Clematis
Well-Known Member
- Joined
- Sep 5, 2015
- Messages
- 1,705
I had a barium swallow fluoroscope test today because I haven’t been able to eat dense protein without discomfort and vomiting since my surgery 7.5 months ago.
To recap:
Sep 2015
I was DXed with “silent” reflux and placed on 40 my omeprazole. Within a week I puked up the meat from my dinner 14 hours earlier as if I had just eaten it. Plus I was awaking at 2 am gasping for air with my dinner in my throat. Despite sleeping on a bed wedge and tremendous weight loss, I still have this middle of the night reflux if I eat after 8pm — even vitamins if I take them after 8. It feels like stomach contents come up under force, which they would have to to come uphill in the esophagus while on the bed wedge.
Nov 2015
Had the DS. But since then, whenever I eat even small amounts of dense protein, it hangs up in my stomach, it aches, then I puke it up. Occasionally this also happens with bread, as if it makes a dough ball and hangs up. Of course ice cream and cookies slide right down.
My theories were not enough acid to digest protein so I reduced PPI from 40mg to 20mg and I do think it helped a small bit. My other theory was a stomach stricture.
Jun 2016
This morning I had a barium swallow fluoroscope test. I liked the radiologist a lot. He had never heard of the DS (they are just not performed around here much) — but he only had to think of it as a VSG as that’s where the problem lies. (I was unclear whether he’d ever scoped a VSG. When we parted he said it might take him a day to come up with a report that sounded somewhat intelligent so I'm guessing I was his first.)
He said he thinks my sleeve has a twist causing a stricture. I don;t think it's horrible, though. From what I saw, it looks like a pouch has formed above the stricture which sags off to the side. I wonder if this is where the protein gets road blocked and has caused stretching… before I puke it up. To me, the stricture has an opening the diameter of my pinky so nothing is going to get strangulated.
He said the stricture was in the part of my sleeve where the stomach had been excised, not in the normal lower part… huh? Doesn’t the VSG remove the outer part of the entire length of the stomach?
The last bit of fun was swallowing barium while lying flat on my stomach — not easy to do. It immediately flowed back into my esophagus so, yeah, I definitely have reflux.
All this is beyond the scope of my PCP so I guess I have to find a gastroenterologist.
I don;t know what can be done about all this. I think they can stretch a stricture with a balloon but I don;t know how that works when the sleeve is twisted. Do they have to surgically straighten it?
As for the reflux, there is clearly a problem with my lower esophageal sphincter. It is truly frightening waking in the middle of the night unable to get in air because my dinner is in my throat. Weird that I had mild symptomless reflux before starting a PPI and then almost immediately developed regurgitation of undigested protein during sleep. So I do believe the PPI has left me with too little acid to digest protein which in turn slows gastric emptying so when reflux happens while sleeping, actual solids are in my throat, not just a spray of stomach acid. Urecholene can strengthen the esophageal sphincter, lower acid and improve movement of food through stomach so maybe that will be recommended.
Any other thoughts?
To recap:
Sep 2015
I was DXed with “silent” reflux and placed on 40 my omeprazole. Within a week I puked up the meat from my dinner 14 hours earlier as if I had just eaten it. Plus I was awaking at 2 am gasping for air with my dinner in my throat. Despite sleeping on a bed wedge and tremendous weight loss, I still have this middle of the night reflux if I eat after 8pm — even vitamins if I take them after 8. It feels like stomach contents come up under force, which they would have to to come uphill in the esophagus while on the bed wedge.
Nov 2015
Had the DS. But since then, whenever I eat even small amounts of dense protein, it hangs up in my stomach, it aches, then I puke it up. Occasionally this also happens with bread, as if it makes a dough ball and hangs up. Of course ice cream and cookies slide right down.
My theories were not enough acid to digest protein so I reduced PPI from 40mg to 20mg and I do think it helped a small bit. My other theory was a stomach stricture.
Jun 2016
This morning I had a barium swallow fluoroscope test. I liked the radiologist a lot. He had never heard of the DS (they are just not performed around here much) — but he only had to think of it as a VSG as that’s where the problem lies. (I was unclear whether he’d ever scoped a VSG. When we parted he said it might take him a day to come up with a report that sounded somewhat intelligent so I'm guessing I was his first.)
He said he thinks my sleeve has a twist causing a stricture. I don;t think it's horrible, though. From what I saw, it looks like a pouch has formed above the stricture which sags off to the side. I wonder if this is where the protein gets road blocked and has caused stretching… before I puke it up. To me, the stricture has an opening the diameter of my pinky so nothing is going to get strangulated.
He said the stricture was in the part of my sleeve where the stomach had been excised, not in the normal lower part… huh? Doesn’t the VSG remove the outer part of the entire length of the stomach?
The last bit of fun was swallowing barium while lying flat on my stomach — not easy to do. It immediately flowed back into my esophagus so, yeah, I definitely have reflux.
All this is beyond the scope of my PCP so I guess I have to find a gastroenterologist.
I don;t know what can be done about all this. I think they can stretch a stricture with a balloon but I don;t know how that works when the sleeve is twisted. Do they have to surgically straighten it?
As for the reflux, there is clearly a problem with my lower esophageal sphincter. It is truly frightening waking in the middle of the night unable to get in air because my dinner is in my throat. Weird that I had mild symptomless reflux before starting a PPI and then almost immediately developed regurgitation of undigested protein during sleep. So I do believe the PPI has left me with too little acid to digest protein which in turn slows gastric emptying so when reflux happens while sleeping, actual solids are in my throat, not just a spray of stomach acid. Urecholene can strengthen the esophageal sphincter, lower acid and improve movement of food through stomach so maybe that will be recommended.
Any other thoughts?