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Can an esophagitis with Z gastric joint above diaphragm be reversible?

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Posted on Wed, 18 May 2016
Question: Hello

I had a lump on the throat with mucus and cough for many years after a throat infection. We sorted this out using anti depressants (due to having a larynx irritable syndrome) and the cough is gone and many throat symptoms seem to be dissapearing slowly.

However I had an endoscopy today which revealed a grade 1 esophagitis and Z gastric joints above diaphragm,. There's no hernia but I think this indicates I am on a pre-stage.

My question is. Are both of these conditions reversible completely? I am unsure if a grade 1 esophagitis can cause a lump in throat. Mostly I can swallow food fine and I never had heartburn. However I assume my cough could have caused this condition. I mostly stopped coughing around 1 year and a half ago or so with the anti depressant

How long does it take for the esophagus to heal from a damage like the one I mentioned if reflux issues have been addressed?

Also I would appreciate any recommendations you can provide with my issue

Thanks
doctor
Answered by Dr. T Chandrakant (1 hour later)
Brief Answer:
Change of lifestyle is the key to success.

Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
To recapitulate: Male/29 - Grade 1 esophagitis with Z gastric joint above diaphragm on Upper GI Endoscopy ( no need to translate if the rest of the report is normal) - no hernia - Doctors feels strange for the age and you were very healthy - lump on throat, mucus, cough for many years - settling with anti-depressants -
wants to know about reversibility of both conditions and details...

My thoughts with explanations:
The throat condition as you have explained is getting reversed well with proper medications you have noted already. Continue the medicines and follow the advise to get the complete relief.
The second condition: grade I esophagitis is surely fully reversible.
The proximal migration of Z-line can be due to reflux and usually stays there.

It is the GERD- gastroesophageal reflux disease that causes the migration of hte Z-line, esophagitis and very well can cause the feeling of lump in the throat.
This in turn may be due to anxiety/stress/ depression and such conditions being the primary cause of all.
Heartburn is a symptom and can be felt only if the injury to the esophageal mucosa is more. There can be asymptomatic presentation of such conditions as seen in your case.
Yes, the severe or violent coughing can assist in progression of the problems under consideration. It increases the intra-abdominal pressure too much during bouts.
It is good that the cough has almost stopped.
Esophagus should heal within 1 to 3 weeks if all the conditions are favorable and you are given proper medication and you too take proper care.

I would advise you the following (recommendations as you have said):
- Small frequent meals, the daily requirements divided into 4 parts and taken as breakfast, lunch, brunch (evening) and dinner.
- Do not sleep immediately on having food, walk around a bit.
- Soft bland diet.
- No alcohol or tobacco in any form (if you have a habit).
- No late nights.
- 8 hours sound sleep.
- The most important: change the lifestyle in such a way that there should be no stress/ anxiety or any psychological pressure.
- Identify and write down all the factors, foods, beverages and anything that instigates or increases your problems and stop them altogether.

I hope this answer helps you, please feel free to ask for further relevant queries if you feel that there is a gap of communication.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (1 hour later)
Thanks

The lump, mucus, throat clearing seem to be getting better. But not always. They get progressively better but with frequent "go backs". I stopped taking the anti depressant in September and it still seems to be getting better. I wheeze tho.

To be honest, I never linked these to reflux, but to the throat infection that caused the lump in throat, mucus and cough. Cough has probably made me damage many things in my airways because it was unproductive. I coughed from April 2010 to October 2014. It would be a cough every minute or minutes and there would be an attack around once a year where I would cough around 100 times in 30 minutes.

The anti depressant was not the most appropiate one for the larynx irritable syndrome, but it worked well. Took it from May 2014 to September 2015

I am still getting better after it, but with frequent "returns". I don't link these returns to reflux, or eating bad the previous night to be honest.

