Can GERD and gastroparesis be related? Can fundoplication be done?

[snowhyte]

I am a  female having problems with burning, chest discomfort, and nausea.  I became quite ill this Spring.  I had severe chest pain and literally felt like I was on fire internally. Cardiology ruled that everything was normal.  I was referred to Gastroenterology who ordered a gastroscopy.  It pointed to GERD and gastritis.  A 24 hour BRAVO ph test confirmed severe reflux. An esophageal motility test was done with normal results.  I was referred to the surgeon for fundoplication.  Because of my problems with nausea, I was also referred for a gastric emptying test.  I apparently have slow emptying...first scored 138...was given Reglan and I don't have the outcome of the latter part of the test yet.  I am scheduled for surgery on the 27th.  What is the relationship between gastroparesis and GERD?  I am having cold feet about surgery.  Will it help?  What about the nausea I am having?  It is worse in the mornings and late evenings.  I am taking Protonix 2 x daily, using Gaviscon 3-4 times a day, and still taking Carafate 2 x daily.  I am 51 years old and about 25 lbs. overweight.  I am watching my diet closer and I am sleeping on a wedge...still having discomfort and feeling ill daily.  HELP!  ( forgot to add that I have a fairly small hiatal hernia.)

[Kevin Pho, MD]

Certainly gastroparesis may exacerbate the symptoms of GERD.  It is also possible that these two diseases may co-exist at the same time.  The nausea can be either caused by GERD or gastroparesis.  

With the 24-hr pH test showing severe reflux, and the symptoms not controlled with medications, surgery is rightly considered.  Studies show that this is not a foolproof procedure - about 60% of people who undergo the surgery still needs anti-reflux medications.  

Before any surgery, you may want to inquire about a second surgical opinion to ensure that this is the correct course to take.  

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.
Medical Weblog:
kevinmd_b

[tessa0825]

Can one of you please tell me what is the right answer in response to fundoplication and reaction to medication treatment. Some surgeons say that if you don't respond to PPI treatment then you probably wont have a successful fundoplication either. And, that the main reason to have fundoplication is not wanting to be on PPI treatment for life. Other surgeons say if you DON'T respond to PPIs then you should have fundoplication. Those are very contradictory statements. Which one is right?

[TJV]

  I think it depends on why a person isn't responding  to PPI therapy. In this situation, a 24 hour ph test  while on medication  prior to any surgery would be a good idea ---- just to see if in fact there really is abnormal acid exposure while on PPIS.  

If non response to medication is due to nocturnal acid breakthrough for example,  then surgery would be beneficial.

  But-- If the patient is non responsive to ppi therapy due to a functional problem such as viseral hypersensitivity , then surgery may be redundant .  

  As for gastroparesis , some surgeons will not do fundoplication depending on the severity.  A partial wrap is more reasonable for those with gastroparesis in my opinion.  

[anxiousandtired]

I am a 49 year old female that has been suffering with reflux for the past 3-4 years.  Earlier this year, I was diagnosed with gastroperisis.  Both gastroperisis and GERD have gotten much worse the past 6 months.  After many tests and procedures, it has been found that I need surgery to correct the GERD, but surgeons in my area (Virginia) are not eager to perform the surgery because of my gastroperisis.  I was then referred to the Medical College of VA (MCV).  The specialist there recommended that I have the 24-hour probe monitoring test performed, which I have completed and retained the results.  My specialist here in VA says my test score is the worse he has ever seen (with -22 being normal, my test score was 95).  I am now waiting for the doctors at MCV to discuss my condition and see if a doctor will perform the surgery that I feel I can not wait much longer for.  I have constant chest pains that have taken me to the emergency room to rule out a heart attack.  I tire very easily over the past 2 weeks and basically feel ill all the time.  I have taken all the medications and nothing helps.  Protonix 4 times a day, etc.  I am now taking Nexium twice a day which does lessen the pain from heartburn (which I did not realize was working until I went without it for a week prior to the 24-hour probe testing).  I know that I need this surgery and want to feel better, but my concern is the concern the specialists have because of the gastroperisis.  I have been told that there is a possiblity that (because of the gastroperisis), the surgery could make me worse than I am now, causing them to have to undo the surgery procedure and could cause permanent damage to the esophagus and leave me without the ability to swallow.  I had the mobility test performed in July and there is some weakening of the bottom of my esophagus.  Is there any hope for 'fixing' me?  My goal is to be 'fixed' by my 50th birthday (in February).  Is this a realistic goal for me?  My fear is that none of the doctors in MCV will want to try the surgery.  I'm not pressing for the surgery, especially if I could end up worse than I am now.  But my quality of life is very important to me and I can see that it is changing by the week.  I am a very active person and my condition is placing me into depression.  I have also developed a cronic cough which sounds like one of a heavy heavy smoker.  I do not smoke.  It is sometimes embarrasing that I can not stop my coughing at work.  People are always coming up and asking me if I am okay.  I just want to feel better.  Any advice you have would be greatly appreciated.
Thank You

[pattiecy]

I feel the same way you do.  I have had GERD for the last 3 years.  I've tried all of the medications and to no prevail.  I had the surgery done 2 months ago and I now feel worse.  I am at the end of my rope.  I have spoken to my surgeon and he feels I should have another 24 hour ph study done.  To make a long story short, they don't know what to do next and they are now just grasping at straws..   Think long and hard before you go through with the surgery.   Good luck and God Bless

[fishinadish]

I had fundoplication a year and a half ago and would do it all over again.  I used to vomit after eating anything other than jello or applesauce and this completely alleviated this problem, although the GERD is still severe.  Although I support Nissen fully, make sure you know all the risks- vagal nerve damage, etc.  It isn't a cure all and it shouldn't be used just because you don't want to use meds anymore.

[JOEBAGADONUTS]

I've suffered for the last two years, miserably.  Primary care doctor initial diagnosis was gastritis, and prescribed aciphex....it helped initially....but later symptoms changed.  I went from pain when eating (which went away) to nausea, mostly in the mornings and now anytime of the day.  I'm a strict diet, but no improvement.  Had my gallbladder removed thinking it was the cause, didn't help.  slow gatric emptying scan, and I'm on reglan now, (which has helped a little)

Took nexium, but it gave me more cramps.  I have two questions, which reading previous comments came to my mind.  One, was there a change in your diets prior to the onset of symptoms...for example ATKINS Diets or other? and secondly, are any of these symptoms accompanied by unusual bloodwork , example...elevated liver functions, high cholesterol, or other blood related issues? any comments would be greatly appreciated.

[fishinadish]

For me, I have had a strict diet before and after the surgery.  I went by the diabetic diet for a while, also restricting the foods that typically cause GERD.  My bloodwork has been completely normal (liver enzymes, cholesterol, etc.) with the exception of a slightly but consistently low white blood cell count, and a positive ANA (Lupus test) everything was normal.  I had the follow-up Lupus tests and they all came back normal.  The rheumatologists ruled out Lupus because I don't have any other symptoms and my other tests came back normal.  They said the ANA test can come back false- positive in up to 10% of people who have had health problems.

Sounds like the Aciphex was the first step to helping your symptoms.  Has your doctor put you on Phenergan (this helps with nausea but can make you sleepy) or Reglan (help your stomach empty)??