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Burning In Lower Oesophagus. Bubbling Air In Stomach. Done With Bravo Test. Is It Gerd? Suggest Further Treatment?

Posted on Sat, 21 Sep 2013

Question: Have burning at my lower valve (lower esophagus). It doesn't come up that often but seems to have a low constant burning just in lower part. Also have bubbling air sitting at top of stomach. Not like a burp..it just slowly comes into esophagus. Bending over seems to really make burning worse. I had a bravo test done but it showed nothing. Is it possible small amounts of acid just sit at valve and not all the way up the esophagus so that's why nothing showed up because it never reached the device? I know my valve is weak so my question is can acid/gerd just slightly leak through valve and sit and burn the valve and not give you classic esophagus burning? Also can gerd come and go even with a weak valve.? It seems I have good and bad weeks. Thanks so much!

Answered by Dr. Amit Jain (2 hours later)

Brief Answer:
Best test will be ph and impedence testing

Detailed Answer:
Hello,

Thanks for putting your query.

I am a Gastroenterologist (DM) and I am pleased to address your concern.

Yes it may also be possible that device may be burried in mucosal folds and could not pick up the acidic pH. It may also be possible that acid reflux may not produce classic burning as it has very low senstivity for diagnosis of GERD. Further the burning is not only due to acid reflux, it may also be due to non acidic, weak acid or bile reflux especially when lower oesophageal sphincter.

So best test will be ph monitoring along with impedence testing.

Another good test will be empirical treatment with a proton pump inhibitor like rabeprazole along with a prokinetic agent like domperidone. If the symptoms are relieved then it is GERD.

Few more things which I found very useful in my patients:
1. Avoid fatty meals
2. Don’t lie down soon after meals for at least half hour
3.Take small and frequent meals, instead of full meals at a time
4. wear loose clothes
5. If you are overweight or obese do weight reduction with dieting and exercise

I hope I have answered your query and this will help you. If you have any further query I will be happy to answer that too.

Remain in touch and get-well soon.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Amit Jain (12 hours later)

I thought the bravo ph test was supposed to show if you had reflux. It showed very little reflux into mid esophagus. I'm confused because I can feel burning and soreness at valve area only.( not all the way into the chest area like typical heartburn) I was on a ppi but since ph bravo test showed no acid they took me off. It seems to act up with bending more then food. I guess because its weak.
They said I have a slight patulous ge junction and most likely visceral hypersensitivity. Can visceral hypersensitivity cause off and on gerd like symtoms? And can it come and go or get better? Thank you so much!

Answered by Dr. Amit Jain (57 minutes later)

Brief Answer:
Hypersensitivity can produce symptoms of reflux

Detailed Answer:
Hello! Thanks for feedback.

Oesophageal Hypersensitivity (Visceral hypersensitivity) produce symptoms like reflux disease with no actual acid reflux.

Hypersensitivity is due to causes like anxiety, depression, stress . So if among these is one of the cause it may resolve completely, and may reappear also.

If you do not have any clarification , you can close the discussion and rate the answer. Wish you a good health.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar