’s possible that I could become low in magnesium, and that’s gentle and the mineral might be helpful.

I asked about possible treatments other than PPIs and forgot to ask about this. But the massive dose of PPI I’m on seems to be doing the job, and

He says there have been an awful lot of studies, and while a couple of issues have popped up with statistical significance (more broken bones, more infections) nothing of much clinical significance has been found. For instance, he says there’s a 1/1000 increase in the incidence of broken bones. And that taking extra calcium doesn’t seem to help. He talked about a lot of other things that were found by one study or another to be a problem, and said that most of them haven’t been reproduced. For instance, there was a scary study finding an increase in alzheimers, but not only has it not been replicated, another study found that H2 blockers were associated with more alzheimers than PPIs. It’s not impossible that there’s a link, of course, but he doesn’t think the risk is very high. He says that he, personally, cuts back on his PPI use when traveling in countries with more food-borne illnesses, but doesn’t think it’s a big enough risk to worry about in the US.

There’s something to be said for a class of drugs that’s been taken by hundreds of millions of people for decades, with very few serious side effects. He thinks that if I can control my reflux with PPIs, it’s the best choice, at least with current options.

He says “no”.

He says it’s not totally clear whether I have a mild case of Barrett’s that was missed in the biopsies, or if I’ve been re-defined out of ever having had Barrett’s, but my risk is relatively low, and unless I have symptoms (trouble swallowing, lots of reflux) I don’t need another endoscopy for 3-5 years.

And thanks again for your help.

9

You might want to look into this: You can buy (we have one for my night time reflux) an elevated incline frame insert that slants your box springs and mattress so your head is higher than your guts as you sleep. Since we bought ours, I’ve had no mouthfuls of searing magma at 2:00AM (save one time I had a huge batch of warm choco chip cookies 20 minutes before I hit the hay – I was really asking for it.) The only drawback I’ve had: if you’re like me and roll over several times a night, you might wake up with your feet hanging off the edge of the bed. Small price to pay.

10

Thanks.

I don’t think that will work with my extremely crappy bed frame, but i could buy a new one. I discussed that kind of thing with my doctor. He wasn’t super optimistic it would help, but it might be worth trying. That is a much better mechanism than anything else I’ve seen.