Laryngopharyngeal Reflux Specialist

[ricklev]

Any recommendations for a good gastroenterologist in Bangkok specializing in laryngopharyngeal reflux (silent reflux)?

 

Any comments on your reflux medical experience here are also appreciated.  

 

Thanks.

[The Hammer2021]

Bumrungrad  hospital

[RJRS1301]

Have you tried or can you access  esomeprazole (Nexium), it may assist 

[Lacessit]

Changing diet and eating habits can help a lot. I was on Somac ( pantoprazole ) for many years for gastric reflux, I have not needed it for at least 3 years.

 

Some of my experience-based rules:

 

1/ Eat early in the evening, no later than 7 pm. Retire to bed at 10.30, so there is plenty of time to digest.

2/ Avoid fatty and rich foods. Vegetables that grow above ground are best, small portions of protein.

3/ It's better to feel a little bit hungry after eating, than full.

4/ Alcohol in excess is bad news.

5/ If I must have dessert, it is fruit or yoghurt, easily digestible.

6/ I have a glass of water with half a teaspoon of baking soda every night before going to bed. That damps down any residual stomach acid.

7/  A glass of water by the bed to sip on if my throat feels a bit raw during the night.

 

I'm not saying these rules will work for the OP. However, they do work for me.

[xylophone]

I suffered from gastric reflux for a few years and it became dangerous because I developed Barrett's oesophagus, which is often called a "precancerous" condition.

 

My doctor put me on omeprazole 40 mg in the morning and the same in the evening for about six months and then wound back the dosage.

 

I also learned what foods exacerbated the problem, namely: – red peppers, onions, milk chocolate and a few others, and stayed away from them.

 

I continued with the omeprazole for a couple of years and then I discovered d-limonene capsules, and took those for a few weeks and my condition completely disappeared, and I have not taken omeprazole for many years now, although I do keep some on standby, just in case.

 

I went back to NZ and my doctor did a gastroscopy on me and was absolutely amazed that my Barrett's oesophagus had disappeared, so I told him about the d-limonene, and he actually ordered some online for a friend of his – – yes that's absolutely true, because despite what this friend was doing he was still suffering a bit.

 

If you do a bit of digging around on d-limonene, and don't be put off by the fact that in one of its forms, it can be a very good cleaner!!, You will find some references to the treatment of gastric reflux and similar.

 

Best of luck, and I did note that another poster has mentioned about raising the head of your bed a couple of inches, and that helped for me also

[ricklev]

3 hours ago, Lacessit said:

Changing diet and eating habits can help a lot. I was on Somac ( pantoprazole ) for many years for gastric reflux, I have not needed it for at least 3 years.

 

Some of my experience-based rules:

 

1/ Eat early in the evening, no later than 7 pm. Retire to bed at 10.30, so there is plenty of time to digest.

2/ Avoid fatty and rich foods. Vegetables that grow above ground are best, small portions of protein.

3/ It's better to feel a little bit hungry after eating, than full.

4/ Alcohol in excess is bad news.

5/ If I must have dessert, it is fruit or yoghurt, easily digestible.

6/ I have a glass of water with half a teaspoon of baking soda every night before going to bed. That damps down any residual stomach acid.

7/  A glass of water by the bed to sip on if my throat feels a bit raw during the night.

 

I'm not saying these rules will work for the OP. However, they do work for me.

Thanks!

 

[ricklev]

1 hour ago, xylophone said:

I suffered from gastric reflux for a few years and it became dangerous because I developed Barrett's oesophagus, which is often called a "precancerous" condition.

 

My doctor put me on omeprazole 40 mg in the morning and the same in the evening for about six months and then wound back the dosage.

 

I also learned what foods exacerbated the problem, namely: – red peppers, onions, milk chocolate and a few others, and stayed away from them.

 

I continued with the omeprazole for a couple of years and then I discovered d-limonene capsules, and took those for a few weeks and my condition completely disappeared, and I have not taken omeprazole for many years now, although I do keep some on standby, just in case.

