My wife has a problem with a possible stricture or with the sphincter in her esophagus. She has been taking at various times and for a few months, AXID, PRILOSEC, and PROPULSID. However, these medications do not ameliorate her problem and without them, the reflux is painful. Do you know of another approach to this condition? Will surgery help? Should we look for a nutitionist? I will be grateful for a reply.
Reply:
Your question was received by the ofcn.digestive.clinic moderator on Aug 2 and answered on the same day. We are trying to re-route questions sent to other clinics who are having staffing problems and where questions are backing up. Look for major improvements in response times in coming months. We appreciate your patience.
Esophageal disorders are relatively easy to treat once the correct diagnosis have been reached. A number of techniques are available to help make a diagnosis of spasm or reflux or stricture although as a rule an expert in digestive diseases can often predict from a patient's description of her symptoms alone what the problem will turn out to be.
If your doctor has not referred your wife to a gastroenterologist this should be done at this time. If your wife has been seen by such a specialist it may be reasonable to ask your family doctor or internist for a referral to another gastroenterologist since I believe with more information a precise diagnosis would be possible. With that diagnosis accurate and effective treatment would logically follow.
While a nutritionist might be of help once we know for certain what the problem is I would discourage such a referral at this time pending further diagnostic studies such as x-ray, endoscopy, esophageal pressure measurements (manometry), and/or 24 hour pH probe recordings (which can help quantitate reflux and see if it relates to symptomatic episodes).
Similarly, any consideration for any type of surgery at this point in time seems very premature.
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Bruce Sckolnick, M.D.
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