Nissen after Duodenal Switch

I had a duodenal switch 4yrs ago. No problems.Great weight loss. Stable weight for 2 years. My problems with GERD have continually gotten worse to the point of regurgitation while sleeping 2-3 nights a week with reflux almost every night. My surgeon says he's not come across this problem before and is afraid there is not enough of my stomach left to do a Nissen procedure.Any cases of this being done that you are aware of and what were the outcomes if so. Thanks for any input

[Ratnakar Kini, MD]

Hi,
If it is a bile reflux, it would have got corrected by the duodenal swicth surgery itself. But since you have problems after surgery also, it is probably an acid reflux.

In Biliopancreatic diversion, only a small portion of stomach is left behind. But in duodenal switch surgery, a large portion of the stomach is left behind.

Analysing your symptoms, it appears that you have more of night time reflux. Surgery should always be the last resort for GERD.

I would suggest the following for you -
1. PPI twice daily before food
2. H2RA like Zantac once at bedtime ( to control night time reflux)
3. Life style modifications.

Lifestyle modifications -
1. Head elevation while sleeping
2. Small frequent meals
3. Going to bed 2- 3 hours after food
4. Avoiding bed time snacks
5. Avoiding smoking and alcohol
6. Avoiding tight fitting clothes
7. Avoiding cola, citrus drinks, carbonated drinks, tea, coffee, spicy food
8. Weight reduction
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The information provided is for patients’ education only and is not a medical advice. Always consult your personal physician for complete evaluation of your health problem.

- Ratnakar Kini M.D.