 

I went back to NZ and my doctor did a gastroscopy on me and was absolutely amazed that my Barrett's oesophagus had disappeared, so I told him about the d-limonene, and he actually ordered some online for a friend of his – – yes that's absolutely true, because despite what this friend was doing he was still suffering a bit.

 

If you do a bit of digging around on d-limonene, and don't be put off by the fact that in one of its forms, it can be a very good cleaner!!, You will find some references to the treatment of gastric reflux and similar.

 

Best of luck, and I did note that another poster has mentioned about raising the head of your bed a couple of inches, and that helped for me also

Thanks!

 

[Sheryl]

Nobody specifically specializes in this. But any good GI doctor can treat it (for that matter most people can treat it on their own). They can also confirm the diagnosis though many are more inclined to treat empirically than bother.

 

8s your issue to confirm a suspected diagnosis, or to treat known  condition?

[ricklev]

Just now, Sheryl said:

Nobody specifically specializes in this. But any good GI doctor can treat it (for that matter most people can treat it on their own). They can also confirm the diagnosis though many are more inclined to treat empirically than bother.

 

8s your issue to confirm a suspected diagnosis, or to treat known  condition?

Thanks Sheryl.

 

So the third ENT I went to in the last month finally did an endoscopy and said there were clear signs of acid and inflammation and probable silent reflux.  He suggested Prevacid (said it would be a little better than omeprazole) but said it is only effective in 40 percent or so of his patients.  That was in Chiang Mai at Chiang Mai Ram hospital, but I actually live in Bangkok.

 

Anyway I have raised my bed and am mostly doing the "Acid Watchers" diet, although I can't really tolerate swallowing food.  Liquids are OK.  

 

I don't want to take the Prevacid or any PPI and hope to find a doctor that can help me make educated decisions and do whatever is needed regarding testing as the next step.  That is not easy.  Any suggestions for a specific doctor?

[rumak]

if anyone is inclined to try "natural"  remedies........ baking soda works wonders for me.   

 

if google it go past the paid for warnings and read some natural health sites

[xylophone]

36 minutes ago, ricklev said:

I don't want to take the Prevacid or any PPI

Of course that decision is up to you, but what I can say is that omeprazole (a PPI similar to Prevacid) really did help my condition, and without it I don't know what I would have done, and the d-limonene which I took later on really was the clincher.

 

Don't be afraid of PPIs, and you don't need to be on them for life, although my doctor was okay with me being on them for a couple of years.

 

What really persuaded me to take PPIs and make a change in my lifestyle (getting out of the extremely stressful job I was in) was when he told me that if I carried on the way I was, then I could well be dead from esophageal cancer within a year or so.

 

So I resigned and took time out for myself, and decided to come over and live in Phuket, and I don't suffer from this any more, thankfully.

[ricklev]

21 minutes ago, xylophone said:

Of course that decision is up to you, but what I can say is that omeprazole (a PPI similar to Prevacid) really did help my condition, and without it I don't know what I would have done, and the d-limonene which I took later on really was the clincher.

 

Don't be afraid of PPIs, and you don't need to be on them for life, although my doctor was okay with me being on them for a couple of years.

 

What really persuaded me to take PPIs and make a change in my lifestyle (getting out of the extremely stressful job I was in) was when he told me that if I carried on the way I was, then I could well be dead from esophageal cancer within a year or so.

 

So I resigned and took time out for myself, and decided to come over and live in Phuket, and I don't suffer from this any more, thankfully.

Thanks.  What is the actual brand/name of the supplement you are taking which contains d-limonene.  It's not so clear when Googling it.

 

[hughrection]

28 minutes ago, ricklev said:

Thanks.  What is the actual brand/name of the supplement you are taking which contains d-limonene.  It's not so clear when Googling it.

