Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
33 Year Old Male. Nearly 10 Years Ago, I Visited
Question: 33 year old male. Nearly 10 years ago, I visited a gastroenterologist for the first time due to repeated episodes of difficulty swallowing certain types of food. In short, I would attempt to swallow something (usually occurring with steak, potato, or bready things), and the food bolus would feel as if it were lodged in my esophagus.
It is an incredibly alarming sensation that, although not obstructing my airway, certainly produces a feeling of panic. Most of the time, I am able to dislodge the food by drinking water. However, there have been occasions when this has not worked. Most recently, I was eating steak and eggs at a restaurant when the food became lodged. The more water I drank, the more "backed up" the esophagus felt, ultimately resulting in me coughing up mucous in the restaurant toilet. The food bolus never fully cleared until twenty minutes later, when I vomited up whatever remained.
At my initial evaluation 10 years ago, my doctor performed an EGD (which I have repeated annually since). He observed irritation and inflammation in the lower esophageal junction, and some linear ulceration of the lower esophagus. Prescribed pantoprazole 40mg in morning, and nizatidine 300mg at night, indefinitely. So, I've been about 80% compliant with this regime since that evaluation.
The original EGD also showed some evidence of eosinophillic esophagitis. I have never been evaluated by an allergy specialist. Some subsequent histology reports also showed eosinophilic infiltration, but not all. No Barrett's esophagus, but I believe there may have been some evidence of strictures at some point. I am attaching a copy of the report from the 2016 procedure (the only one I have readily scanned), although be mindful this procedure was also performed in 2017 and 2018.
Subsequent EGDs have showed that the ulcerations had healed, but some irritation and inflammation remain. On several of the procedures, he dilated the esophagus. The first time, this was quite successful. On the second time, the effects were not as long lasting.
As a general observation, it appears as though the medication works, and that when I take it I don't have the swallowing issues or, at least, they are minimized. However, I am nervous about "putting a bandage" on a problem and treating symptomatically.
My questions concern where I go from here. Am I stuck on these medications for the rest of my life? Is there something else I can explore to address my concern? Lifestyle/diet changes? Alternative diagnoses? In all cases, of course, my goal is a healthy body without any metaplastic or dysplastic changes in my esophagus. Thanks for any guidance.
It is an incredibly alarming sensation that, although not obstructing my airway, certainly produces a feeling of panic. Most of the time, I am able to dislodge the food by drinking water. However, there have been occasions when this has not worked. Most recently, I was eating steak and eggs at a restaurant when the food became lodged. The more water I drank, the more "backed up" the esophagus felt, ultimately resulting in me coughing up mucous in the restaurant toilet. The food bolus never fully cleared until twenty minutes later, when I vomited up whatever remained.
At my initial evaluation 10 years ago, my doctor performed an EGD (which I have repeated annually since). He observed irritation and inflammation in the lower esophageal junction, and some linear ulceration of the lower esophagus. Prescribed pantoprazole 40mg in morning, and nizatidine 300mg at night, indefinitely. So, I've been about 80% compliant with this regime since that evaluation.
The original EGD also showed some evidence of eosinophillic esophagitis. I have never been evaluated by an allergy specialist. Some subsequent histology reports also showed eosinophilic infiltration, but not all. No Barrett's esophagus, but I believe there may have been some evidence of strictures at some point. I am attaching a copy of the report from the 2016 procedure (the only one I have readily scanned), although be mindful this procedure was also performed in 2017 and 2018.
Subsequent EGDs have showed that the ulcerations had healed, but some irritation and inflammation remain. On several of the procedures, he dilated the esophagus. The first time, this was quite successful. On the second time, the effects were not as long lasting.
As a general observation, it appears as though the medication works, and that when I take it I don't have the swallowing issues or, at least, they are minimized. However, I am nervous about "putting a bandage" on a problem and treating symptomatically.
My questions concern where I go from here. Am I stuck on these medications for the rest of my life? Is there something else I can explore to address my concern? Lifestyle/diet changes? Alternative diagnoses? In all cases, of course, my goal is a healthy body without any metaplastic or dysplastic changes in my esophagus. Thanks for any guidance.
Brief Answer:
Biopsy every one or two years.
You are stable on minimal dose of medicines so you just keep on taking it and enjoy life.
Detailed Answer:
Hello and Welcome to 'Ask A Doctor' service.
I have reviewed your query and here is my advice.
Have gone through the text and report attached it seems that you are suffering from Acid peptic disorder.
Lets come to answers-
In a patient suffering from gastro-esophageal reflux disorder the aim of therapy is to give patient a near normal life.We can't cure it unless there is a pathological factor(like hiatel hernia) which causes the symptoms.In your case there is no pathological cause of acid peptic disorder so all a doctor would target is to control your symptoms and keep a watch on progression by doing endoscopy followed by biopsy once a year or in two years.
All you need to do is to follow the medications and diet control.If you are fine almost 90% of time then our goal is achieved.
General precautions are(you must be knowing most of them already)-
Follow a bland diet (low acid levels, low in fat, not spicy) eat home cooked food and try to be vegetarian.
Eat frequent, small meals.
Lose weight.
Avoid the use of alcohol, tobacco, and caffeine.
Do not eat food less than 2 hours before bedtime.
Raise the head of the bed before sleeping.
Avoid clearing of the throat.
No alternative diagnosis because as per you multiple biopsies have revealed nothing so in take home message is-
1)Strict diet control
2)Proper antacids
3) If anxiety is there natural supplements like Lactium can be taken to curb anxiety.
4)Never go for surgery its a last resort treatment and definitely not for those who are responding very well to medicines.
Hope i was helpful,
Thanks!
Biopsy every one or two years.
You are stable on minimal dose of medicines so you just keep on taking it and enjoy life.
Detailed Answer:
Hello and Welcome to 'Ask A Doctor' service.
I have reviewed your query and here is my advice.
Have gone through the text and report attached it seems that you are suffering from Acid peptic disorder.
Lets come to answers-
In a patient suffering from gastro-esophageal reflux disorder the aim of therapy is to give patient a near normal life.We can't cure it unless there is a pathological factor(like hiatel hernia) which causes the symptoms.In your case there is no pathological cause of acid peptic disorder so all a doctor would target is to control your symptoms and keep a watch on progression by doing endoscopy followed by biopsy once a year or in two years.
All you need to do is to follow the medications and diet control.If you are fine almost 90% of time then our goal is achieved.
General precautions are(you must be knowing most of them already)-
Follow a bland diet (low acid levels, low in fat, not spicy) eat home cooked food and try to be vegetarian.
Eat frequent, small meals.
Lose weight.
Avoid the use of alcohol, tobacco, and caffeine.
Do not eat food less than 2 hours before bedtime.
Raise the head of the bed before sleeping.
Avoid clearing of the throat.
No alternative diagnosis because as per you multiple biopsies have revealed nothing so in take home message is-
1)Strict diet control
2)Proper antacids
3) If anxiety is there natural supplements like Lactium can be taken to curb anxiety.
4)Never go for surgery its a last resort treatment and definitely not for those who are responding very well to medicines.
Hope i was helpful,
Thanks!
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you for your thorough response. A quick follow up, are there any long-term effects of being on these medications (PPIs and H2 blockers) for so long? Anything I can do to mitigate those effects?
Brief Answer:
follow up.
Detailed Answer:
Hello there,
Theoretically yes, but practically they are very safe and can be taken for years without any significant side effect.
Thanks!
follow up.
Detailed Answer:
Hello there,
Theoretically yes, but practically they are very safe and can be taken for years without any significant side effect.
Thanks!
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
