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What Does My Biopsy Test Result Indicate?

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Posted on Fri, 10 Jun 2016
Question: Hello

Just wanted to let you know I got the biopsy results of my gastroscopy.
Results revealed no inflammation on my esophagus and duodenum, only a chronic inflammation of my stomach which apparently never caused any symptoms.

I still tried to have even healthier eating habits as well.

I guess that reflux is not the cause of my throat problems as I have suspected.
In case you can't see my previous request. I will attach a PDF of our previous conversation
doctor
Answered by Dr. T Chandrakant (6 hours later)
Brief Answer:
Thanks for review

Detailed Answer:
Hi.
Thanks for the review.
Noted that the Gastroscopy biopsy reveals no inflammation on esophagus and duodenum, only chronic inflammation of stomach.
Which you feel apparently never caused any symptoms.
You still tried to have even healthier habits.
Your guess that reflux is not the cause of your throat problems as suspected earlier.

Read all our previous discussion afresh.

So the most important findings are:
No metaplasia or any cancerous changes.
Only stomach has the problem and that too a chronic one, again nothing serious about cancer or so.

I hope your throat problem is also under control.
This seemingly appears that reflux is not the cause of your throat problems.
Please elucidate on throat problems if you have any at the moment.

Awaiting your further queries if you have any, please feel free to discuss further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (17 hours later)
Hello

They are throat and breathing problems. So maybe I should ask another doctor on that specialty. But here is my problem. And this is the disease I am facing for 6 years. It's a complex story

In April 2010 I ate a badly cooked fish and after that I got a throat infection, high fever, yellow stuff coming out from my throat, etc. I got diagnosed with tonsillitis and got antibiotics

The infection seemed to clear up but after a few days I woke up with a globus/tight throat feeling. I would have problems swallowing my saliva but no problems swallowing food. I would also feel mucus on my throat all the problem and swallowing was like painful and awkward. I would also have a constant cough to get rid of the phlegm inside my mouth

I was told this could be sinusitis so I got prescribed a bunch of nasal sprays, none of them ever helped. I knew the problem was my throat and not my nose.

After a year or so, around January 2011 I got a cough attack, probably because of the irritation of my throat due to my previous coughing to get rid of the phlegm of my throat.

After that coughing attack I got new symptoms, a burning/cold/needle feeling in the right side of my chest and throat, a wheeze, which I would say it's like a whistle that comes when I exhale, however it seems to be heard on my throat but not on lungs and like a shortness of breath feeling.

After that I would get laryngospasms often and sometimes I would get a zing on the right side of my throat which would trigger a constant cough

Afte that I got prescribed more nasal sprays, allergy medication with no success.
The only thing that worked, only for 3 weeks to one month which was prescribed on October 2012 was a shot of Trigon depot (a powerful corticosteroid shot I had put in my butt). I got completely symptom free.
Then my symptoms returned, all of a sudden with almost the same intensity.

I stopped seeing doctors because they would try the same things and would never get any relief. Only Trigon did it and that's the one they didn't want to give me

In March 2014 I got seriously tired by this problem because it would disrupt any social and life activity I would have. I was coughing every minute, having this sharp pain in the right side of my chest, and the globus and tight throat feelings in my throat.

I don't know how I managed to live with these symptoms, but I did. I tried to ignore them hopefully someday they would dissapear, but they don't.

In march 2014 I went to two more doctors who prescribed antibiotics which didn't work, and omeprazole for reflux for 3 months.

No single relief. Still same symptoms I was getting desperate. I had a chest CT scan with no contrast and that was clear. a Barium swallow which was clear too, chest x ray and that was clear too.

There doesn't seem to be any serious post nasal drip running thru my throat and I also don't feel anything falling thru the back of my throat.

After helpless doctors I decided to look on the net and found a group of people on a forum who had the same symptoms as I had (before the coughing attack in January 2011) after an upper respiration infection. Just like I did. It was called "Larynx Sensory Neuropathy", "Irritable Larynx Syndrome", "Post viral vagal neuropathy".

I decided to go to a doctor to prescribe anti depressants to handle this. And while we didn't try the right ones, they worked. I did get a relief from symptoms, not complete but at least there's rarely cough anymore.
I took these for one year, from XXXXXXX 2014 to September 2015.

My cough was "replaced" with a throat clearing that seems to be happening below my XXXXXXX apple at the right side. The globus is still there but usually better. Althought not always.

I do still seem to be getting better, but just too slow and I would like to know if there's something else I can do. I do feel this is mostly neurological. Not on my head, but on my nerves

I also got a spirometry done to discard asthma. There was no improvement after trying bronchodilaters, but according to the test I do show a reduction of breath on my smaller airways. Is this reversible? The shortness of breath seems to be felt only on the right side of my chest/ throat (I really cannot differenciate if it's the throat or my chest).