 

Try JAPANESE AS HITABA. (all one word)

Edited May 29, 2022 by hughrection

[Sheryl]

2 hours ago, ricklev said:

Thanks Sheryl.

 

So the third ENT I went to in the last month finally did an endoscopy and said there were clear signs of acid and inflammation and probable silent reflux.  He suggested Prevacid (said it would be a little better than omeprazole) but said it is only effective in 40 percent or so of his patients.  That was in Chiang Mai at Chiang Mai Ram hospital, but I actually live in Bangkok.

 

Anyway I have raised my bed and am mostly doing the "Acid Watchers" diet, although I can't really tolerate swallowing food.  Liquids are OK.  

 

I don't want to take the Prevacid or any PPI and hope to find a doctor that can help me make educated decisions and do whatever is needed regarding testing as the next step.  That is not easy.  Any suggestions for a specific doctor?

This is an excellent GI specialist:

 

https://www.bumrungrad.com/en/doctors/Parit-Mekaroonkamol

 

 Doctor might advise gastroscopy, even though your ENT did an endoscopy, in order to check the condition of your esophagus and stomach. In particular, changes to the esophagus are a worry. If the reflux was bad enough to seriously inflame your larynx, it may have done a number on the esophagus as well and this if can sometimes lead to cancer later if not identified and addressed.  Gastroscopy will also show whether you have a hiatal hernia and if so, how severe it is. (In very severe cases, surgery is soemthimes necessary. Most cases can be managed conservatively).

 

Any doctor  is  going to  advise PPIs. If your larynx is very inflammed, as sounds like it is,  I think you have no choice but to take PPIs until it has fully subsided. Once tissue is inflamed, whether in the larynx, esophagus or stomach, exposure to stomach acid will further aggravate it and healing is impossible. I don't like PPIs either, but had not choice but to take them for gastritis/ulcers on 2 occasions. I got off them once the problem was resolved. And yes, it was difficult (rebound hyperacidity) so I had to taper it. But possible.

 

If after making all necessary lifestyle modifications (see below) the problem persists, and especially if you notice that you have a lot of gas coming up, then the possibility of small intestine bacterial (or fungal) overgrowth might be worth investigating, but do not go down that rabbit hole until you have covered all other bases.

 

In terms of lifestyle changes, you may know them already but no harm in repeating:

 

- elevate the head of your bed or use a GERD pillow so that your upper body is elevated while in bed

 

- do not eat anything for 2 hours before lying down

 

- eat small amounts at a time. Avoid overfilling the stomach. If hungry with smaller portions, take more frequent meals rather than large portion at once.

 

- minimize caffeine intake (very important, it loosens the sphincter and contributes to reflux)

 

- if you smoke, stop. Also very important - smoking also weakens the sphincter and contributes to reflux.

 

- If at all overweight, weight loss will definitely help.

 

- there may be specific foods which set off reflux in you, this is very, very individual. Since you have "silent" reflux this will be harder for you to determine than it is for those who have symptomatic GERD. However if you can pay close attention and try to spot any gas eructions - even very small ones - and then link that to any specific foods, avoid or minimize them. The likely mechanism when specific foods seem to cause reflux is excess gas formation putting pressure on the stomach.

 

In cases where hiatal hernia is present some people report relief by taking a large glass of warm water then jumping up & down (you can keep toes on the floor and just lift the heels, but come down hard) a few times before eating. The idea being to get the stomach back down where it belongs first so you don't end up with food stuck in a portion of stomach that has pushed up into the thorax as that will put pressure on the sphincter and easily lead to reflux. This advice only for those with hiatal hernia, won't do any good if you don't have one.

 

[ricklev]

35 minutes ago, Sheryl said:

This is an excellent GI specialist:

 

https://www.bumrungrad.com/en/doctors/Parit-Mekaroonkamol

 

 Doctor might advise gastroscopy, even though your ENT did an endoscopy, in order to check the condition of your esophagus and stomach. In particular, changes to the esophagus are a worry. If the reflux was bad enough to seriously inflame your larynx, it may have done a number on the esophagus as well and this if can sometimes lead to cancer later if not identified and addressed.  Gastroscopy will also show whether you have a hiatal hernia and if so, how severe it is. (In very severe cases, surgery is soemthimes necessary. Most cases can be managed conservatively).

