Case study

My symptoms

I had been experiencing pain about an inch beneath my breastbone. It varied in intensity and was particularly bad immediately after drinking hot liquids or wine. After most meals, I would suffer mild heartburn. My doctor initially prescribed a two week course of Omeprazole, which alleviated the symptoms, but when I stopped the tablets the pain came back after a few days.

My doctor suspected a hiatus hernia (hiatal hernia) and sent me for a gastroscopy.

Before the gastroscopy

I was not allowed to take Omeprazole for two weeks before the examination. The pain came and went but I got some relief from Gaviscon liquid. As the day of the gastroscopy approached, I became more nervous. I could not comprehend how I could possibly swallow a tube containing a camera!

On arrival at hospital

I arrived at hospital at 11.15am. After a short wait, I was taken into a room to discuss the procedure with a nurse. She was most reassuring, in fact she explained that she herself had had three gastroscopies, and like most people, she said it was not painful, but was uncomfortable.

Sedation or no sedation?

So it was decision time over whether to have sedation or not. Up until this point, I was sure I was going to have sedation, but the nurse was so reassuring about the procedure I had started to relax a little anyway. I had also just walked past other patients “in recovery” after their sedations – they were out for the count – and I decided a few minutes of discomfort was better than spending the rest of the day asleep.

I decided against sedation.

The gastroscopy room

After another short wait, I was finally called in to the procedure room. The doctor performing the procedure introduced himself, and he was assisted by three nurses. The room was like a small operating theatre, with subdued lighting.

Local anaesthetic spray

The doctor sprayed a local anaesthetic (pharyhngeal lidocaine) into my throat. It had an unusual taste – a bit like burnt bananas! Powerful stuff, I could no longer feel the back of my throat. When I swallowed, it felt like I wasn’t really swallowing, there was no sensation at all, such was the strength of the anaesthetic.

Preparation

I lay down on the operating table, on my left side. A plastic bite guard was placed between my teeth and the doctor approached me to start the examination.

Passing the endoscope into my stomach

The endoscope was passed through a hole in the bite guard and the doctor asked me to swallow. This was difficult, because the local anaesthetic makes it feel like you cannot swallow. As I swallowed, the endoscope was pushed down my throat. For about three seconds, I was choking, it was quite unpleasant (but not painful, remember). I was very tense, and the nurses were holding me down as I tended to move around.

Once the endoscope had passed further into the oesophagus (food pipe) the choking stopped. There was still an uncomfortable sensation but it was tolerable. The only further discomfort was when the endoscope touched the inside of the stomach – this produced a retching reflex but it wasn’t too bad.

The nurses urged me to relax and just focus on my breathing, and this was very effective.

I was unable to watch the procedure on the monitor as I was facing away from it.

“Good news”

After about one and a half minutes, the doctor said to me “It’s good news – you have a small hiatus hernia”. Whilst some may not consider this really good news, it is certainly better than some of the other diseases that could have been causing the symptoms. The doctor then said he was starting to remove the endoscope. From start to finish, the procedure lasted about two and a half minutes.

After the gastroscopy

With the endopscope removed, I sat upright and immediately did some very large belches as air had been blown into my stomach to assist with the procedure. This brought up a lot of saliva / phlegm which I spat into a tissue.

I was taken into a side room and about ten minutes later a nurse came in to discuss the results. She confirmed they had discovered a hiatus hernia and gave me a report sheet, which included photos of my insides!

Treatment

A few days later I went to see my general practitioner to discuss treatment options. He put me back on Omeprazole which relieved the pain completely within two days. I am to take an intensive course of tablets for 28 days, then take them “as required”.