Weak Les
in [Heart Medication]
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From: christophe on 24 Sep 2007 07:17 Is it possible to diagnose a weak LES based simply on an endoscopy? I was reading the GI surgeon's report and that's what it said. I am still waiting for the impedance results and I am still a little groggy from what has proved a very trying day. I meet the GI again for a consultation in 2 weeks. However, if he thinks I have a weak LES, then it's surgery for me because the medical management of my illness has caused more problems than it's solved. When I'm a little better, I'll write a report on today - especially for Pete - to show some of the problems in our hospitals on this side of the world.
From: Howard McCollister on 24 Sep 2007 08:10 "christophe" <chris_pham(a)optusnet.com.au> wrote in message news:1190632635.769993.269080(a)57g2000hsv.googlegroups.com... > Is it possible to diagnose a weak LES based simply on an endoscopy? I > was reading the GI surgeon's report and that's what it said. > I am still waiting for the impedance results and I am still a little > groggy from what has proved a very trying day. I meet the GI again > for a consultation in 2 weeks. However, if he thinks I have a weak > LES, then it's surgery for me because the medical management of my > illness has caused more problems than it's solved. > > When I'm a little better, I'll write a report on today - especially > for Pete - to show some of the problems in our hospitals on this side > of the world. > Actual function of the LES can't be determined at EGD, but viewing the hiatus from the underside (scope retroflexed in the stomach) might show gaping at the LES...that would be called a lax, or patulous LES. Although that is *suggestive* of a condition that might contribute to refllux, for this to be a significant finding requires correlation with manometry, which provides *functional* evaluation of the LES. For THAT to be significant, it has to be correlated with actual documentation of reflux and correlation of symptoms (ambulatory pH testing). It's simply too great a leap to say that your LES looks loose, therefore surgery will get rid of all your symptoms. I see frequently see hiatus hernias and patulous LES on EGD in asymptomatic patients. HMc
From: christophe on 24 Sep 2007 21:21 On Sep 24, 10:10 pm, "Howard McCollister" <nos...(a)nospam.net> wrote: > "christophe" <chris_p...(a)optusnet.com.au> wrote in message > > news:1190632635.769993.269080(a)57g2000hsv.googlegroups.com... > > > Is it possible to diagnose a weak LES based simply on an endoscopy? I > > was reading the GI surgeon's report and that's what it said. > > I am still waiting for the impedance results and I am still a little > > groggy from what has proved a very trying day. I meet the GI again > > for a consultation in 2 weeks. However, if he thinks I have a weak > > LES, then it's surgery for me because the medical management of my > > illness has caused more problems than it's solved. > > > When I'm a little better, I'll write a report on today - especially > > for Pete - to show some of the problems in our hospitals on this side > > of the world. > > Actual function of the LES can't be determined at EGD, but viewing the > hiatus from the underside (scope retroflexed in the stomach) might show > gaping at the LES...that would be called a lax, or patulous LES. Although > that is *suggestive* of a condition that might contribute to refllux, for > this to be a significant finding requires correlation with manometry, which > provides *functional* evaluation of the LES. For THAT to be significant, it > has to be correlated with actual documentation of reflux and correlation of > symptoms (ambulatory pH testing). It's simply too great a leap to say that > your LES looks loose, therefore surgery will get rid of all your symptoms. I > see frequently see hiatus hernias and patulous LES on EGD in asymptomatic > patients. > > HMc My goodness, you probably don't realize how much you have helped me - thanks very much. He said previously that my manometry was borderline. Although, I don't really know what that means. The impedance testing results will be interesting (as long as the batteries didn't go flat because I definitely had symptoms this time. Naturally, I am also a bit worried about my malabsorption problems. I have terrible gas pains and I am concerned about what surgery will mean for this particular symptom. He did take a biopsy from the lower bowel, but that will only rule out a few of the possible causes of malabsorption. Still, if the les is defective I will get the fundo in spite of gas problems. The benefits far outweigh the riskes in my case. Interestingly, his notes mentioneed no hiatus hernia. My understanding - correct me if I'm wrong - is that this is good and is likely to make the antireflux surgery even more straight forward.
From: Bob Noble on 24 Sep 2007 23:06 The fundo may also help your gas problems. It can all be part of gerd. I don't have any of the terrible gas problems I sometimes had with gerd now, after the fundo operation. I do pass a lot of air after the fundo, but the gas disturbances in my stomach area are mostly gone. -- Bob Noble http://www.sonic.net/bnoble "christophe" <chris_pham(a)optusnet.com.au> wrote in message news:1190683319.495691.128410(a)n39g2000hsh.googlegroups.com... > On Sep 24, 10:10 pm, "Howard McCollister" <nos...(a)nospam.net> wrote: >> "christophe" <chris_p...(a)optusnet.com.au> wrote in message >> > Still, if the les is defective I will get the fundo in spite of gas > problems. The benefits far outweigh the riskes in my case. > Interestingly, his notes mentioneed no hiatus hernia. My understanding > - correct me if I'm wrong - is that this is good and is likely to make > the antireflux surgery even more straight forward. >
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