 

Any doctor  is  going to  advise PPIs. If your larynx is very inflammed, as sounds like it is,  I think you have no choice but to take PPIs until it has fully subsided. Once tissue is inflamed, whether in the larynx, esophagus or stomach, exposure to stomach acid will further aggravate it and healing is impossible. I don't like PPIs either, but had not choice but to take them for gastritis/ulcers on 2 occasions. I got off them once the problem was resolved. And yes, it was difficult (rebound hyperacidity) so I had to taper it. But possible.

 

If after making all necessary lifestyle modifications (see below) the problem persists, and especially if you notice that you have a lot of gas coming up, then the possibility of small intestine bacterial (or fungal) overgrowth might be worth investigating, but do not go down that rabbit hole until you have covered all other bases.

 

In terms of lifestyle changes, you may know them already but no harm in repeating:

 

- elevate the head of your bed or use a GERD pillow so that your upper body is elevated while in bed

 

- do not eat anything for 2 hours before lying down

 

- eat small amounts at a time. Avoid overfilling the stomach. If hungry with smaller portions, take more frequent meals rather than large portion at once.

 

- minimize caffeine intake (very important, it loosens the sphincter and contributes to reflux)

 

- if you smoke, stop. Also very important - smoking also weakens the sphincter and contributes to reflux.

 

- If at all overweight, weight loss will definitely help.

 

- there may be specific foods which set off reflux in you, this is very, very individual. Since you have "silent" reflux this will be harder for you to determine than it is for those who have symptomatic GERD. However if you can pay close attention and try to spot any gas eructions - even very small ones - and then link that to any specific foods, avoid or minimize them. The likely mechanism when specific foods seem to cause reflux is excess gas formation putting pressure on the stomach.

 

In cases where hiatal hernia is present some people report relief by taking a large glass of warm water then jumping up & down (you can keep toes on the floor and just lift the heels, but come down hard) a few times before eating. The idea being to get the stomach back down where it belongs first so you don't end up with food stuck in a portion of stomach that has pushed up into the thorax as that will put pressure on the sphincter and easily lead to reflux. This advice only for those with hiatal hernia, won't do any good if you don't have one.

 

Thank you!  I appreciate your help. 

[xylophone]

2 hours ago, ricklev said:

Thanks.  What is the actual brand/name of the supplement you are taking which contains d-limonene.  It's not so clear when Googling it.

 

Jarrow Formula d-limonene 1000mg capsules, which can be bought from Amazon, eBay and other sites. And I no longer need to take it now, as I don't suffer from reflux of any sort. Just a note here.........when you first start taking the capsules you will experience "orange burps" for a few days and these taper off soon then disappear.

 

[ricklev]

Sheryl, can you recommend a GI doctor at Saint Louis Hospital or do you suggest spending the money for Bumrungrad because of the quality of care or that particular doctor?  I will spend the money if need be but the last couple times I went to Bumrungrad it felt a bit painful when I got the bill, especially when compared to Chiang Mai.  

 

Edited:  Just spent a few minutes looking at the listed doctors at Saint Louis.  I will just go see Dr. Parit as you suggested.

 

Edited May 30, 2022 by ricklev

[ricklev]

On 5/29/2022 at 9:49 PM, Sheryl said:

This is an excellent GI specialist:

 

https://www.bumrungrad.com/en/doctors/Parit-Mekaroonkamol

 

 

 

Thanks again Sheryl!  I always appreciate your help.  I saw Dr. Parit and he performed an upper GI endoscopy and a colonoscopy.  He was definitely the right choice in all aspects! (Nothing major was discovered.)