Anyone with Acid Re flux / GORD?

[SheepPilot]

Hi everyone,

Before i embark on my journey to becoming a pilot I would like to know if i can get a 1st Class Medical with the condition. I'm taking medicine for it and its been under control for about 6 months now. Other than this I have no problems what so ever. Will this stop me from getting a medical?

Cheers.

[mothminor]

Hi Sheep,
I`m sure others who are AME`s/doctors will give you the correct advice (along with your GP).
I developed GORD in my 30`s and continued flying commercially, with some discomfort, for many years.
Flying was never a problem (I didn`t do any negative g aero`s), but the airline lifestyle was.
Constantly changing shift patterns, not being able to eat when arriving at a hotel (due to needing several hours between eating and being able to lay down).


Eventually on Omeprazole I`m back to almost normal. My AME was happy with this medication controlling my condition, (I`m now retired).
If you have had acid reflux for any length of time, I`m sure medics will advise having your osophagus checked for any cell damage.

[gingernut]

The usual scheme of things is to try and rule out anything nasty (like gastric/oesophageal cancer.) This is a very rare cause of problems.

This is usually quite a simple process, involving a doctor listening to your symptoms, he or she may feel your abdomen, and even send you for some blood tests.

The amount of "digging" he'll do will depend on your other "risk factors" the main one being your age. He will also ask about "red flags" (eg weight loss, food sticking in the gullet etc)

If he has any doubt, he's likely to send you for an "endoscopy." (Camera down your tum).

Usually symptoms are managed with ppi's (something like omeprazole) or lifestyle changes.

PPI's shouldn't be a problem, (but obviously ask your AME.) Regular "high" doses have been linked to dehli beli.

[Loose rivets]

I became a gannet at about 30 years of age. For gannet, read pig. I have no idea how I could consume the food I did. I started to pay the price.

One day in Texas, a friend of family gave me a Tagamet. (Cimetidine) it changed my life - but allowed me to not be afraid of going to bed after a late dinner. I cringe now at my behaviour.

Recently, I've given up wine and lost 40lbs - but it's a bit late! I wish I'd done it years ago, but maybe next life.

Diet is important but not going to bed with too much (or perhaps too little) food is vital. It takes a long time to train one's systems to calm down at night. For much of my life, without 'Tags' I'd start eating myself at 05:00.

Once you've got that sore patch in there, it's difficult to heal and could well lead to much more serious issues.

I've got to take my own advice now. It seems Cimetidine is being pulled off the chemist's shelves. To this day I'm not confident I can really be free of the morning burn.

I'm aware of the PPI type drugs but just found the Tags acted exactly when I needed them.

P.S. Anyone taking stuff like Ibuprofen needs to be aware not to take it and lie down. I was astonished to find a neighbour did that every night for years and was surprised to find he'd caused some serious problems.

[gingernut]

Quite interesting perspective LR.
In the "old days" if you got heartburn through eating too much curry, and drinking too much Stella, you had several choices.

1) Take a crap medicine ("raft" ) that didn't work.
2) Undergo horrendous surgery, which, at the very least, tended not to work, or at the worse, killed you.
3) Stop eating curry and drinking Stella.


Now with the advent of PPI's, it allows us to continue (3)

A "lifestyle" drug perhaps ??

Of course I'm being a bit simplistic here.

For the information of my over seas friend's, "Stella" is the drink of choice for "lager louts" such as myself.

[Lou Scannon]

A cautionary tale for those who experience acid reflux or heartburn:

I retired some 16 years ago. For the last 30 years I have been experiencing heartburn and always had a bottle of Gaviscon next to my bed or anti-acid tablets in my nav bag and car glove box.

I finally told my doctor about this and was referred to a Gastroenterologist.

It seems that the NICE protocol requires a gastroscopy peep down the oesophagus. Samples were taken and and these revealed that I had high grade displaysia caused when cells from my stomach work their way into the lower oesophagus.

The bad news is that these are pre-cancerous.

They have been scraped away and I am now subject to an annual gastroscopy to make sure that they have not returned.

So the moral is: Don't just stand there, if you have regular heartburn, Do something!