However I already did follow some of the advices you mentioned such as:
- Not going to bed after eating food (I would have dinner at 8 or 9 and go to bed at 12)
- My diet is quite healthy, althought I didn't restrict myself about other things. But it's mostly home made stuff, ecological things too for a long time..
- I do sleep late at nights, not too much but sometimes I do
- I don't smoke, but drink a beer from time to time
- I mostly sleep 8 hours if I don't have trouble sleeping (which all began since doctors never found a solution to my lump)

I was treated for allergies, used all nasal sprays of all brands.. etc..

However, about stress, anxiety. It's been really difficult to manage that. I try to ignore this condition but it's really complicated. My neck and throat feels tight all the time and there are moments where swallowing was painful (on my XXXXXXX apple) specially after a throat infection

My arytenoids were (or are) a little bit red but my vocal cords are fine.

Do you recommend me seeing a psychologist, or any other help with this? It's really difficult, been ongoing for 6 years, and even if I do feel some kind of relief... Sometimes I wonder if the relief is "real"

Also. Is there any way to reverse that hte Z line back to where it was? Any treatment you can recommend which is not invasive?
Do you think a esophagitis grade 1 like mine can trigger this throat symptoms when I absolutely have no other symptoms that I can remember?
WHat do you think of Peptest (the pepsin test) Is it reliable? Is it true that pepsin shouldn't be on the throat?

Also, I don't have the endoscopy images, but I think I can get them and upload them here.

Thanks.
I am sorry because of asking questions that might be outside of your medical area. But this has been going on for so long that I am really tired physically and psychologically.
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Follow up: Dr. T Chandrakant (1 minute later)
Forgot to mention that the LES; according to the test, had a correct pressure.
But the doctor mentioned that this seemed to be a condition for years. So I am a bit reluctant to be able to decrease that inflamattion in 3 weeks..
doctor
Answered by Dr. T Chandrakant (8 hours later)
Brief Answer:
As discussed

Detailed Answer:
Thanks for your your elucidate feedback.
You have stopped anti-depressants in Sept and still getting better with throat problem means depression was just a contributory factor to the GERD/reflux.

April 2010 to October 2014 is a long time to suffer from coughing and that too with the severity that you have explained. This must have added to the problem of GERD and the changes seen on Endoscopy.
Not a single cause can be implicated as there looks to be a cause and effect relationship in a cyclic manner and hence difficult to decided what caused what.

I was wondering whether the causes of coughing for so long were investigated or not. Please enlighten.

It is great details that you have mentioned and gave as a feedback, quite on the right path. Seeing a Psychologist may certainly help as they are experts at getting at the problem and have better solutions than we can really think of.

There is nothing that can be actively done to reverse the Z-line and if is about half a cm above is a normal variant in some cases.
The proper treatment of all the factors will stabilized it nicely. If your Endoscopist did not do biopsy means he felt it unnecessary. If done the biopsy, please post the reports.
It is not the esophagitis that causes the throat problem; it is reflux that causes the Z-line to traverse up, cause esophagitis and the throat problems; the coughing and stress/anxiety as a major contributory factors.
Also read the added information, be on the correct line of management and you will be fine.
I am not really aware of the pepsin test as is not done in our settings.
Surely, upload the images if available.

Oh,no, please do ask all the queries, this is an additional information and management that may help you get a complete recovery, we all are here to help the patients. No worry on my part.

Have made the list of the factors that instigate or enhance your problems?

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (6 hours later)
Thanks

The report says irregular Z-line. I will take a few days to get the images and the results of the biopsies. It says he took biopsies from random places.

The causes of coughing were investigated as a larynx sensory neuropathy or irritable larynx syndrome that got triggered after a throat infection. (After being misdiagnosed with other things) Anti depressants made it stop and now I have throat mucus most of the time (even on mornings or without eating anything) even eating causes relief most of the time.

These throat symptoms have decreased with the use of the anti depressant (I assume because it made me quit coughing) and even after quitting it.
I didn't really change the diet during the time I was taking the anti depressant, mainly because my diet was already good. However I will try to make it a bit better following some of the hints you recommended and I also got a book for that which I hope helps.