I also tried Trigon again in October 2015 and I was dissapointed because it didn't give me relief (But it worked in 2012)

So, this is a really long story, that has been really horrible for me althought I tried to learn to live with it during the time I could, but after seeing that no doctors could help me I got worried. I was the healthiest guy on the world and after that throat infection in 2010 my life changed completely. I was a healthy guy who did jogging and I was fit, but in 2014 I had to stop.

So obviously I don't know what to do here. I think it's a not ordinary illness, maybe neurological or functional.

Here's a short version of everything that happened:

After throat infection in April 2010 I felt:
Globus
Tight throat
Difficulty swallowing saliva
Cough to get my phlegm out

After a cough attack in January 2011 I got these other symptoms as well
Burning cold/hot/needle pain in the right side of chest and throat that seems to radiate to the back
feeling of shortness of breath on the right side of chest or throat (I am unable to say if it's in the throat or chest)
Cough attacks caused by a zing, tickle in the right side of my throat. These attacks would last 30 minutes or more
wheeze when I exhale. It's like a whistle sound that seems to be heard in the throat

Tests done:
Barium swallow = Normal
DYsphagia using another barium swallow = Apparently not difficulty
Chest CT Scan without contrast = Normal
Chest X Ray = Normal
Gastroscopy = Normal, small chronic inflammation in the stomach that doesn't seem to be related
Spirometry = Bronchodilaters don't help, but according to the woman that did it I have a 25% reduction on smaller airways and I am not sure what this means or if this is reversible. (Can they differentiate if it's because of the larynx or the lungs?)

Medicines I tried:
Antibiotics = No help
Nasal sprays, all brands = No help
Omeprazole = No help
Trigon Depot = Made me symptom free in October 2012 for around one month, but didn't work or do anything in October 2015
Allergy medicine = No help
Bronchodilater inhalers or steroid inhalers = Didn't try them for too long, but didn't help either.
Anti depressants = They seemed to help, tried them to treat the irritable larynx syndrome or laryx sensory neuropathy. We never confirmed if I had this, but I proposed this to my doctor as it seems to happen in some people. I still have symptoms but I don't cough anymore more or less


So this is all my story, six years with it and it's really debilitating. I used to be a fit healthy guy who would do jogging, but it's impossible for me to do that. Jogging inmediately triggers phlegm, I also can't laugh, it triggers phlegm in my throat inmediately.

Which others tests can I do? What is this? Any next steps to try?
Is that "25% small airways reduction" reversible and is this causing my shortness of breath feeling in the right side of my chest?

And are all those symptoms reversible? I really want to cure one day and wake with no symptoms but sometimes I feel it's impossible and I don't want to live with this.

Thanks
doctor
Answered by Dr. T Chandrakant (6 hours later)
Brief Answer:
FDR / allergy // find out and short 3 week courses of medicines...

Detailed Answer:
Hi.
Dr T Chandrakant here again: I have done two specializations one in General Surgery and also in ENT (double post-graduations) I will try to assist you in this regards too.

Thanks for your highly elucidate history and feedback related to throat and breathing problems.
The problem started in April 2010 after eating badly cooked fish and got throat infection, high grade fever, yellow stuff coming from throat and got diagnosed as tonsillitis and received antibiotics.
Woke up with globus after a few days.
Problems swallowing *only saliva *not food.
Constant cough to get rid of the phlegm- told sinusitis - sprays - no relief. XXXXXXX 2011 - cough attack - new symptoms - a burning/cold/needle feeling in the right side of chest and throat, an expiratory wheeze heard on throat - shortness of breath feeling - zing on rt side of throat - instigating coughing -
** First shot of Trigon Depot - symptom free - only to recur.
March 2014: 2 more Doctors - antibiotics, Omeprazole - X-ray, CT, Barium -N
Forum on net : "Larynx Sensory Neuropathy", "Irritable Larynx Syndrome", "Post viral vagal neuropathy > anti-depressants XXXXXXX 2014 to Sept 2015 - rare coughing - feels not on head but on nerves -
Spirometry:
Trigon tried again Oct 2015 - not helpful
Six years
Wants to be normal and jogging

Read and **re-read carefully in a Chronology that you have provided so well>
My thoughts:
It looks that you got a severe allergy to fish proteins and hence the array of symptoms you have mentioned, like a cascade and the allergies added on them by other various agents.
This is sort of a FDR, that is fixed drug reaction (do not take literally the drug- this can be an allergen in any form). Since the fixed drug reaction got very well response by Trigon in the first place that did not work again as there are so many allergen that now start working to re-instigate on a previously occurred reaction.
hence the routine symptomatic treatment failed to give any response other than Trigon and anti-depressant. Many antidepressants have varies actions including antihistamine and may be during this period the load of allergen also was least so that you got partial response.

