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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Can a Barium sallow esophagram test confirm GERD?

Answered by
Dr. Ramesh Kumar


Practicing since :1986

Answered : 2382 Questions

Posted on Tue, 15 May 2018 in Digestion and Bowels
Question: I was diagnosed with GERD and had the Nissen Fundoplication surgery 6 weeks ago to fix my hiatal hernia. Since the surgery I still have the same exact symptoms I had before and I'm taking the same amount of acid medication as before to control it. My doctor is not convinced that I still have acid reflux and he wants me to get an esophagram today. I just read on your website that "Barium swallow isn't a surefire method of diagnosing GERD. Only one out of every three people with GERD has esophageal changes that are visible on X-rays." This is coupled with the fact that the last barium swallow I did pre-surgery showed no physiological problems (and I still had GERD). What does he expect this test to confirm now post surgery? Will this text be conclusive if I still have GERD or not?

Currently I am taking 60-80 milligrams of Nexium daily and 320-400 mg of Famotodine daily.

If the barium swallow test is not conclusive, what tests should he perform to confirm if I still have GERD or not?

A probe was put in my esophagus to measure pH pre-surgery and I was in the 95th percentile. At the end of that 48 hours (off my meds) I was in extreme pain and it hurt to even swallow my food.

I suggested I go off my meds again for 48 hours to prove my point that I probably still have GERD. But he wants data. What other tests can he perform to get data besides putting another probe in my esophagus which he said was not necessary.
Answered by Dr. Ramesh Kumar 15 hours later
Brief Answer:
You need proper medication my dear patient.

Detailed Answer:
Hello my dear patient,
Have gone through your details and i appreciate your concerns.

Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD) and its long-term effectiveness is above 90%.However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases(unfortunately you have them)There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. To confirm this your gastro wants to do Baruim swallow.Its a standard procedure.
No test is not a gold standard test it canjust be suggestive but can’t confirm the reason.
My first question is why you proceeded for surgery.
GERD can be controlled very well on medication.
You were on Nexium 40 mg twice daily with Famotadine.Believe me nexium can be used safely in doses as high as 8mg infusion per hour .These are just basic drugs.I don’t know why doctors in US don’t prescribe better and new medications to their patients.
Surgery is a last resort treatment my dear patient but it fetches a lot of revenues.

There are a number of drugs available to control GERD symptoms effectively and you can lead a near normal life having them.

Ask you doctor to add Levosulpiride once daily to your regimen.Acotiamide is a motility inhibitor and is really very effective in thrice daily doses for three months.

See GERD means reflux diseases.As the name suggest it has to parts-
Excessive acid production
Reflux of acid back into esophagus.
Your Gastro has prescribed you Nexium and famotidine which prevent secretion of acid(Part 1 covered) but what about preventing reflux?
He should have prescribed you levosulpiride or domperidom and acotiamide in combination.

I would request you to take a print out and ask your gastro why he proceeded for surgery directly without even properly controlling disease conservatively.

Hope i explained you the basic concept in easy language.
Feel free to query.
warm regards!

Above answer was peer-reviewed by : Dr. Kampana
Follow up: Dr. Ramesh Kumar 10 hours later
Thank you so much for your help Dr. Kumar! I am shocked that no one has ever mentioned to me anything about drugs that can prevent reflux. In all my online research, I have not heard of these drugs either. Maybe a specialist in the U.S. would have known about these?

Do the 3 drugs you mentioned (Levosulpiride, Domperidom, Acotiamide) have any major side effects in taking them? If I took this regimen of drugs as you prescribed, could I entirely eliminate taking the Nexium and Famotodine possibly?

If these drugs help me, is it still beneficial that I had the surgery? Would there be any reason to reverse part of the surgical procedure I had completed? The hernia was repaired which I'm assuming was good regardless, but what about the Nissen wrap? I know I'll never swallow exactly the same, but I'm guessing there isn't a good reason to get that reversed correct?

Thanks again for your help. I hope to meet with my doctor soon. Would you mind if I followed up with you after that appointment?

So grateful! Bxxxx Chassard
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
You can send me a direct query any time its a pleasure to help Mr. XXXXXXX

Detailed Answer:
Hello dear,

Yes, all these drugs have some side effects but believe me, even in Europe and Asian countries patients are using them for years without any major side effect and are living a near normal life.

One example you must be knowing that Omeprazole is over the counter. Now read about side effects of Omeprazole on some online sites, where they've mentioned even severe side-effects. Do you believe that an over the counter medication in a strict country can cause kidney damage or death(unless abused)?
I did my fellowship from the US but I choose Europe to practice.

Sir as already explained earlier, Surgery for GERD is suggested only when despite maximum possible treatment patient is not responding.

You're on 40 mg twice Nexium. Its an optimal does not even a high dose.
Secondly, no medication was given to control reflux.

What I would suggest you now is to discuss with your gastroenterologist to prescribe you-
Tablet Rabeprazole 20 mg twice daily.
Tab Levosulpiride twice daily
Syrup Mucaine gel or any trade name(ALUMINIUM HYDROXIDE-0.291MG+ MAGNESIUM HYDROXIDE-98MG+OXETACAINE- 10MG) 2 tsp thrice daily
Probiotic VSl# 3 twice daily for 7 days.

Don't rely on those online information as they can be quite confusing.
Have faith on me and tell me how you feel in 7 days.
Drink a glass of cold milk every morning.

Avoid alcohol and please revert back after another 5-7 days.
You can send me a direct query whenever you want I would be obliged to help you.

Do not lie down for 2-3 hrs after eating.
Avoid acidic foods - citrus, tomatoes, juices
Decrease caffeine (colas, coffee) and sodas in general.Decrease alcohol or completely stop it.
If you smoke cigarettes, now is the time to stop. They increase acid production and delay healing.

Take home message-
Surgery is always done when despite all conservative methods patient is not feeling well.
Give this 7 days and inform me how you feel.
You may take a print out and ask your gastro why he didn't use acotiamide levosulpiride etc on you and proceeded to surgery.
please let me know what your doctor says, sir.

Hope I was helpful.
Please do rate the answer if found helpful.

Get well soon.

Above answer was peer-reviewed by : Dr. Arnab Banerjee
Follow up: Dr. Ramesh Kumar 46 minutes later
Thanks again Dr. XXXXXXX I agree that surgery is a last resort and my Dr. agreed as well. He thought I WAS on the maximum meds/treatment and still not feeling better. But I'm not sure why he never recommended the anti-reflux drugs. I will certainly ask him.

As far as my health and diet, I am aware of all of that and I eat very healthy and avoid those things you mentioned. I don't drink any caffeine anymore and have alcohol sparingly.

I definitely will give you a good review, but I was afraid to hit the button, "Close Discussion & Review Doctor." I didn't want to lose contact with you. Can I start a new conversation anytime and ask for you by name?

By the way, where do you practice at?
Answered by Dr. Ramesh Kumar 7 hours later
Brief Answer:
follow up.

Detailed Answer:
Hello dear no you were on at maximum medication,
Maximum medication means-
Capsule Esomeprazole 80 mg twice daily
Tab Dompridon 30 mg twice daily
Syrup antacid 2-3 tsf thrice daily
Tab itipride once a day
for minimum of 12 weeks.
You can send me a direct question by going on closed discussion clicking my name and go on ask query.Customer care guys would intimate me asap.
Do you want me to send lists of trials and efficacy of these medicines on GERD patients!

Above answer was peer-reviewed by : Dr. Yogesh D

The User accepted the expert's answer

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