[Dysphagia] PPIs - At last!

[DGregore at Christianacare.org (Gregore, Dale)]

A question for the listserv:

69 year old patient with a 27 year history of myotonic dystrophy.  Was fully
PO/ with mild oropharyngeal dysphagia until reflux induced pneumonitis last
year.  PEJ placed. Now with graduated PO intake without aspiration.

HOWEVER, I did a FEES on him recently and saw the most unusual UES:  it was
open at rest!  What a sight to see!  It varied in size based on tone and
closed when the swallow was initiated.  Whiteout preculded the rest until
post swallow and the uES was open again.  My thoughts were that it
(circopharyngeus) tightened with the initiation of the swallow and relaxed
as the bolus passed.  It then stayed relaxed.

Need less to say, he is a huge reflux risk.  His LES is open at rest but he
is not a candidate for a fundaplication of the UES, per patient report.
Free flowing reflux.....

He strictly follows reflux precautions, but easliy has reflux in the upright
postion.

What options are available, if any for UES tightening, etc......  His
fatigue factor is a problem so he is continuing partial PO w/ PEJ primary
nutrition/ bolus feeds.

Ideas?

Thanks.

Dale Gregore


-----Original Message-----
From: Irene Campbell-Taylor [mailto:eripley@yahoo.com] 
Sent: Monday, June 21, 2004 1:16 PM
To: Dysphagia@b9.com
Subject: [Dysphagia] PPIs - At last!


After years of jumping up and down and yelling that PPIs do NOT treat GERD,
I am pleased to say that this appeared today:

Full article at:

http://www.medscape.com/viewarticle/480912_print

Complete Elimination of Reflux Symptoms Does not Guarantee Normalization of
Intraesophageal and Intragastric pH in Patients With Gastroesophageal Reflux
Disease (GERD)

 

David Milkes, M.D.; Lauren B. Gerson, M.D., M.S.; George Triadafilopoulos,
M.D. 

Am J Gastroenterol 99(6):991-996, 2004. 

Posted 06/17/2004 
Abstract and IntroductionAbstract
Background: Acid plays a significant role in the development of
gastroesophageal reflux symptoms, such as heartburn and regurgitation. It is
generally assumed that acid suppressive therapy improves or eliminates
symptoms by normalizing intraesophageal pH.
Aims: The aim of this article was to assess the efficacy of proton-pump
inhibitors (PPIs) in normalizing intraesophageal and intragastric pH in
patients with GERD without Barrett's esophagus (BE) rendered symptom free by
therapy.
Methods: Patients were evaluated by dual-sensor 24-h pH monitoring while
receiving PPI therapy for complete control of GERD symptoms. Analyses of
intraesophageal and intragastric pH profiles were then made.
Results: Fifty patients, 39 men and 11 women, with GERD, without BE, were
studied. All tolerated PPIs well and were asymptomatic at the time of the
study. Fifty percent of patients had abnormal intraesophageal pH profiles
despite adequate symptom control on PPIs, which was associated with
significant breakthrough of intraesophageal acid control in both the upright
and supine positions. Low intragastric pH correlated highly with
intraesophageal acid reflux only in patients with persistent abnormal
esophageal acid exposure (p = 0.001).
Conclusions: Fifty percent of patients with GERD without BE continue to
exhibit pathologic GERD and low intragastric pH despite PPI therapy that
achieves complete reflux symptom control.

 [I suspect that the real number is higher than 50% but that alone is
significant- Irene]




Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia