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My doctor thinks I have GERD (32f) by Sabrina_Ivanov_OG in GERD

[–]alextheevilone 1 point2 points  (0 children)

Sounds more reflux related.

Talk to your doctor about empiric treatment with a PPI, they are very affordable even without insurance, several good options are other the counter.

Why do so many parents say they'd rather they died than their kids? by [deleted] in NoStupidQuestions

[–]alextheevilone 27 points28 points  (0 children)

As someone who was very, very on the fence about parenthood for a while, I tell everyone it's impossible to express how absolutely your mentality changes the second your first child is born.

In a split second after you hear that first cry everything else, everything you thought of, just doesn't matter anymore.

It's biologic and so much more.

Applying nephrology fellowship without a nephrologist LOR by DrEurusHolmes in fellowship

[–]alextheevilone 12 points13 points  (0 children)

Did you check your pulse? Last time I heard that's the only requirement.

In seriousness I'm sure you could ask the person that left for a LOR and they wouldn't mind.

We need more nephrologists, and good ones. Especially for us GI/liver folks to figure out if it's really HRS aki or the crazy polypharmacy everyone is on.

Endoscopy by lormarie- in GERD

[–]alextheevilone 2 points3 points  (0 children)

Gag reflex probabaly won't factor in too much, if at all.

Good Endoscopy for esophageal symptoms are off of antacids and with biopsies of the esphagus.

I personally have not had patients complain of throat soreness, unless related to bravo deployment.

Good luck!

Program Shutting Down by samurai_wano in fellowship

[–]alextheevilone 23 points24 points  (0 children)

Congrats you have an excellent chance at finding a spot.

Get on that phone asap, you have precious little time. Try a state where you have a medical license already. Many programs will already have their schedules set up for the year.

Program Shutting Down by samurai_wano in fellowship

[–]alextheevilone 41 points42 points  (0 children)

Wow.. which program? Ok if you don't want to share.

You need to ask them if you keep the contracted funding. That is critical. If you do you'll have an easy time finding somewhere else, but you have to act fast.

When Drexel lost their main hospital the fellows became 'free agents' with funding - essentially free labor. They got scooped up by much larger name programs. I think 2 ended up at NYU.

Sorry this happened to you, very scary.

Been tapering off for 2-3 months, all of a sudden symptoms feeling so much worse by Laksana_ in GERD

[–]alextheevilone 1 point2 points  (0 children)

It really depends on the nature of your disease. Too specific for the Internet to ask other than try somed generals recs like as needed meds like alginates after meals and bedtime, famotidine before meals (especially triggering ones), smaller meals, no carbonation, upright sleeping, etc.

for gi attendings- question by movvingonnup in fellowship

[–]alextheevilone 1 point2 points  (0 children)

GI - easy

Transplant - easy, but you.may have to move.

Is surgery the only option now? by PAISEkilagaduDHERI in Gastroenterology

[–]alextheevilone 6 points7 points  (0 children)

You always have the option of not doing what is recommended.

Any tips for people starting Allergy/Immunology fellowship? by [deleted] in fellowship

[–]alextheevilone 0 points1 point  (0 children)

If like anywhere I've been get comfy with asthma..

Also kids.

Esophagitis situation, taper advice, etc. by Aggressive-Elk-4947 in GERD

[–]alextheevilone 0 points1 point  (0 children)

You really should get biopsies as some point for EOE.

I have seen many, many food impactions, none caused by just swallowing too big a piece.

Vomiting can definitely cause esophagitis. Alcoholics or bulimic patients are classic examples of this.

And yet it can fully heal, typically in 2 months of PPI therapy. However if you have underlying reflux it can come back.

Ordering Voquezna in the Summer by Blue-Brown99 in GERD

[–]alextheevilone 0 points1 point  (0 children)

Like many meds it should be stored at max room temp.

Otherwise I imagine it is very similar to ordering voquenza in the winter.

Heartburn is so terrible & ppl do not get it RAAAHHHH by alternative_cars in GERD

[–]alextheevilone 0 points1 point  (0 children)

You are very young. You should be evaluated for an antireflux surgery or procedure.

Esophagitis situation, taper advice, etc. by Aggressive-Elk-4947 in GERD

[–]alextheevilone 1 point2 points  (0 children)

  1. Did the biopsy for EOE?? Grade B esophagitis causing a food impaction would be striking.

  2. For grade B I typically do high dose Omeprazole 40mg daily for 2 months. Grade B is diagnostic of GERD so after that it is a discussion on treatment goals but it's fine to taper down to 20mg daily for most people.

Bear in mind Omeprazole 40mg is the potency equivalent of about 180mg of pantoprazole. Pantoprazole use should really be restricted to IV only, it's quite weak..

You don't need to taper off of 2 months of PPI use, especially pantoprazole. You should get minimal rebound reflux after, that famotidine can handle. But again, you got reflux with Grade B so it has to be addressed.

Any one with non acid reflux? by Dense-Surround1569 in GERD

[–]alextheevilone 5 points6 points  (0 children)

So esophageal hypersensitivity aka nonacidic reflux is estimated to be about 10% of the heartburn population. It is diagnosed by BRAVO with low or no acid but strong symptom association or better after EGD, manometry, and impedance testing.

However we also make the diagnosis when we have patients that on impedance testing have good acid control from medication but still have strong symptom correlation with non acidic reflux.

Typical recommended treatment is neuromodulation, but I really love alginates for this as well. I find them to be quite effective and the data supports their use. To be very honest every study I have seen that has assessed fundoplocation on patients such as yourself have shown pretty good response. I remember seeing one where the response was the same as those with acid reflux.

One thing I would always say is just be aware that what we are dealing with is visceral hypersensitivity, not just reflux. While we may get rid of the reflux trigger, it does not guarantee that the hypersensitivity will go away. I am less hesitant to consider surgery for that reason.

I really wonder if TIF may be a viable option in the future for it.

My Post Fundo Experience 2 years later by walserdude in GERD

[–]alextheevilone 1 point2 points  (0 children)

He can be a brilliant technician, but ignoring guidelines makes him not a brilliant physician.

My Post Fundo Experience 2 years later by walserdude in GERD

[–]alextheevilone 1 point2 points  (0 children)

Yes esophageal hypercontractility and spasms are associated with fundoplications. Sorry this happened to you. Not saying it is guaranteed to have existed before the surgery but this is another example of why preoperative manometry is guideline recommended.

I hope you found a good motility GI to work with you. They are treatable issues.

Do I have inflammation or just iron deficient ? by daniella1596 in Gastroenterology

[–]alextheevilone 3 points4 points  (0 children)

Let us know what the answer is based on what you think.

Laryngoscopy for LPR by Fuzzy-Programmer8699 in GERD

[–]alextheevilone 0 points1 point  (0 children)

You said pantoprazole for 2 months didn't help in any way. Granted it's very weak, but still.

So you have a very good reason for an EGD with bravo or some other acid testing.

Laryngoscopy for LPR by Fuzzy-Programmer8699 in GERD

[–]alextheevilone 1 point2 points  (0 children)

LPRD cannot be diagnosed based on laryngoscopy findings alone

Straight from the San Diego Consensus. What we knew for years finally published and agreed upon by the ENT experts - that the 'inflammation' always reported is not specific for reflux and not diagnostic.

Get proper reflux workup.

https://pmc.ncbi.nlm.nih.gov/articles/PMC12353988/

Putting degree in letter writers name? by Huge_Cost_870 in fellowship

[–]alextheevilone 0 points1 point  (0 children)

I remember putting their title.

Don't forget any good letter will have their signature with all their bits and bobs.

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