...and don't worry about the tube down the throat: With an injected sedation it is absolutely no problem.

[mothminor]

Totally agree Lou,


I was diagnosed with Barrett’s esophagus following a camera job (definitely go for the sedation).
I`m now checked with 3 yearly gastroscopy/biopsies.
Hence my daily omeprazole to prevent further damage.

[Loose rivets]

I was a judo fanatic, even in my early thirties. Hanging by one's ankles doing 'gut-busters' seemingly did just that. A small bulge under stress near the solar plexus was enough evidence but I had the tube anyway.

Sloped off to a pin-strip-suited man in his charming house. The Rivetess watched as he offered me something to calm me. I didn't know much else but while it was kicking in, he said, "If it doesn't work I'll get a nurse to sit on your face". I grinned . . . and fell asleep.

Yes, it was a HH. Fifty quid please. That was a lot of money back then. Anyway, when I phoned to say I'd pop in to pay, the lady, who seemingly doubled as nurse and secretary, said, 'You don't own anything. It was free. What he said. I don't know why he says things like that. It's free.

Who was I to argue. I wonder if he ever knew.

[gingernut]

The endoscopy question is an interesting one.

I'm a bit out of the loop, perhaps some GI bod's could chip in.

Questions I would need to know the answers to:

How long have you had the symptoms ?
Are there any potential "sinister" symptoms eg weight loss, persistent vomiting.
What are the risks of complications of performing an endoscopy, and what is the ball park figure?
What is the risk of those complications killing me?

I think ultimately,
will this investigation make a difference to this patient ? or should I just prescribe the ppi anyway ?

I am, of course, looking at this from a population perspective, but worth bearing in mind that most of the population will suffer "heartburn/reflux" (whatever you want to call it, I'll call it undiagnosed dyspepsia for now).

The figures I used to work on were 1:1000 for perforation through endoscopy, 1:10000 for death through endoscopy, 1:250000 missing a gastric cancer for not doing endoscopy (with no "red flags")

Like I say, things have moved on, and I am aware of the new NICE 2 week stuff for us in Primary Care, just interested if any other GI experts had an opinion.

[mothminor]

gingernut,


I understand your reservation about performing an endoscopy for anyone with acid reflux.


I am not a doctor so can only comment on my own condition, diagnosis and treatment.
As I understand it my Barrett's oesophagus is a pre-cancerous condition, which presents no symptoms.
I also understand that about 1 in 20 with Barrett`s will develop oesophageal cancer but if the cells in the oesophagus are monitored, treatment can be given to prevent (hopefully) cancer developing.


I am monitored as part of a research program at Addenbrooks (Cambridge), with a 3 yearly endoscopy. If the biopsy`s taken indicate any change, then more frequent checks and or treatment can be given.


I also recently took part in a trial (soon to be available in GP surgerys, I think) of a sponge to take cell samples without the need for an endoscopy.
The sponge is coated with a gell and attached to a string.
You swallow it, wait until the gell has dissolved, then it is pulled out scraping some cells with it.
Sounds horrible and I found it most unpleasant but only for a few moments.
This will enable cell samples to be taken easily (and cheaply) by a GP to check for Barrett`s.


As you said, I hope some GI experts will comment.

[gingernut]

Thanks for the insight mothminor.

As I say, I'm out of the loop, last time I was anywhere near this field, there was some debate as to the value of (endoscopic) surveillance in Barretts.

Thankfully, things have moved on.

What I can provide is a primary care perspective. Two ends to the continuum really, scope no-one, or scope all.

We are, of course, somewhere in the middle, and the science is getting getting better all the time.

Good luck with your treatment.

[Lou Scannon]

With hindsight Gingernut, had I been sensible and reported the gastric reflux after a few years and not 30, I might have been prescribed a proton pump inhibitor such as Pantoprazole and the subsequent damage might never have occurred.

If on my routine check, I still have traces of "Barrett's", I will get a radio frequency ablation to sort it, but as that will no doubt lead to some stricture that will require dilations, I am hoping that all will be well.

