Continued reflux post Nissen Procedure

[mjb0925]

HI i am 20 year old male, 6'1 160 pounds, have always been active.  Last year i started to get a horse voice and always found myself clearing my throat, i got an upper GI done and my valve near my esophogus was open and i was diagnosed with acid reflux, I went on Nexeum for a few months and that seemed to help with the stuff in my throat although i never experienced any real "burning" sensation. I then started to get episodes where i would get a feeling of "fullness" and bloating in my stomache and chest where it would be tough to take deep breaths and this would bring on palpitations. It progessed and got worse and i started to get an acidic taste in my mouth along with endless belching,i was pretty miserable and could hardly eat anything without these symptoms occuring daily, I went to a GI doctor and decided to go ahead with the nissen wrap procedure, on Dec.19th i had that done and seemed to feel alot better within the first week while i was on liquids.  As i progressed to soft food and started moving around again i could feel air/gas from my stomach trying to get up past the wrap and it was somewhat painful. Within the last week or so i am starting to get the same feeling of my chest being "bloated" and i can feel the air comming up into my esophogus, this causes me to have heart palpitations and causes more burping to occur.  I do have recorded episodes of SVT of the heart and had a holter monitor but everything was normal, however it is very difficult to function and eat with this gas constantly filling my esophogus. I had a catskan of the chest a few months ago and it showed a slight hital hernia which was corrected during the nissen wrap but it also showed that my esophogus was filled with air and this is before i even felt the severe symptoms that i had prior to surgery and now again, is there anything that should be looked at to determine why all this gas/air wants to come up into my esophogus? i have continued to take Nexeum daily which doesnt seem to help at all with this. I also notice if i eat and then lie down i can actually hear my own heart beat it seems as though the esophogus is boating out and putting pressure on my heart but i am not certain. What should i try to do to find answers?
thanks
-Matt

[jaz1314]

I am recovering from Nissen Fundoplication. 3 weeks now and no meds and no reflux.

I am 46 and had sever reflux since I was 18. I had been diagnosed with a large hiatal hernia at 20. I've been on all the proton pump inhibitors ( Aciphex, Protonix, Nexium etc etc etc ) and while I woould get a couple months of releif, eventually the drug would stop wroking for me. My reflux began to reach a point where I would acutally have my stomach contents come up on me when I was sleeping only to breath it in and wake up in a panic gagging and choking with a horrible burning in my bronchial tubes. Extremely scary! Of course teh doc sauid, dont eat late, dont eat this dont eat that. Inother words, stop enjoying life! Since I am early to bed ( usually 9PM ) and not able to eat dinner until 7:30PM how can I possibly wait 3 hours + to go to bed? I couldnt. Then what to do when you are out? On vacation? For me this change in lifestyle was not in the cards. I went to see my GI again and he repeated the upper endoscope. No Barrets syndrome ( thank God!) but certainly inflammation of the lower esophogeal sphincter and the large hernia confirmed again. I asked about a surgical repair. He told me that is a last alternative, to which I replied "Im at the end of the line doc! Nothing is working anymore! " So I was referred out to a doctor in Wilkess Barre, PA at Surgical Specialists. Dr. Clark Gerhart. I was very impressed with Dr. Gerhart and asked everything I could think of havignread the horror stories on the net from people with bad experience getting a Nissen Fundoplication.

First of all, I would not let soemone do this surgery who ash not done MANY of them. Dr. Gerhart goes around the coutnry teaching others how to do them, laproscopically. He has done hundreds of them himself. e was very thorugh in advance of teh srugerry to make sure I was doign the right thing, he had me do a gastric emptying test ( to make sure food was passing through in a reasonable amount of time and not forcing a back up ) and an esophogeal manometry ( an unucomfortable but not unbearable test and very ncessary ) to make sure that the esophagus muscles were strong enough to be swallowing correctly. Mine were normal.

Secondly, realize that most people who have success with thier Nissen usually dont come back to post which is why you find more negatives than positives. I wanted to share my experience, even though its only been 3 weeks, Ive got some things to share while they are fresh in my mind.

I had my Nissen on Feb 20 2006. No surgical complications. Liquid diet for a couple days then started eating soft food.