I would advise you in such a situation the following:
You will have to discuss with your Doctor and if he is convinced try this for three weeks, I hope this will help you.
PPI Like Omeprazole
Oral steroid in tapering dosages reducing the dosage every week. Try for Deflazacort if available in your country or the else any other will do. 3 weeks course of steroids in tapering dosages will have no side effects (except in diabetics)
Antihistamine
Multivitamins with Lycopene are the best anti-oxidants.
Anti-inflammatory like Serratiopeptidase.
Now: the important aspect:
You have to make a list of the foods, beverages, things that you use, wear, scents, deodorants, fumes, molds and mildews if you have damp places in house, kitchen, bathroom or working places, think-think-think and I am sure you will realized the instigating or enhancing factors and to stop them altogether.
This can be as simple as an additive commonly used in foods and beverages.
If you can, this will help you to get a cure since an old adage says ''anything under the sun, including the sun can cause an allergy"...
Control of stress and/or anxiety are also a very important part of the treatment, preferably by non-medicinal methods.
Avid smoking and smokers.
Since you are suffering for such a long time, an extra effort can help you to become symptom free.
This way it helps all my patients and hence should help you too.

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 (5 hours later)
Thanks

But.. are you sure it's an allergy? I am not allergic to foods apparently, neither fish. I ate fish all my life and I assume that one contained bacteria or something that triggered tonsillitis. I seemed to be getting well until 5 or 6 days later, it triggered the lump in my throat.

Also, the cough was neurogenic. The pain is really strange as I can say. I have tried antihistamines in the past and they caused me swallowing problems (maybe they will work now tho)

Also, the symptoms are constant, might be little better or worse. Althought they seem to be getting better and I guess it's because my cough is no longer there so Idon't do self harm

Also, the new symptoms that triggered in 2011 developed after an attack of cough and I think I "broke" something there.
The pain was really needle like, like hot needles in my chest

Maybe not in my lungs (maybe that's why it doesn't show on the chest CT Scan. But in my trachea or larynx or bronchi?

Sorry for the questions but I really think it's something more complex than an allergy.

I've moved to other places as well and stayed there for sometimes and not a single improvement..

I do believe that it's not an ordinary thing caused by external agents (except the throat infection in first place) but also my cough harmed it

Thanks
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Follow up: Dr. T Chandrakant (1 minute later)
The pain also irradiates to my back or neck at the right side too. It's a really strange pain to describe
doctor
Answered by Dr. T Chandrakant (2 hours later)
Brief Answer:
Please give a thought, this may help you to get causes and cure.

Detailed Answer:
Hi.
My thoughts/explanations were as per the detailed history you have provided and I just correlated the things - all of them together to give you a probable cause.

This may be an allergy as by far this is the most important reasons for the symptoms that you have , then added on by the neurological, psychological and such factors.
As I said, it is a cascade phenomenon or a vicious cycle that has to be broken somewhere; which in your cause was broken twice: once on the first shot of Trigon and another on antidepressants.
You need a sort of carpet therapy meaning all possible factors to be treated simultaneously to get a relief first.
Your Keen observations will add on to finding the probable instigating and enhancing factors.
As per the symptoms you have explained there may be involvement of the the tracheo-bronchial tree hence you are getting typical pains.
One needs bronchoscopy to get the exact picture inside the airways.
Allergy itself is the most complex thing, ill understood and there are so many factors as I said : anything under the sun including the sun can cause allergy.

Due to persistent coughing, the muscles, nerves of the neck get stretched so many times hence one gets the referred pains locally or get additional referred pain to upper back to shoulder and anterior chest wall. This acts as a chronic focus.

I hope this answer helps you further.
All the experiences and modes of trial and error are not written in textbooks and net will take lifetime to read about just one topic.

Please feel free to discuss further.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (8 hours later)
Hello

Thank you very much. I will take a few days to see my doctor again, but I will try suggesting this. Lets see if this aggressive therapy helps...

Thank you so much
doctor
Answered by Dr. T Chandrakant (2 hours later)
Brief Answer:
Please go ahead, 3 weeks course for a suffering of 6 years.

Detailed Answer:
Hi.
Thanks for your appreciation.
Let me hope that your Doctor understands what I mean by, please discuss with him/her in details.
This is just a three weeks course for a suffering of 6 years.
Hope for the best outcome.
In between stop eggs and fish for some time, say 4 weeks to see if this too helps and to see if it aggravates after re-starting.

Awaiting for your feedback after the course.
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 19777 Questions

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What Does My Biopsy Test Result Indicate?

Brief Answer: Thanks for review Detailed Answer: Hi. Thanks for the review. Noted that the Gastroscopy biopsy reveals no inflammation on esophagus and duodenum, only chronic inflammation of stomach. Which you feel apparently never caused any symptoms. You still tried to have even healthier habits. Your guess that reflux is not the cause of your throat problems as suspected earlier. Read all our previous discussion afresh. So the most important findings are: No metaplasia or any cancerous changes. Only stomach has the problem and that too a chronic one, again nothing serious about cancer or so. I hope your throat problem is also under control. This seemingly appears that reflux is not the cause of your throat problems. Please elucidate on throat problems if you have any at the moment. Awaiting your further queries if you have any, please feel free to discuss further.