The throat symptoms usually come back randomly on a day (maybe when I talked too much the previous day), tight throat muscles. But these "random attacks" are less frequent since the time I started the anti depressant in May. I am also doing acupuncture since October 2014, don't know if it helps but all the combination seems to work for my throat. But I am unsure for the esophagitis since I didn't even know I had it due to the fact I never felt real disturbances in my esophagus or heartburn at all

There are good articles about the larynx sensory neuropathy, irritable larynx syndrome, post viral vagal neuropathy online. It helped me to understand what was going wrong and to finally quit coughing, and apparently still getting better. However I am really surprised it's so slow to heal and sometimes it makes me tired

Something that surprises me is that the Lower esophageal sphincter was checked and it sais the pressure was good. Plus I had a barium swallow 2 weeks ago, they tried to put me upside down to force reflux and they were not able to do it..

Thanks
Should I keep this open until the biopsies arrive or just open a new question? It will take more than 2 days to get here.

Again, thank you for your answers. It really enlighted this!
doctor
Answered by Dr. T Chandrakant (4 minutes later)
Brief Answer:
Whichever way it suits you.

Detailed Answer:
Good to know that the biopsies were taken, to rule out metaplasia and such conditions.
Noted about irritable larynx syndrome, varies diagnoses in past and getting relief with anti-depressants. Now the problem remains of is throat mucus and sometime food giving relief. Throat symptoms come back randomly but now with reduced frequency.
Good to know that your are well read and understand the problems.
Yes, we can continue on or stop and ask a fresh question whichever suits you.
Continue acupressure and all the good habits you have been changed to.
Biopsy report awaited.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (10 hours later)
Hello

Thanks. Results will take a few weeks to arrive. So I think it's better to open a new question.

Thanks!
doctor
Answered by Dr. T Chandrakant (15 minutes later)
Brief Answer:
Thanks for your appreciation.

Detailed Answer:
You are most welcome.
The reports are awaited, till then follow the advise as discussed above.
....
You may please rate this answer before closure of the discussion and can certainly contact me on the bellow link in future, whenever you may need me.
http://bit.ly/askdrtchandrakant
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Dr. T Chandrakant

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Can an esophagitis with Z gastric joint above diaphragm be reversible?

Brief Answer: Change of lifestyle is the key to success. Detailed Answer: Hi. Thanks for your query and an elucidate history. To recapitulate: Male/29 - Grade 1 esophagitis with Z gastric joint above diaphragm on Upper GI Endoscopy ( no need to translate if the rest of the report is normal) - no hernia - Doctors feels strange for the age and you were very healthy - lump on throat, mucus, cough for many years - settling with anti-depressants - wants to know about reversibility of both conditions and details... My thoughts with explanations: The throat condition as you have explained is getting reversed well with proper medications you have noted already. Continue the medicines and follow the advise to get the complete relief. The second condition: grade I esophagitis is surely fully reversible. The proximal migration of Z-line can be due to reflux and usually stays there. It is the GERD- gastroesophageal reflux disease that causes the migration of hte Z-line, esophagitis and very well can cause the feeling of lump in the throat. This in turn may be due to anxiety/stress/ depression and such conditions being the primary cause of all. Heartburn is a symptom and can be felt only if the injury to the esophageal mucosa is more. There can be asymptomatic presentation of such conditions as seen in your case. Yes, the severe or violent coughing can assist in progression of the problems under consideration. It increases the intra-abdominal pressure too much during bouts. It is good that the cough has almost stopped. Esophagus should heal within 1 to 3 weeks if all the conditions are favorable and you are given proper medication and you too take proper care. I would advise you the following (recommendations as you have said): - Small frequent meals, the daily requirements divided into 4 parts and taken as breakfast, lunch, brunch (evening) and dinner. - Do not sleep immediately on having food, walk around a bit. - Soft bland diet. - No alcohol or tobacco in any form (if you have a habit). - No late nights. - 8 hours sound sleep. - The most important: change the lifestyle in such a way that there should be no stress/ anxiety or any psychological pressure. - Identify and write down all the factors, foods, beverages and anything that instigates or increases your problems and stop them altogether. I hope this answer helps you, please feel free to ask for further relevant queries if you feel that there is a gap of communication.