My STRONG suggestion if you get this done. Do liquid as long as you can! You surgical area is swollen making the wrap even tighter than it will be once the swelling subsides ( usually after day 10 ) I made the msitake of eating soolids too soon and
ran into trouble when I didnt CHEW SMALLL BITES throguhly and take a small sip of WATER after each swallow. Food got stuck above my Nissen and I tried to wash it down with a glass of water thinking it had to wash through.  WRONG! In fact the glass of water made it worse because once there was a clog there, water which is non compressable filled my esophogus  and casued a spasm whci brought me to my knees! The pain was horrendous!! From the front below the rib cage all the way round to my back and lasted for about 35 minutes until the food and water finally passed. This happened to me a couiple more times in the first 10 days. The doc sent me for a swallow test and an upper GI which both showed the wrap was perfect and the liquid barrium passing into my stomach perfectly. The issues I was having were self induced.

Remember when you are eating to EAT SLOW! SMALL BITES! CHEW THROUGHLY! TAKE A SIP OF WATER AFTER EACH BITE! It is so easy when you start to feel better to fall back into your regular pattern of eating. You cant- yet.

So now a little over 3 weeks later, Im feeling sooooo much better. NO REFLUX! Food is going down fairly easy now. I did notice that my stomach capacity is less and this is due to the fact that tehy used part of your stomach to do the wrap, but Ive been told that will stretch out again. Be careful not to eat too much! Stop when you feel full. I did have bad gas for 17 days but treated it with Gas EX but what REALLY helped was wearing looser pants. Remember that your anatomy has been recontructed, things will be moving around a bit.

I wish everyone luck with resolution for their GERD, its a horrible way to live. And if you had a Nissen that hasnt worked out right, maybe you want to see another doctor who is more experienced at getting it "just right" becasue it has to be "just right" too loose or too tight = no damn good. Good luck to all!

PS I can burp just fine! That was a concern for me as well.

[twicerepaired]

A related discussion, third Nissen? was started.

[Pietro80]

A related discussion, Post-Nissen complications was started.

[fu doctors]

my name is kevin fonseca ,Ive been to the so called best hospitals in the world for reflux in boston .Best doctors in boston ,guys that write books & go on tv news .My conclusion, they just want to make a million dollars they could give 2 shits about any of us and to boot they all suck.What ive done is educate myself about it ,& I now believe I know as much as any of them on the subject.So ive made my own prescription half of a zantac before i go to bed .During the day organic apple cider vinegar,gets rid of those strange sensations that you people describe like breathing diffuculties or not being able to belch it really works.To all the medical doctors that pissed me off ,caplan,chang or ching (the zit face),lichtenstein or whatever(snob wannabe) ,kesselman needs a slap to straighten his **** eyed ,eye balls.nasser ,learn the friggin language {egyptian magician),sutherland the only guy i liked he was sincere .Ill ad other names when i remember.Now all you doctors know that what you deserved was to be taken into a alley ,& get smacked around .

[amnlobo]

i hear u on almost all ur symptoms. i myself feel constantly bloated with air that always seems to exert pressure on my heart. what's more i even recently experienced heart attack-like symptoms, with breathlessness and slight pressure at the centre of my chest. was scared to death. in fact am almost always scared...
am scheduled to go for endoscopy, but dunno wen yet, cos of long waiting list.

hope things go well for u.

[yoshi]

try red delicius apple and see what it can do for you.
From what I read all that nexium,prilosec will make the stomach produce a hormone which makes more acid,so a never ending cycle.

[imeccentric]

After 10 years on Prilosec, 2 surgeries for reflux, every test in the book, and several Dr's who gave up on me, I still had reflux, hiccuping, belching, and nausea.  This was to the point of not eating, losing about 35 lbs and not even being able to leave the house.  I finally found a Dr. who gave me Thorazine to stop the hiccups and belladonna for the gas and I haven't belched or had hiccups in 2 weeks.  Specialists don't know everything but some old country Dr's still do, thank heavens.  Anyway, just a thought for some of you to try.  It sure has brought me back to life.  The only side effects I have are dry mouth, and(if I take them at the same time), I get really tired.  Spread them out and there seems to be no interaction.

[mjb0925]

Yea some of the OTC medications like maalox seem to help neutralize the gas at times but it seems to constantly keep comming up from the stomach at all times, very tough to deal with.
Thanks for the comment
-Matt

[Kevin Pho, MD]

Up to 60 percent of patients who undergo a fundoplication continue to have symptoms of reflux.  Surgery is not a definitive treatment for GERD.

You can consider further testing to see if reflux is still at significant levels.  An endoscopy or 24-hr pH study can be considered.  

If the symptoms cannot be controlled with Nexium, you may want to discuss with your surgeon a revision of the fundoplication - or any other surgical options.

This can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b

[yoshi]

You should watch what you eat and when you eat,you can neutralise gas with any of the OTC medication,but it would not stop your stomach from producing more gas.