I recently had a colonoscopy and upper G.I. scope. My results showed diverticulosis in the sigmoid colon. As I am reading through the results it also states that there is mild mucosal abnormality characterized by nodularity in the gastroesophageal junction. I also have a hiatus hernia that didn’t show much concern to the doctor. The recommendation was to use 20 mg of Prilosec daily. This has helped minimally. I have extreme back and abdomen pain associated with continuous burping on occasion when the abdomen in rubbed. My questions are many but I guess I am wondering most if by just increasing the Prilosec is that going to be enough? Shouldn’t the upper G.I have showed if I really do have a problem? I am miserable with the back and abdominal pain, which has intensified over the last month. What would you recommend for me to do at this point?
Nodularity of the gastroesophageal junction (GEJ) can be something of a concern. It just depends on exactly what was seen by the endoscopist. You might ask if he biopsied this area and what these biopsies showed. If there is indeed nodularity in that region, biopsy is indicated. Dr. Chandrasoma wrote an excellent article on the importance of a biopsy that I recommend you read: The role of biopsies in the diagnosis of GERD.
The upper endoscopy rules out certain problems in the esophagus and stomach, but it is a poor test for reflux. Eighty percent of patients with reflux have a normal endoscopy, and yours was not even normal! This was discussed in our article: What to expect from an upper endoscopy.
As we have stated throughout RefluxMD, pH testing is in order to definitively determine if you indeed have reflux. If this study is positive, increasing Prilosec to twice a day may help your symptoms. However, if the pH test shows you have reflux and the medications do not resolve symptoms to your satisfaction, consideration of a surgical approach is an option. This argument was made in my article When should I consider surgery for acid reflux?
I would contact your endoscopist to find out what he meant by nodularity at the gastroesophageal junction and if he took biopsies. I really have no way of knowing, but this sort of terminology makes me think of pre-cancerous conditions, Barrett’s esophagus or Barrett’s with nodularity. Both of these need attention, so it is worth clarification.