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Is Fluoroscopy Esophagram Required When Diagnosed With Polyps And GERD?

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Posted on Fri, 13 Oct 2017
Question: Good Morning. Last month i had colonoscopy and upper endoscopy by my GI doctor. Colonoscopy showed 6 begnin polyps and upper endoscopy wss normal no barretts esophagus looked normal. I was on omeprazole 40 mg and it stopped working and Gerd got worse. Went to different hospital (Rush)now they are sending me for a fluoro esophagram. Im really nervous. I dont know what they could be looking for. I know Rush is top notch so i hope they are not suspecting anything. Please advise what that test shows. I did see an ENT and he put a sope down my nose said tbroat and everything looks good. No abnormalities.
doctor
Answered by Dr. Ramesh Kumar (19 minutes later)
Brief Answer:
Please don't panic.

Detailed Answer:
Hello XXXXXXX
Have gone through your details and i appreciate your concerns.

See dear in GERD endoscopy is done to rule out complications like Achalasia or carcinoma etc.As such there is no investigation in medical science which can diagnose GERD.
Diagnosis of reflux disorder is based on clinical evaluation and symptoms of patient. Through investigation we try to rule out any other possible disease which can cause such symptoms.

I can see that you are in canada. Doctors there are too conscious about using medications. Omperazole is an Over the counter PPI,So in lay man terms you can understand that its just a baseline medication used to treat GERD;Secondly 40 mg once daily is a normal dose and if patient is not responsive doses should be increased.

Thirdly treatment was incomplete,Why?
I will explain you in easy language.
GERD means Gastro esophageal reflux disorder.Acid is produced by stoamach and is refluxed back into esophagus.The lining mucosa of esophagus is not naturally designed to tolerate acid hence symptoms starts appearing.

Now as the name suggests treatment should consist of two parts-
Control Acid production-Omeprazole was given
Stop acid reflux-Nothing was given for that.

Suggestion-

Please request your gastroenterologist to start you on better PPI-antacids like Rabeprazole or Esomeprazole. Omeprazole is a basic ppi and will not help you much. Esomeprazole can be used in the dosage as high as 80 mg twice daily.Trials have shown that esomeprazole is superior to other PPI's in controlling reflux symptoms. Also, request him/her to add Domperidone 30mg or Levosulpiride(both are prokinetic)slow release once daily. This will slow down the reflux of acid back.

An antacid containing local anesthetic (Mucaine gel ) should be taken 2tsf thrice daily.

Acotiamide is another wonderful new drug and is very effective in controlling symptoms of GERD and esophagitis. In trials- Acotiamide, a gastrointestinal motility modulator, at a standard dose of 100mg thrice daily has significantly affected esophageal motor functions or gastroesophageal reflux in healthy adults.

All these drugs can be considered by your gastroenterologist to provide you with symptomatic relief in your problem.All these medicine can be used at a time also by your primary.

Esophagram is an x-ray examination of the esophagus, stomach and first part of the small intestine . Images are produced using a special form of x-ray called fluoroscopy and an orally ingested contrast material such as barium.If endoscopy is normal i don't think it has any significance.

Please don't mind but canadian doctor create unnecessary panic in patients.Endoscopy is the gold standard test.Only possibility is that they can't visualize your gut properly in endoscopy,so are trying to go for another test to rule out achalasia.

Please feel free to follow up,
Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2805 Questions

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Is Fluoroscopy Esophagram Required When Diagnosed With Polyps And GERD?

Brief Answer: Please don't panic. Detailed Answer: Hello XXXXXXX Have gone through your details and i appreciate your concerns. See dear in GERD endoscopy is done to rule out complications like Achalasia or carcinoma etc.As such there is no investigation in medical science which can diagnose GERD. Diagnosis of reflux disorder is based on clinical evaluation and symptoms of patient. Through investigation we try to rule out any other possible disease which can cause such symptoms. I can see that you are in canada. Doctors there are too conscious about using medications. Omperazole is an Over the counter PPI,So in lay man terms you can understand that its just a baseline medication used to treat GERD;Secondly 40 mg once daily is a normal dose and if patient is not responsive doses should be increased. Thirdly treatment was incomplete,Why? I will explain you in easy language. GERD means Gastro esophageal reflux disorder.Acid is produced by stoamach and is refluxed back into esophagus.The lining mucosa of esophagus is not naturally designed to tolerate acid hence symptoms starts appearing. Now as the name suggests treatment should consist of two parts- Control Acid production-Omeprazole was given Stop acid reflux-Nothing was given for that. Suggestion- Please request your gastroenterologist to start you on better PPI-antacids like Rabeprazole or Esomeprazole. Omeprazole is a basic ppi and will not help you much. Esomeprazole can be used in the dosage as high as 80 mg twice daily.Trials have shown that esomeprazole is superior to other PPI's in controlling reflux symptoms. Also, request him/her to add Domperidone 30mg or Levosulpiride(both are prokinetic)slow release once daily. This will slow down the reflux of acid back. An antacid containing local anesthetic (Mucaine gel ) should be taken 2tsf thrice daily. Acotiamide is another wonderful new drug and is very effective in controlling symptoms of GERD and esophagitis. In trials- Acotiamide, a gastrointestinal motility modulator, at a standard dose of 100mg thrice daily has significantly affected esophageal motor functions or gastroesophageal reflux in healthy adults. All these drugs can be considered by your gastroenterologist to provide you with symptomatic relief in your problem.All these medicine can be used at a time also by your primary. Esophagram is an x-ray examination of the esophagus, stomach and first part of the small intestine . Images are produced using a special form of x-ray called fluoroscopy and an orally ingested contrast material such as barium.If endoscopy is normal i don't think it has any significance. Please don't mind but canadian doctor create unnecessary panic in patients.Endoscopy is the gold standard test.Only possibility is that they can't visualize your gut properly in endoscopy,so are trying to go for another test to rule out achalasia. Please feel free to follow up, Thanks.