My Friend’s Endoscopy

It’s always great to get an email from an old friend, isn’t it?  Today I got one from a close friend from college who now lives across the country.  He asked me for some GI advice, and did his email bother me!

Actually, the reason it bothered me was not what you might be thinking.  I am very happy to educate people about GI issues, especially my friends.  That’s what I do for a living.  The reason I became so frustrated was not at all because he asked me for “free” advice.  It was the content of the email that frustrated me.  It frustrated me so deeply that I called him and asked him if he wouldn’t mind me blogging about it.  He’s a writer so he had no problem with it.  To keep this blog “HIPAA compliant,” we’ll call him Alan.

Alan had his endoscopy today.  Well, he actually had both an upper endoscopy and a colonoscopy today.  Alan is 39 and healthy.  And here is the strange thing…he has no GI symptoms.  He doesn’t have heartburn.  He swallows fine.  His bowels give him no problems, and he has no abdominal pain.  Nothing out of the ordinary.  But Alan’s dad died of esophageal cancer recently.  And some distant relative might have had some polyps, or something else like that; he didn’t know.

His endoscopy showed a small hiatal hernia and some “mild acid irritation”.  His colonoscopy was normal.  He was given several pieces of information and recommendations:

  1. Take Prilosec or something like it every day before a meal.  (Remember, he has no symptoms.)
  2. He should stop caffeinated soda because that can make things worse.
  3. Come back in 5 years for another check.  He wasn’t sure if this meant that he was supposed to be for an endoscopy, a colonoscopy, or both.
  4. If things get worse, it could lead to cancer.

He seemed generally unbothered by everything, except for that one thing at the end…he might get cancer.  And caffeinated soda could make it worse, and if things get worse, that could mean he gets cancer.

Caffeinated soda is, in his words, his “beverage of choice”.  He couldn’t care less about taking the medicine or returning for another procedure (or many more procedures).  He hates caffeine-free soda, and he only cared about having to cut out the soda altogether.  His exact quote was, “how can I still drink soda and not get cancer?”

All of a sudden, he went from a healthy man to someone who has to take a medication every day, has to have periodic screenings, and can’t enjoy his soda, all because of a little “acid irritation” in his esophagus.

That is really not even this worst part of it at all.  My question was really if he should have had either procedure today at all.  The answer, it turns out, depends on who you ask.   I submit that many doctors would have done the same thing for Alan.  But that doesn’t make it the right way, or (as we like to say) the “evidence-based” way.

Alan got those procedures for many reasons.  Unfortunately those reasons were not based on as a strong medical rationale as much as you would think.  And now, Alan has to face the fact that he has been “medicalized.”

In my next blog, we’ll see just why he REALLY got his procedures and try to figure out if he can ever drink soda again.

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About Ryan Madanick, MD

I am a gastroenterologist at the University of North Carolina School of Medicine, as well as the Program Director for the GI & Hepatology Fellowship Program. I specialize in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD. I can be followed on Twitter: @RyanMadanickMD (he/him)
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4 Responses to My Friend’s Endoscopy

  1. Terry says:

    Congratulations on starting the blog, by the way…

    And thanks for bringing this issue up. I’m guessing you’ll address this in more detail in an upcoming post – but I can’t really imagine any medical reason an asymptomatic 39-YEAR-OLD (!) would end up with an upper and lower GI, even given his family history! I can’t count how many times I’m faced with a patient who was “medicalized”, as you put it, by a colleague – tests done that weren’t needed, and the patient scared unnecessarily. And if I see it that often in private practice, I can only imagine how often you run into it at an academic institution! Frustrates the heck out of me, too.

  2. Janet says:

    His mother made him do it…family history goes back a lot further than revealed on both sides…as for the meds, 1 pill a day might be all that is needed…if his dad was diagnosed in his 20’s, he would still be here! & he didn’t smoke or drink either! Carbonated sodas 3 or 4 times a day is a bit much in my humble motherly opinion!!!
    Love you anyway Doc. XOXO

  3. Pingback: Lessons from My First Six Months at the Crossroads of Healthcare and Social Media | Gut Check

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