[Loose rivets]

Many years ago there was a snippet in the Sunday Times saying a leading authority on heart disease had been found dead in his hotel room. He'd died of a heart attack but had a pack of antacid tablets beside him. It was that memory that made me kill the protagonist in my novel by the same denial.

Those tubes of big white tablets. I'd gone that route before I discovered Tagamet. It was a bit like having a house that's on fire and just buying bottles of water to dull the flames.

[Nervous SLF]

I was on Omeprazole 40Mg dose for just over 3 years after being diagnosed with a hiatus hernia and for the first 3 months I took 2 capsules everyday.
By the end of those 3 years they had stopped working very well so much so that I was getting recurring reflux problems and was also coughing a lot
during the night and the next morning. For some reason that I am unable to rationally explain I decided that I would just stop taking them. Within a few
days "bingo" my reflux problem stopped.The coughing also stopped and I had the best nights sleep for a long time. To check if that was a good idea I
took one each night for 2 nights and my coughing returned.
I then made an appointment to see my GP and after listening to me, asking some questions etc he agreed that I could stop taking them but asked me
to see him when my problem reappeared. I am ecstatic to report that it hasn't so far touch wood and whistle.

.

[Tee Emm]

In my case at age 84, I had open heart surgery six months ago for mitral valve replacement and was found to also need a double bypass. Besides other medications after the successful operation, I was given instructions to take a daily Esomeprazole 40mg tablet each day.
About four months later I asked my GP about the need to continue taking this tablet. He said to stop taking it and see if any problems arise. So I did.
It is now two months since I stopped taking my daily dose of Esomeprazole and no problems that I am aware of.

[Flyin'Dutch']

@ the OP; simple GORD managed with a proton pump inhibitor is normally not a problem in obtaining a Class 1 Medical Certificate.

Each case is of course looked at individually so you will have to discuss it with the doctor at your initial Class 1 examination.

[olympus]

I suffered from reflux oesophagitis on and off for many years (since a child) without knowing what it was or even that it could be treated. Eventually my wife (a nursing sister) convinced me to take advantage of the company-provided BUPA and get it checked out. Following gastroscopy (under sedation) and an xray (barium meal and swallow) I was diagnosed with hiatus hernia. Subsequent treatment with one 20mg Losec (omeprazole) a day has kept me symptom-free for twenty years.

Declared this to my AMEs (I used two different ones randomly) and was told 'not to worry, it's not a problem for flying'. I don't drink Stella but I do still enjoy a curry!

[Union Jack]

A great deal of useful information here and, although not a sufferer, I am most grateful to those of of you have highlighted your personal experiences.

I only wish that my elder brother had had access to such helpful information.

LR's Once you've got that sore patch in there, it's difficult to heal and could well lead to much more serious issues is sadly all too true and a warning to be heeded.

Jack

[Mechta]

If I don't have access to my normal medication (Omeprazole) for any reason, I take half a teaspoonful of bicarbonate of soda in a glass of water, and at night keep a glass with some stirred in within reach. It a heck of a lot better than nothing. I've tried Gaviscon but it made me nauseous.

Regarding the endoscopy, it is very, very uncomfortable if you just have the localised throat spray anaesthetic, I must have been in quite a state, as the nurse was stroking my head as if I was a favourite dog taking its last breaths. The upside of the spray anaesthetic is that you can leave the hospital the within half an hour of the inspection and are able to drive home.

A strange side effect of the inspection for me was caused by the air that is blown down a tube on camera probe. As an asthmatic, having air blown down my throat was equivalent to supercharging me, and must have put a lot more oxygen into my blood than I get from normal breathing. I felt really quite invigorated as I left the hospital.

[olympus]

An unexpected side effect of my gastroscopy was an unpleasant chest infection. This manifested itself when I started coughing blood as I lifted down my case on the 146 after positioning to ABZ on my first day back at work after the gastroscopy. This was particularly worrying as my only previous experience of this was when I had a pulmonary embolism following DVT so I was fearing the worst - heparin drips, long-term warfarin, frequent visits to the phlebotomist and probably the end of my flying career.

Fortunately, 'just' an infection was diagnosed and a course of Amoxil cleared it up. Phew!