Now, the burping has slowed right down. Not gone, but under control.
As an extra bonus, we decided to try calculating how many incessant burps I belched, correcting for sleep time and slower moments. Turns out I burped approximately 50,000 times within a week.
The running theory:
Crohn's flare-up triggered an intestinal Hereditary Angioedema episode that mimicked the Crohn's symptoms, then a dental appointment took that swelling episode further by triggering more swelling in my stomach and esophagus, which caused the burping. THEN, the burping was so 'violent' that it caused esophagitis (inflammation and ulcerations in my esophagus), which, in turn, caused more burping.
Having multiple diseases is a complete mind meld when these kinds of things happen.
Here is the more detailed story:
Part I: Crohn's Flare
My Crohn's Disease has become fairly predictable over the past few years. My 'normal' is bathroom breaks 8-12x per day, plus 1 or 2 in the night. It is always loose or liquidy and has been that way for twenty years. When I start feeling intestinal pain, from various triggers, there are a few things that happen. The frequency jumps to about 16x per day, sometimes more, I reduce to a soft food and full fluid diet, and when the blood shows up, that's a pretty clear sign that the flare is almost over. The last several flares have lasted anywhere between one and three weeks, usually not longer than that unless something else is wrong. I should have realized something additional was going on when the blood showed up, stopped, but my other symptoms became worse and even soft foods were causing major problems.
Part II: Intestinal Swell from Hereditary Angioedema
A Crohn's flare has caused an angioedema attack before. The intense increase in inflammation has been known to cause swelling in my intestines and even my bladder, plus any external swelling in that general area. Intestinal swells mimic the symptoms I get with Crohn's Disease: more frequent bathroom breaks, abdominal pain, difficulty keeping food in, nausea, sometimes vomiting, and sometimes blood. .
Part III: Dental Appointment
The day before the burping started, I had a dental appointment. Dental appointments are notorious for triggering HAE episodes, but because I opt for getting Nitrous Oxide during these appointments along with a benzo, I have only ever had minor swelling episodes. Plus, I make sure to schedule my dentist appointments the day after my regularly scheduled prophylactic injections for HAE. I felt more relaxed at this specific appointment and felt I was in the clear. My usual episode from these appointments (which have been rare) include airway swelling and sometimes facial swelling
Part IV: Esophageal and Stomach HAE Swell
So I have had many swelling episodes, and they rarely present the same way more than a couple of times. The throat swells that I have had that have affected my breathing have some pretty specific triggers and symptoms, but my internal swells - which cause the most trouble - have been widely varying. When the burping started, I thought it might be from the Nitrous Oxide and Oxygen - that maybe I swallowed a bunch of that air while my mouth was wide open. It wasn't until I had to let my hematologist know about the urgent sigmoidoscopy that I even THOUGHT about the burping maybe being caused by HAE. After my sigmoidoscopy (technically a pouchoscopy) showed a very healthy looking J-Pouch, I started to think that my HAE may have more to do with things - including the Crohn's-like symptoms and potentially the burping. I called up to the clinic about getting an IV treatment of my HAE medication. Although I had had several prophylactic sub-cutaneous injections within this burping fiasco, many severe HAE episodes will only be settled by IV intervention. I thought it was worth a shot.
Part V: Upper Endoscopy
Luckily, the gastrointestinal specialist who performed my sigmoid recognized that the burping and its cause would be better understood by an upper endoscopy. The burping could be caused by a host of problems that would most likely be originating from the esophagus, stomach, or duodenum. Of course, before sticking a camera down my throat, I would require the IV HAE medication anyways. So I got my IV treatment, then was brought in for an endoscopy. The second that that conscious sedation hit me, I was out. Normally I remember some of the procedure, but not this time. The incessant burping was so exhausting that I was happy for the mental break. The endoscopy showed Grade B esophagitis. It is considered to be fairly mild, with some ulcerations between 5mm-10mm. The stomach and duodenum were both fine (apart from some fresh and old blood sitting in the stomach from the esophagitis) and they did reflexion tests which were normal - so that was fantastic. No sign of a stomach ulcer or a hiatal hernia. It was unclear, though, whether the esophagitis was the cause of the burping or the result of the burping, but the esophagitis likely did cause some burping.
So I was given a requisition to do a stool sample to check for H. Pylori, just in case, and prescriptions for medications that will help heal the esophagus.
When I went home, the burping had slowed to approximately every 5 or 10 minutes instead of seconds. Over the next two days, the burping just kind of died off and I didn't feel as though my guts were constantly filling up with air. I definitely still feel fragile and like if I make a wrong move it might start right up again, but I am feeling as though I am on the mend. This leads me to think that this was a severe HAE episode, so when I got my IV treatment before the upper endoscopy, it was also treating the source of the problem.
So now I know - if I start burping nonstop, go and get an IV treatment for a Hereditary Angioedema swelling episode.
What a whirlwind, and so complicated!
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